Letters
Rehabilitation Health services administration Musculoskeletal diseases
Volume 210 - Issue 2

Predictors of inpatient rehabilitation after total knee replacement: an analysis of private hospital claims data

Authors:  Steven G Faux and Lee Laycock

Med J Aust 2019; 210 (2): 100. || doi: 10.5694/mja2.12073
Published online: 4 February 2019
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To the Editor: In reply to Shilling and colleagues,1 the Rehabilitation Medicine Society of Australia and New Zealand refers the authors and readers to our position statement regarding referral for rehabilitation in the home after total knee replacement (TKR).2

Shilling and colleagues1 state that the most important determinant for referral to inpatient rehabilitation was the hospital where the TKR took place. Independent researchers might be more circumspect, considering there is no acknowledgement that Medibank Private did not fund rehabilitation in the home nationally during the study period nor whether their data included outpatient rehabilitation carried out as “same day rehabilitation”, usually coded as inpatient.

Also, disturbingly, some of the literature is misrepresented. The unblinded Canadian randomised controlled trial3 comparing a publicly funded combination of rehabilitation in the home and hospital‐based outpatient therapy with inpatient rehabilitation is not generalisable to privately insured Australian patients. Moreover, the Australian randomised controlled trial4 showing equivalent outcomes for the same two groups excluded patients who were appropriately referred for inpatient rehabilitation on the basis of numerous patient factors. The present study included few patient factors and not clinically relevant factors, such as obesity, ability to walk after TKR, or complications.1

Finally, while no patient safety or outcome data were included, the choice to include the dollar value of the previous year's private hospital claims seems gratuitous — are those patients with higher cost to insurers more likely to use inpatient rehabilitation, or perhaps they were just sicker? It is interesting that no reference is made to the 2017 study that found that referrals to inpatient rehabilitation were directly influenced by preferences of the patient, the surgeon, therapists, discharge planners, insurers and others.5

Authors

  • Steven G Faux1,2
  • Lee Laycock2
  • 1. St Vincent's Hospital, Sydney, NSW.
  • 2. Rehabilitation Medicine Society of Australia and New Zealand, Cairns, QLD.

Correspondence: sfaux@stvincents.com.au

Competing interests

No relevant disclosures.

References

Linked content

  • MJA Letter: Predictors of inpatient rehabilitation after total knee replacement: an analysis of private hospital claims data

  • MJA Letter: Predictors of inpatient rehabilitation after total knee replacement: an analysis of private hospital claims data

  • MJA Letter: Predictors of inpatient rehabilitation after total knee replacement: an analysis of private hospital claims data

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