***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To compare the improvement in disability , kinesiophobia , pain , and quality of life obtained by means of home-based functional exercises aim ed at managing kinesiophobia with that obtained by giving subjects undergoing total knee arthroplasty ( TKA ) advice to stay active after discharge from a rehabilitation unit . DESIGN R and omized controlled trial with 6-months ' follow-up . SETTING Patients ' homes . PARTICIPANTS Patients ( N=110 ; 40 men ; mean age , 67y ) at the end of a 15-day period of in-hospital rehabilitation after undergoing primary TKA . INTERVENTIONS In the experimental group , before returning home , the patients were asked to continue the functional exercises learned during hospitalization in twice-weekly 60-minute sessions for 6 months , and were given a book containing theoretical information about the management of kinesiophobia . In the control group , the patients were advised to stay active and gradually recover their usual activities . MAIN OUTCOME MEASURES Repeated- measures analysis of covariance with baseline values as the covariates ( P<.05 ) was used to assess the effect of treatment on disability , fear-avoidance beliefs , pain intensity , and quality of life . RESULTS The analysis revealed a significant time by group interaction in all the variables in favor of the experimental group . Post hoc analysis showed that the effect of the group was statistically significant at the end of home training and follow-up . The treatment effect was clinical ly tangible in terms of disability and quality of life , and persisted for 6 months after the intervention ended . CONCLUSIONS A home-based program based on functional exercises and the management of kinesiophobia was useful in changing the course of disability , fear-avoidance beliefs , pain , and the quality of life in patients with TKA Background Payers of health services and policymakers place a major focus on cost containment in health care . Studies have shown that early planning of discharge is essential in reducing length of stay and achieving financial benefit ; tools that can help predict discharge disposition would therefore be of use . The Risk Assessment and Prediction Tool ( RAPT ) is a preoperative survey constructed to predict discharge disposition after total joint arthroplasty ( TJA ) . The RAPT was developed and tested on a population of Australian patients undergoing joint replacement , but its validity in other population s is unknown . A low RAPT score is reported to indicate a high risk of needing any form of inpatient rehabilitation after TJA , including short-term nursing facilities . Questions / purpose sThis study attempts ( 1 ) to assess predictive accuracy of the RAPT on US patients undergoing total hip and knee arthroplasty ( THA/TKA ) ; and ( 2 ) to determine predictive accuracy of each individual score ( 1–12 ) . Methods Between June 2006 and December 2011 ,  RAPT scores of 3213 patients ( 1449 THAs ; 1764 TKAs ) were prospect ively captured during the preoperative clinical visit . Scores were stored along with other clinical data , including discharge disposition , in a dedicated data base on a secure server . The data base was queried by the nursing case manager to retrieve the  RAPT scores of all patients captured during this time period . Binary logistic regression was used to analyze the scores and determine predictive accuracy . Results Overall predictive accuracy was 78 % .  RAPT scores < 6 and > 10 ( of 12 ) predicted with > 90 % accuracy discharge to inpatient rehabilitation and home , respectively . Predictive accuracy was lowest for scores between 7 and 10 at 65.2 % and almost 50 % of patients received scores in this range . Based on our findings , the risk categories in our population s should be high risk < 7 , intermediate risk 7 to 10 , and low risk > 10 . Conclusions The RAPT accurately predicted discharge disposition for high- and low-risk patients in our cohort . Based on our data , intermediate-risk patients should be defined as those with scores of 7 to 10 . Predictive accuracy for these patients could potentially be improved through the identification and addition of other factors correlated to discharge disposition . 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 OBJECTIVES The purpose of this study was to evaluate the relationship between the Risk Assessment and Predictor Tool ( RAPT ) and patient discharge disposition in an institution participating in bundled payment program for total joint replacement , spine fusion and cardiac valve surgery patients . METHOD Between April 2014 and April 2015 , RAPT scores of 767 patients ( 535 primary unilateral total joint arthroplasty ; 150 cardiac valve replacement ; 82 spinal fusions ) were prospect ively captured . Total RAPT scores were grouped into three levels for risk of complications : < 6 = ' high risk ' , between 6 and 9 = ' medium risk ' , and > 9 = ' low risk ' for discharge to a post-acute facility . Associations between RAPT categories and patient discharge to home versus any facility were conducted . Multivariate analysis was performed to determine if there was any correlation between RAPT score and discharge to any facility . RESULTS 70.5 % of total joint patients , 80.7 % of cardiac valve surgery patients and 70.7 % of spine surgery patients were discharged home rather than to a post-acute facility . RAPT risk categories were related to discharge disposition as 72 % of those in the high risk group were discharged to a facility and 91 % in the low risk group were discharged to home in the total joint replacement cohort . In the cardiac cohort , only 33 % of the high risk group was discharged to a facility , and 94 % of the low risk group was discharged to home . In the spinal fusion cohort , 60 % of those in the high risk group were discharged to a facility and 86 % in the low risk group were discharged to home . Multivariate analysis showed that being in the high risk category versus low risk category was significantly associated with substantially increased odds of discharge to a facility . CONCLUSION The RAPT tool has shown the ability to predict discharge disposition for total joint and spine surgery patients , but not cardiac valve surgery patients , where the majority of patients in all categories were discharged home , at an institution participating in a bundled payment program . The ability to identify discharge disposition pre-operatively is valuable for improving care coordination , directing care re sources and establishing and maintaining patient and family expectations OBJECTIVE To assess the relevance of the RAPT ( Risk Assessment and Prediction Tool ) , among a cohort of patients undergoing total hip arthroplasty ( THA ) . METHOD Prospect i ve