Going through surgery for a fractured hip, a damaged knee or any other orthopaedic injury is painful enough. Having to also maneuver through the maze of medical facilities and programs to choose the right hospital and best rehabilitation option makes the process even more difficult. In order to make the patient’s journey easier, OrthoVirginia — the largest orthopaedic physician specialty group in Virginia — along with Bon Secours Memorial Regional Medical Center and Hanover Health & Rehabilitation Center, has created a collaborative pathway for patients to move smoothly from surgery to rehabilitation and back to their homes.
To maximize the benefits a patient can get from a stay in a rehab facility, Hanover Health & Rehabilitation offers a focused physical therapy program called Fast Track Ortho that is designed to facilitate the patient’s return to optimum strength and mobility in the most efficient way possible. Patients in this program can usually return to independent living with no need for in-home assistance in a much shorter time frame than was previously possible.
Lorraine Albertson, of New Kent, raises miniature schnauzers, and her five dogs are a handful. To keep them out of her living room, Albertson installed a baby gate. In September 2014, she stepped over the gate like she did every day, but this time her foot caught on it. Falling forward, she landed on her hip. The fracture was intensely painful, but on the way to the hospital, she was more worried about who would care for her disabled son, her husband (who was due to have knee surgery) and her dogs while she was unable to.
Albertson was taken to Bon Secours Memorial Regional Medical Center. The fracture was a bad one, and doctors recommended a hip replacement. The average hospital stay for hip replacement surgery is three to four days, followed by physical therapy that can be delivered either in the home or in a rehab facility. While getting home quickly was important to Albertson, she needed to be sure she would return to complete mobility so she could care for her family.
Like Albertson, most people want to get home as soon as possible following an orthopaedic procedure, but physical therapy is a critical component in getting back to their preinjury abilities.
Why Rehabilitation Following Surgery Is Important
Following surgery, patients experience pain, swelling, reduced range of motion, stiffness and bruising. Research shows that physical therapy after orthopaedic surgery improves recovery and lowers the odds of being readmitted to the hospital. Getting moving soon after surgery is one of the most important things orthopaedic patients can do to return to their previous activities. Movement improves blood circulation to the injured area, which enhances healing, and helps remove fluids that build up in the body. This is difficult to do without the assistance of therapists because most patients do not feel like moving, and they may be afraid of injuring themselves.
Physical therapy focuses on rebuilding strength and range of motion, while occupational therapy focuses on accomplishing the activities required for independence, such as bathing, cooking, cleaning, taking medications and other activities of self-care. And just as fitness trainers keep their clients motivated and on task, physical and occupational therapists keep their patients working toward their goals.
Suffering an injury that requires surgery is a stressful event in anyone’s life, and the recovery process often causes anxiety about the future. Physical therapy can go beyond restoring patients to their previous activity levels and abilities; the exercises can help patients regain their self-confidence by showing them that they can do more than they thought was possible.
What To Expect
The coordination of medical service providers — having all the medical experts on the same page — lessens stress and speeds recovery. Barton Harris, MD, the OrthoVirginia surgeon who performed Albertson's hip replacement, says, “The advantage of the collaboration of OrthoVirginia and Memorial Regional is that we have a team approach to a patient’s care integrated from the moment the patient decides to have surgery until he is discharged. We also meet with the rehabilitation providers who will work with our patients after discharge from the hospital.”
OrthoVirginia patients attend a class that teaches them how their joints work. They also meet with a therapist weeks before they have surgery for a “prehab” session, where the therapist gives them exercises to do to improve their strength and prepare them for surgery. Patients are shown how to use the devices they may need postsurgery, like walkers and crutches, so they are comfortable with that part of the process before they have to use these aids.
Albertson had heard good things about Hanover Health & Rehabilitation Center from friends, so she chose to go there. The center offers the Fast Track Ortho program, a patient-centered program that was developed by Medical Facilities of America to provide a safe and efficient return to life for its patients. The program delivers a more complete, progressive form of physical and occupational therapy in a shorter time period than traditional delivery in a facility or at home.
