Abstract
Objective: To determine whether congestive heart failure (CHF) influences the magnitude and rate of motor and cognitive functional improvement, and specific rehabilitation outcomes after lower-extremity joint replacement. Design: Retrospective, comparative study. Setting: Freestanding inpatient rehabilitation facility. Participants: A total of 7817 total hip replacement (THR) and 14,995 total knee replacement (TKR) patients from 14 independent inpatient rehabilitation facilities were included (70.1±0.1y, 66.9% women). Interventions: Not applicable. Main Outcome Measures: FIM scores (motor, cognition subscores) at admission and discharge, rate of FIM change, length of stay (LOS), comorbidity type, and discharge destination. Results: Patients with CHF had 6% to 10% more cases of chronic obstructive pulmonary disease, 4% to 9% more hypertension, 17% to 19% more diabetes, and 9% more anemia in TKR than those without CHF. Overall total FIM score improvements were 33.5 and 35.8 points (THR) and 33.0 and 32.6 points (TKR) in those with and without CHF, respectively (P=.003). Discharge FIM scores were 1.0 to 4.3 points lower in patients with CHF than those without (P<.001). Improvements in FIM cognition scores were 0.7 points lower and 0.2 points higher for THR and TKR patients with and without CHF, respectively (P<.016; for joint only). Motor FIM scores at discharge were 3.2 and 1.0 points lower in groups with CHF than those without (P<.0001). LOS was 0.7 days shorter for THR and 0.3 days longer in TKR for those with and without CHF (P=.013). The rate of FIM score improvement during rehabilitation was 8% lower in those with CHF than those without (P=.020). However, there were no differences in discharge destination based on the presence of CHF (93.3% to 93.9% returned home). Conclusions: While CHF may be linked with additional medical concerns, the overall functional and cognitive changes and ability to return home were not impaired by this condition. Rehabilitation teams can expect comparable outcomes in lower-extremity joint replacement patients with CHF as comparable to those without.
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