Does it Matter Where You Have Your Total Knee Replacement Rehab?

Total knee replacement rehabilitation.
Your physical therapist can help guide you through rehabilitation after total knee replacement surgery. Francesco Ruggeri/Getty Images

A recent study has indicated that physical therapy services after a total knee replacement (TKR) at a physician owned practice may result in twice as many sessions with no improvement in care or outcomes.

If you have had a total knee replacement surgery, you may benefit from physical therapy to help you regain your normal range of motion (ROM) and strength to restore your optimal functional mobility.

Your PT may work with you in a hospital, at home, or in an outpatient clinic.

There are different types of outpatient physical therapy clinics. Some are run as part of a hospital system. Others are owned by private practitioners.

Some outpatient clinics are owned by physicians. Patients attend rehab there through something called "physician self-referral," known as physician owned physical therapy services, or POPTS. The question is: does it matter if you have TKR rehab at a POPTS or a privately owned outpatient clinic? (Physical therapy at POPTS may pose an inherent problem; your physician has a financial stake in your rehab when you attend therapy at a POPTS. The more times you go to the PT clinic after TKR, the more money your physician can make after your surgery.)

What Does the Research Show?

In a study published in Health Services Review (free, online abstract available), researchers analyzed data from Medicare patients receiving PT services after TKR during the years of 2007 through 2009.

The researchers looked at various data points, including:

  1. Time from hospital discharge to the first PT session
  2. Length of episode of care after TKR
  3. Number of PT sessions during the outpatient episode of care after TKR
  4. Number of PT service units per episode of care (basically, the different treatments your therapist bills to your insurance company during your PT sessions)

    So, the researchers looked at when patients started outpatient PT after TKR surgery, and looked at how long the episode of care took and what services were billed during the episode of care. Then, comparisons were made between PT services at a POPTS and non-physician owned outpatient physical therapy clinics.

    The Results

    The results of the study indicate that patients who went to POPTS after TKR had on average 8.3 more visits when compared to non-physician owned clinics. Patients at POPTS also received almost 9 fewer service units at POPTS per episode of care after TKR. 

    The authors concluded that: 

    Physical therapists not involved with physician-owned clinics saw patients for fewer visits, but the composition of physical therapy services rendered during each visit included more individualized therapeutic exercises.

    Basically, patients with TKR attend therapy more and get less at POPTS versus a non-doctor owned PT clinic.

    What Does This Mean for Outpatient Rehab after Total Knee Replacement?

    If you have had a total knee replacement, you will likely benefit from physical therapy in an outpatient clinic. There you may perform exercises to improve balance, range of motion, and strength. You may improve your endurance on a stationary bike.

    Depending on your insurance situation, you may have to pay a co-payment each and every time you attend a PT session. It would be in your best interest financially to achieve all of your PT goals within a shorter period of time with fewer sessions.

    Attending physical therapy for few sessions and with more individualized care packed into each session can help you quickly get back to your normal activities and mobility.

    Your Therapy, Your Choice

    Going to outpatient therapy at a physician owned clinic is not illegal, and you may really enjoy the experience of working with a physical therapist who has a close, professional relationship with your surgeon.

    This can help keep communication lines open and can ensure that you get optimal care after your TKR. You may like your doctor and your PT and have a fine experience.

    Bottom line: the location of your therapy should be your choice, and you should be able to attend PT where you feel you get the best care. Knowing that this study shows you may have to attend more sessions and receive less individualized care is one variable that can help you make the best possible choice when attending outpatient physical therapy after total knee replacement.

    Source: Mitchell, J. M., Reschovsky, J. D. and Reicherter, E. A. (2016), Use of Physical Therapy Following Total Knee Replacement Surgery: Implications of Orthopedic Surgeons’ Ownership of Physical Therapy Services. Health Services Research. doi: 10.1111/1475-6773.12465

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