Rapt tool

The assessment uses age, gender, functional abilities, and social support to identify patients who could require a shorter hospital stay and those who would benefit from a more traditional length hospital stay of 2 days on average. Using the assessment prior to surgery can help you better prepare for your return home and know what to expect during your recovery. In a study from , conducted on 3, American subjects, RAPT accurately predicted discharge disposition for high- and low-risk subjects. Predictive accuracy was lowest for scores between 7 and 10 at To study the relation between RAPT scores and functional discharge criteria, Oosting et al 12 found that two performance-based tests, the Timed Up and Go test TUG 13 and m walking test 10MW , 14 in association with a more conventional screening concerning patient's age and comorbidities, could give a significant added value in predicting patient's functional recovery after THR.

At the end of the study, the RAPT has shown the ability to predict discharge disposition for TJR and spine surgery patients, but not cardiac valve surgery patients. The RAPT was created to be a valid instrument for predicting the discharge destination for patients after an elective hip or knee arthroplasty. During its development this tool has shown significant benefits as well as some limitations. The really interesting aspect is represented not only in its capacity to influence LOS of patients but more importantly in its ability to stratify patients' postoperative risks to individualize the appropriate rehabilitation program and setting according to actual patient necessity while reducing health care costs.

All analyzed studies demonstrated that RAPT could reduce LOS and accurately predict discharge disposition especially for high- and low-risk patients while some doubts still remains for those in the intermediate risk category as well as for the range that should be used to classify this risk category, 6 to 9 or 7 to To reduce the uncertain outcome associated with increasing home discharged of medium risk patients, a targeted intensive postoperative rehabilitation program has demonstrated good results.

For example, some studies 8 11 considering the role of comorbidity in discharge outcome, suggested that patients with medical comorbidities, if acceptable candidates for TJA, do not have an increased need for rehabilitation and that the medical criteria seem to have very little influence on postoperative management.

This particular aspect could be justified by the long duration of hospitalization that patients had at the time of these studies and the differences existing between health care systems, but remains an interesting field for researchers. In every study, it emerged that patient's preferred discharge destination had a significant influence on LOS and discharge setting, even Oldmeadow el al found that this variable had the highest weighted impact on outcomes 8 and, to avoid bias, it was taken out of RAPT scoring.

But this aspect highlights how patients who might feel confused due to the lack of information on operation and discharge procedures are more afraid to return home and could strongly influence postoperative management. The clinical and institutional heterogeneity existing between nations and also between hospitals of the same country makes data difficult to extend to other medical institutions.

For example, Dauty et al concluded that it would be relevant to conduct a French prospective multicenter study to test specifically in his country the use of the RAPT to orientate patients before TKR surgery. Other limits of current studies concern the differences in patients discharge criteria conditioning the LOS variability, the role of insurance coverage which depends on the health care system of each country, and the postacute rehabilitation care settings.

The growing demand for TJA and the rising health care costs highlight the need to plan the hospital discharge more efficiently and appropriately. This emphasizes the importance to create specific care pathways based on the preoperative stratification and prediction of patient outcomes and needs to limit the LOS and correctly manage destination discharge.

The RAPT has demonstrated good predictive accuracy assisting clinicians with identification of patients for targeted interventions to facilitate home discharge. It is an easy-to-use instrument that has been validated in many countries with relatively similar results. Conflict of Interest None declared. National Center for Biotechnology Information , U. Journal List Joints v. Published online Jul Author information Article notes Copyright and License information Disclaimer.

Received Dec 13; Accepted Jun Copyright notice. Neurosurgery Speaks! Audio abstracts available for this article at www. Listen to audio translations of this paper's abstract into select languages by choosing from one of the selections below. Oxford University Press is a department of the University of Oxford.

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Close mobile search navigation Article Navigation. Volume Article Contents Abstract. Neurosurgery Speaks Audio Abstracts. Editor's Choice. Department of Neurosurgery, Hospital of the University of Pennsylvania. Oxford Academic.

Matthew Piazza, MD. Ian Berger, BS. Benjamin Osiemo, MS. Eric Winter, BS. H Isaac Chen, MD. Neil R Malhotra, MD. Correspondence: Neil R. Email: NRM uphs. Select Format Select format. Permissions Icon Permissions. Graphical Abstract. Open in new tab Download slide. Discharge disposition , Lumbar spine , Predictive scale , Spine.

Risk Assessment And Prediction Tool. TABLE 1. Model A. Model B. Open in new tab. TABLE 2. Patient Demographics of the Analytic Cohort. Variable Name. Google Scholar Crossref. Search ADS. Issue Section:.

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Psychiatric comorbidity in childhood onset immune-mediated diseases - a systematic review and meta-analysis. Ecological thresholds under atmospheric nitrogen deposition for herbaceous species and 24 communities across the US. The RAPT allows for identification of patients who are likely to be discharged home or to rehabilitation, which may facilitate preoperative planning of postoperative care.

Additionally, it identifies intermediate-risk patients and could be used to implement targeted interventions to facilitate discharge home in this group of patients.

Level of evidence: Level III, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.