Area orthopedic surgeons and the Bacharach Institute have together pioneered a new form of rehabilitation, one that is likely to transform the recovery process for the growing number of Americans who have knees or hips replaced.
Called “day rehab” and conducted at a handful of centers in the region, the therapy restores patient mobility more quickly, doctors say, while cutting the cost of rehabilitation after joint replacement by half or more.
“I’ve done many literature searches and inquiries, and I think we’re the first and possibly the only day rehab for joint replacement,” said Joyce Glick, 51, Bacharach Institute for Rehabilitation’s senior director for ambulatory care.
“Patients return to work earlier and go home earlier,” said Rothman Institute orthopedic surgeon Dr. Fabio Orozco, an early advocate of day rehab and a participant in a study of its effectiveness.
Bess Kathrins, professor of physical therapy at Richard Stockton College and another study co-author, said that when the study is released in September it will show that the average cost for day rehab after knee replacement is $1,860, compared to the $4,914 for rehab in an inpatient nursing home. She said another alternative, hospital inpatient rehab, cost almost $13,000 in a 2006 study.
That kind of cost reduction, while still improving outcomes, is crucial to health-care reform, especially since U.S. hip and knee replacements have doubled the past decade — from 451,000 to 995,000 in 2009, says the Centers for Disease Control and Prevention.
“Hip and knee replacements are expected to double again, and if it’s to stay affordable, we have to find an equally safe but more cost effective way of caring for patients after the surgery,” said Dr. Stephen Zabinski, one of the first orthopedic surgeons to embrace the new rehab therapy.
Day rehab is three hours of intensive movement therapy — over five days for new knees, seven for hips — under the guidance of physical therapists and nurses experienced with joint replacement care.
Zabinski, 45, of Longport, the head of orthopedics at Shore Medical Center and practitioner with Shore Orthopaedic University Associates, also in Somers Point, said day rehab combines the best features of the rehab in a hospital that was the standard 25 years ago and of rehab at home by a visiting physical therapist.
“Day rehab means you’re doing the intensive rehab you would have done at a rehabilitation hospital or nursing care center, but instead you’re just doing it during the day at an outpatient center and then going back home,” Zabinski said.
For surgeons, he said, an important advantage is that patients are under medical scrutiny similar to that in a hospital to ensure all aspects of recovery proceed well.
“The great thing is, at a day rehab center, as opposed to regular outpatient therapy or a home setting, there are nurses there used to seeing post-operative wounds, a doctor on call, so you’re going into a very controlled setting with nurses and therapists used to looking at patients in that first week after surgery and can contact doctors if there is any problem,” Zabinski said.
Patients like day rehab because it gets them moving and back to their lives more quickly, while letting them live at home.
At Bacharach’s day rehab center in Somers Point recently, patients talked about the experience while lounging in recliners between sessions of challenging movement guided by therapists.
“I wanted to be home. I didn’t like spending nights away from my wife,” said Clement Wasleski, 79, of Margate, recovering from hip replacement.
A retired architect who happened to have designed the center he was in and other buildings for Bacharach, Wasleski said he was already familiar with the quality of the institute’s operations and staff. But that didn’t get him any coddling in rehab.
“They don’t baby you at all. They put you right to work,” he said.
Sandy Maloney, 59, of Cape May, whose knee was replaced by a third orthopedic surgeon who was developing and studying day rehab, Dr. Alvin Ong of the Rothman Institute, said she would recommend day rehab to others. “It gets you moving and makes you more active staying in your own home, and I think you recoup faster.”
Another of Ong’s patients, Paula LaMaina, of Ocean City, can compare the different forms of rehabilitation because she’s on her third joint replacement and had inpatient rehab 10 years ago after her first operation.
“That was OK, but I love it here. This is much faster and you have fun,” LaMaina said.
She said the joint replacement patients enjoy being together and motivate each other to work harder at their recoveries. Relaxing in the recliners while chatting with fellow patients seems like a reward for their efforts.
Day rehab has become possible in part because joint replacement is done at earlier ages and uses less invasive surgical techniques that often spare the tendons at the joint, the doctors said.
Zabinski said his interest in such techniques and the quicker recovery possible is why he’s been an advocate of day rehab from the start.
Orozco, 42, of Linwood, said not every patient is a candidate for day rehab, but with typical post-operative hospital stays dropping from three days to one or two, most would do well in it.
“They still have the right to make a choice of where to go for rehab, but it’s becoming one of the most appealing choices for patients,” he said.
Bacharach began looking for alternative rehab procedures following a 2004 Medicare ruling on which patient diagnoses call for acute inpatient rehab, said Glick, of Galloway Township.
Day rehab had been used previously for stroke patients needing multiple therapies, so the institute and local doctors tried it for joint replacement patients, she said.
The new approach worked so well at Bacharach’s main facility in the Pomona section of Galloway Township that a dedicated center was opened first in Somers Point and then another in Manahawkin — which started drawing patients from Monmouth County to the north, she said. Next up will be a center, probably in North Cape May, to handle demand in Cape May County.
She said rehabilitation providers from the Philadelphia area have come down to see how day rehab is done.
Interest in day rehab will spread much farther after the September publication of the study on day rehab’s effectiveness and cost.
The study — conducted by the Rothman Institute, the Bacharach Institute and Stockton College under the leadership of Dr. Ong — already has been accepted for publication in the American Journal of Physical Medicine & Rehabilitation.
In November, the study will go global with a presentation at a medical conference in Dubai, said Kathrins, of Toms River.
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