Prevalence and Characteristics of Prehabilitation Utilization Among Older Medicare Beneficiaries Undergoing Elective Inpatient Lower Extremity Joint Replacement.

Objectives: To characterize trends and characteristics in individual receipt and facility delivery of preoperative rehabilitation ("prehabilitation") for lower extremity joint replacement (LEJR), and to characterize prehabilitation services delivered in terms of timing, frequency, duration, examining differences by preoperative frailty status and operative joint.

Design: Retrospective cohort study using administrative claims data.

Setting: Inpatient facilities conducting elective LEJR surgery for Medicare beneficiaries in the United States.

Participants: Medicare fee-for-service beneficiaries ages ≥65 years undergoing an incident elective inpatient hip or knee replacement between January 1, 2016, and December 31, 2019, identified in claims from a 20% random sample of Medicare beneficiaries.

Interventions: Physical or occupational therapy initiated within 30 days preceding LEJR surgery.

Main Outcome Measures: (1) Prevalence and characteristics of individual receipt of prehabilitation; (2) prevalence and characteristics of inpatient facility delivery of prehabilitation; and (3) prehabilitation attributes (timing, volume, setting).

Results: In this sample of 196,690 older adult Medicare beneficiaries undergoing inpatient LEJR (mean age, 73y; 45.4% nonfrail; 37.5% hip), prehabilitation prevalence increased from 8.03% in 2016 to 11.14% in 2019. Stratifying by operative joint and frailty status, greatest increase was noted among nonfrail knee replacement patients (+3.64%). Most prehabilitation patients (77%) received a single visit, primarily in the outpatient physical therapy setting. Odds of receiving prehabilitation varied by patient race, sex, and financial and health characteristics. More than half (55.7%) of inpatient facilities delivered prehabilitation to at least one LEJR patient during the study period; odds of delivering prehabilitation varied by facility location, size, and financial characteristics.

Conclusions: Findings demonstrate growth in LEJR prehabilitation utilization over time, supporting further investigation of why and how providers are implementing prehabilitation, what factors may affect patient access, and what strategies may maximize the utility of this spreading service delivery innovation.