Commentary on the comparative effectiveness of alternative settings for joint replacement rehabilitation

The comprehensive Joint Replacement Outcomes in Inpatient Rehabilitation Facilities and Nursing Treatment Sites 1 and 2 studies presented in this issue of the Archives by DeJong and colleagues focus on an important issue facing U.S. rehabilitation today: the comparative effectiveness of alternative rehabilitation settings for the management of conditions such as joint replacement. Although there are hints in the data that patients receiving care in inpatient rehabilitation facilities compared with those treated in skilled nursing facilities may have slightly better recoveries of physical function, the evidence is weaker than for a number of other conditions. It is important to look beyond the question of which setting is best, toward gaining a deeper understanding of the elements within these settings that most enhance outcomes.