Association Between Patient and Facility Characteristics and Rehabilitation Outcomes After Joint Replacement Surgery in Different Rehabilitation Settings for Older Adults: A Systematic Review.

All but one of the studies followed people over time without deciding at random who went to which setting. Patients are chosen for inpatient rehabilitation partly because they are expected to do well, so better outcomes there may reflect who they were rather than what the facility did. The authors note these selection forces themselves. The studies measured such different things that the authors could not pool the results, so no single combined estimate is available. Only 17 studies were found, and very few were published after the 2015 change in Medicare payment rules, so the evidence describes practice that has already shifted. Most participants were women over 65 and most were White; two studies did not report race or ethnicity at all, so nothing here speaks to how these pathways work for other groups. None of the studies discussed whether they had enough patients to detect a difference. Few studies reported adverse events, and reporting on confounding factors and dropouts varied between studies. The studies did not describe the exercises or activities therapists used, so the review cannot say whether recovery at home came from therapy or from ordinary daily activity. Only one randomised trial was included, and it tested preoperative water exercise before knee replacement rather than a rehabilitation programme. Including only United States studies means the setting comparisons are tied to American payment rules and may not transfer to other health systems.

The article text provided contains no funding statement and no conflict of interest declaration. The record lists the paper as receiving extramural research support from the National Institutes of Health, but the paper itself does not say who paid for this review or whether the authors had any competing interests.