“Hanover Health & Rehabilitation’s Fast Track Ortho program is a real advantage to our patients,” says Dr. Harris. “If a patient wants complete independence upon return to the home, this program is for them. They have the benefits of constant supervision by a medical doctor overseeing them and a higher intensity of rehabilitation than at home, delivered frequently and consistently. Therapists teach them how to do these exercises on their own so they can continue them at home. They also are given a fitness score before and after therapy to help them measure their progress.”
Candidates for the program are generally in good health and without complications. Albertson had done so well that Dr. Harris recommended her for the program.
In-Home Versus In-Patient Rehab
Differences between traditional rehab and Fast Track Ortho are numerous. If a patient goes directly home after surgery, they may wait as many as four days for their first physical therapy session. With Fast Track Ortho, patients start therapy immediately.
In-home therapy may include three one-hour sessions a week, while Fast Track Ortho therapy takes place seven days a week, with sessions broken into multiple shorter increments that are based on the patient’s level of ability. Therapists have found that this method results in more progress than the traditional schedule of one hour a day with days off in between.
Albertson’s daily schedule included breakfast in the dining room (“the food was great!”), followed by sessions of physical or occupational therapy. While the sessions initially were short to prevent fatigue and pain, she had three to four therapy sessions each day, with breaks to allow for recovery and rest. Albertson ultimately received two and a half hours of therapies daily.
Another benefit of facility-based rehab is access to state-of-the-art therapeutic equipment and machines. Albertson’s favorite was the Alter-G antigravity treadmill. “No one else has this,” she says. “They put a sling around your body. It supports some of your weight while allowing you to exercise more freely.”
Between sessions with the therapists, patients can exercise on their own by walking and using the various machines.
In the Fast Track program, Albertson rapidly advanced in her ability to walk and perform all the activities she does at home. “I was walking the day after surgery. I enjoyed the therapists; our talks kept my mind off my discomfort,” she recalls. Her physical therapist was Robert Green. “He was fantastic. He really listened and cared. There is pain involved in this, but they always gave me the medication I needed before therapy began and always listened to my needs. In three weeks I was done.”
According to Green, “The idea is to develop a plan with the patient based on their own goals. This allows them to take charge.” Patients are asked, “What things do you want to be able to do?”
“It’s a very safe approach, and of course, pain management is key,” Green continues. “The best candidates are ones that are highly motivated to return to their lives and activities.” Green says that Albertson was the perfect candidate for the Fast Track Ortho program because she was always motivated and wanting to try.
A further benefit of getting in-patient as opposed to at-home rehab is that medical supervision is on hand whenever needed. Patty Lankford, director of rehabilitation at Hanover Health & Rehabilitation, says, “Our medical director is Dr. Khalid Karim. He is here every day to be available if a patient has medical issues, and he can directly communicate with the patient’s surgeon. We also schedule and provide transportation for the patients’ follow-up visits with the surgeon while they are here.”
When considering discharge, Lankford says, “We ask what they must be able to do once they are home. Can they independently get out of bed, walk, dress, feed themselves, get in a car, bathe? After three days of doing [those activities] well, they can go home. They should not require assistance when they get home. We also visit the home prior to discharge to identify and resolve any problems that might be obstacles for patients. We have a checklist for the home: the width of doors, height of tables, number of stairs, rugs, etc.,” explains Lankford. “Will they be able to get around safely?”
Albertson adds, “They even got me the equipment I would need — a shower chair and a cane. It helped a lot to have those things ready for me when I left.”
Lorraine Albertson returned home to her family in time to help her husband through his knee surgery. “I had a very good outcome; I recovered much more quickly than others I know. If I ever need therapy again, Hanover Health & Rehabilitation will be where I will go.”
Physical therapist Green says that patients like the Fast Track Ortho program because it gets them back to their lives quicker and gives them independence. "We give them support and input and start them on a path. They continue doing exercises on their own. It’s all about what they want to do. They may say, ‘I want time with my grandchildren; I want to be able to play with them.’ We include the human elements, the things that make them happy. Sometimes they come back to show us what they can do. That makes us feel great. My job is a privilege; it’s a redeeming eight hours with many victories.”
Differences between Fast Track Ortho at Hanover Health & Rehabilitation Center and traditional in-home rehabilitation.