Physical and Cognitive Function Trends in Post-acute Care after Total Joint Arthroplasty in Medicare Beneficiaries: 2013-2018.

The study was observational and likely did not account for all unmeasured confounding, such as severity of osteoarthritis or availability of caregivers. Physical and cognitive measures were not directly comparable across SNF, home health, and IRF. The sample was fee-for-service Medicare beneficiaries aged 65 and older, so findings may not apply to Medicare Advantage or younger patients. The cohort was limited to non-Hispanic White, non-Hispanic Black, and Hispanic beneficiaries, excluding less than 3% of the study cohort. Outcomes were measured at the start of post-acute care, not after therapy or during ongoing care.

One author reported no conflicts. One author reported a research grant from the Department of Defense. One author reported speaker honoraria from the National Institutes of Health, Brown University and Boston University; reviewer honoraria from the National Institutes of Health and the Veterans Affairs; and editorial roles. One author reported research funding outside this work from Johnson and Johnson and the National Institutes of Health, editorial board roles, and committee roles in orthopaedic societies.

Do not read the rise in home health patients' dependence and cognitive impairment as proof that home health care became unsafe. The study measured patient status at the start of post-acute care and did not evaluate post-discharge adverse events or readmissions.