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  • Contact
    The Total Joint Center

    If you would like additional information about the Total Joint Center or wish to make an appointment, please call 401-793-5852.

    Meet the
    Total Joint Center Physicians

  • Planning for Your Discharge and Recovery

  • The Role of Case Manager

    The case manager will:

    • review your patient education worksheet and contact you by telephone before your surgery to begin your discharge planning and answer any questions you may have.

    • see you the day after your surgery and continue to monitor your progress and facilitate your safe discharge from The Miriam Hospital.

    • serve as a liaison to insurance companies and assist with discharge planning.

    • review your discharge options and ensure you are prepared.

    Determining Your Discharge Plan

    • It is a state mandate and your right to have a choice in selecting providers, services and agencies. Choice can be limited for many reasons, including your insurance coverage and bed availability.

    • The team's goal is to identify the best and safest discharge option for you. Case managers work closely with you and with physical and occupational therapists to develop your individual discharge plan.

    • Often discharge plans change for a variety of reasons. We encourage you to maintain flexibility in planning for discharge, and the team will help you find solutions if unforeseen challenges arise.

    Home Care: Option 1 after Discharge

    • If you reach a good level of independence while working with PT in the hospital and have good support at home, you may be discharged to your home and receive therapy and nursing care in your home. This option may not be ideal if you have numerous stairs to get into your home or if you do not have family or friends that who check on you at least two or three times a day.

    • Most joint replacement patients are able to go home after their hospital stay.

    Skilled Nursing Facility: Option 2 after Discharge

    • This option is ideal for patients who need more frequent physical therapy before they are able to return home safely. Skilled nursing facilities have nursing care available and offer physical therapy five to seven days a week. A list of facilities is located in the Resources section of your guide.

    • Admission to an acute rehabilitation hospital or program is for patients with bilateral (two) joint replacements or other major injuries.

    • Transportation from the hospital to a skilled nursing facility via ambulance or wheelchair van is usually a covered service, but there may be a co-pay. Please contact your insurance company for details.

    • Case managers are responsible for making referrals to facilities and/or agencies based on your choice. If a bed is not available at the facility of your choice, the case manager will seek other alternatives.

    Tips for Preparation

    • Review approved provider lists of facilities and home care agencies.(See Resources section.)

    • Visit skilled nursing facilities that you are considering. No appointment is necessary.

    • Call your insurer regarding co-pays and other coverage questions.

    • Follow the list of tips provided in the "Preparing for Surgery" section of your patient education materials.

    • Remain flexible-sometimes plans change for a variety of reasons.

    Outpatient Rehabilitation Services after Total Joint Replacement

    Outpatient rehabilitation is recommended as part of the plan of care for patients who have undergone total joint replacement surgery. Once you are able to walk and are no longer homebound, your rehabilitation will continue in an outpatient setting where the focus is on moving like you're meant to.

    The following information describes the "who, what, when and why" of outpatient rehabilitation.

    Who: After a total joint replacement, you will see a physical therapist and may see an occupational therapist at an outpatient facility.

    What: A physical therapist works with all aspects of the body including lower extremity and spine problems. Occupational therapists specialize in ensuring you are as independent as possible with your activities of daily living.

    When: Your surgeon may encourage you to receive outpatient therapy before surgery. You will work on range of motion and strengthening to better prepare you for surgery. After surgery, you may be discharged to home or to a skilled nursing facility. You will receive home therapy services until you are able to leave your home without difficulty. You may begin outpatient therapy when home therapy services end. If you are discharged to a skilled nursing facility, you may begin outpatient therapy when you leave the skilled nursing facility.

    Why: You may require additional therapy even after a short stay at a skilled nursing facility or receiving home services. This may be necessary because of pain and swelling that interferes with your functional abilities, due to loss of strength or range of motion. For example, after a total knee or hip replacement, it is very important to have flexibility in your joint. If not, the lack of motion will interfere with your walking, sitting and toileting. Lacking strength in your muscles will also limit your ability to perform activities such as transferring out of a chair or climbing stairs. Finally, you may still be having difficulty with activities of daily living and recreational activities that you were performing prior to your surgery.

    On your first visit to the outpatient rehabilitation clinic, the therapist will:

    • Perform an examination

    • Obtain a history of your prior medical and surgical procedures

    • Assess your pain

    • Obtain a history of your prior and current functional status

    • Take several measurements

    • Observe your range of motion, strength, and balance

    • Identify your goals for therapy

    • Observe your transfer, walking and stair-climbing abilities

    • Consult your surgeon's orders

    • Develop a unique treatment plan for you

    The frequency and duration of outpatient therapy varies as each patient will progress differently. Patients may be seen between two to three times per week for a duration of four to eight weeks or more.

    Equipment you may work with includes (but is not limited to):

    • a stationary bike to improve range of motion, strength and endurance

    • a treadmill to practice gait sequencing and build your walking endurance

    • stairs to promote balance training and safety

    • floor exercises to improve your range of motion and strengthen the affected extremity

    • weights and machines to improve flexibility, strength, and range of motion

    • hands-on, manual therapy techniques to improve flexibility, strength, and range of motion

    • assistive devices, progressing to walking with the least restrictive device or without a device

    The Miriam Hospital offers outpatient rehabilitation as part of its center of excellence for joint replacement surgery. At The Miriam Hospital's outpatient rehabilitation department, we are dedicated to providing expert one-on-one care in a friendly, enthusiastic environment. The goal of therapy is to maximize your independence and ensure maximum benefit from your surgery. We work closely with your surgeon and provide timely communication regarding your progress. The staff is experienced in treating orthopedic conditions and is proud to have maintained a patient satisfaction score of 99 percent. There is free on-site parking and the facility is easily accessible via RIPTA or RIDE. If continued rehabilitation is needed in an outpatient setting, please keep us in mind.