study of a cohort of patients evaluated before and after THA . The difference between the postoperative orientation predicted by the RAPT and the real one is assessed . Clinical , environmental and psychosocial criteria that could significantly change the orientation are discussed . RESULTS One hundred and thirty-four patients ( 94 women and 40 men ) were included . The average age was 71.6 ( ±10 ) years . Primary hip osteoarthritis was the indication for surgery in 78 % of cases . The average length of stay in the surgery ward was 10 ( ±3 ) days . It was significantly higher for patients referred to a rehabilitation ward ( P<0.0001 ) . Sixty-six percent of patients were referred to a rehabilitation ward and 34 % returned directly home . The average length of stay in rehabilitation ward was 27 ( ±13 ) days . The validity of the RAPT  as a help decision tool has been confirmed . Thus , a low RAPT score was significantly associated with more frequent referral to a rehabilitation ward , conversely , a high RAPT score is significantly related to more frequent direct return to home . CONCLUSION This study confirmed the usefulness of the RAPT to help in patient orientation decision after total hip arthroplasty . The patient preference remains the main variable for orientation after THA . By the way , the patient preference must not be integrated into the RAPT , but need to be collected and be discussed with the patient Objective : To evaluate the efficacy of an in-hospital programme based on task-oriented exercises associated with early full weight-bearing in patients with multiple comorbidities undergoing total hip replacement . Design : R and omized controlled trial . Setting : Specialised rehabilitation centre . Subjects : A total of 100 patients ( mean age of 69 ( 8) years ; 40 males , 60 females ) . Interventions : The experimental group underwent task-oriented exercises and was encouraged to ab and on any walking aids by the end of their in-hospital stay . The control group underwent open chain kinetic exercises , and was recommended to use partial weight-bearing and walking aids until three months after surgery . Both groups individually followed programmes of 90-minute sessions five times a week for three weeks . Outcome measures : Western Ontario and McMaster Universities Osteoarthritis Index , Pain Numerical Rating Scale , Functional Independence Measure , and Short-Form Health Survey . The participants were evaluated before , after training , and after a further 12 months . Results : There were no significant between-group differences at baseline . After training , a between-group difference of 12 points was found for the Western Ontario and McMaster Universities Osteoarthritis Index – functional subscale , indicating a clinical ly tangible treatment effect on disability . The Functional Independence Measure increased by 31 and 15 points in the experimental and control group , respectively . A linear mixed model revealed significant effects of time , group , and time by group interaction on disability , pain , activities of daily living , and most of the physical quality of life domains . Conclusion : Task-oriented exercises associated with early full weight-bearing improve disability , pain , activities of daily living , and quality of life after total hip replacement OBJECTIVE To explore the use of the Risk Assessment and Predictor Tool ( RAPT ) as a pre-operative tool to predict postoperative discharge destination and length of stay for patients undergoing total knee replacement ( TKR ) in Singapore . PARTICIPANTS AND SETTING A cohort of 569 patients undergoing primary TKR at the Singapore General Hospital were recruited prospect ively from November 2009 to June 2010 . INTERVENTION All patients completed a modified RAPT question naire pre-operatively , and underwent st and ard clinical pathway guidelines for TKR throughout the study . MAIN OUTCOME MEASURES Actual discharge destination ( ADDest ) and length of stay ( LOS ) . DESIGN  Total RAPT score  and  preferred discharge destination ( PDD ) were recorded pre-operatively , while ADDest and LOS were obtained immediately after discharge . Multivariable logistic regression and multivariable regression analysis were used to determine whether the RAPT items and score could predict the discharge outcomes . RESULTS Total RAPT score was a significant predictor of LOS for patients following TKR ( R=0.24 , P<0.001 ) ; the higher the RAPT score , the longer the LOS . Total RAPT score was also a significant predictor of actual discharge to home [ odds ratio ( OR ) 2.32 , 95 % confidence interval ( CI ) 1.11 to 4.85 ] . PDD was a significant predictor for LOS ( R=0.22 , P<0.001 ) and ADDest ( R=0.33 , P<0.001 ) . Patients who chose to be discharged home were more likely to be directly discharged home ( OR 9.79 , 95 % CI 5.07 to 18.89 , P<0.001 ) . CONCLUSION Total RAPT score and PDD were significant predictors of ADDest and LOS for patients following TKR in Singapore . The ability to predict discharge outcomes following TKR could assist caregivers , healthcare professionals and administrators in optimising care and re source allocations for patients OBJECTIVE To determine whether targeted postoperative care , based on preoperative risk assessment , can increase the number of patients who are discharged home directly from acute care after elective hip or knee arthroplasty . DESIGN Quasiexperimental with historical control . SETTING A public university teaching hospital . PARTICIPANTS One hundred patients who had an elective hip or knee arthroplasty . INTERVENTIONS Between January and July 2001 , 50 patients had their risk of discharge to extended inpatient rehabilitation assessed preoperatively with a newly developed Risk Assessment and Prediction Tool ( RAPT ) . Postoperative management was targeted on the basis of the identified level of risk . Results were compared with those of a similar group of 50 patients treated between January and July 2000 . MAIN OUTCOME MEASURES Discharge destination , length of stay ( LOS ) , and readmission rates . RESULTS The percentage of patients discharged directly home increased significantly , from 34 % during 2000 to 64 % in 2001 ( P=.002 ) , with no increase in readmission rates in the 12 months postdischarge . In addition , the mean acute hospital LOS decreased by 1.1 days to 7.5 days in 2001 ( P=.02 ) . CONCLUSIONS Use of the RAPT and targeted postoperative care result ed in more patients being discharged directly home after hip or knee arthroplasty while hospital LOS further decreased 
    Output:
    
All analyzed studies demonstrated that RAPT could reduce LOS and accurately predict discharge disposition especially for high- and low-risk patients .
In the intermediate risk category , a targeted intensive postoperative rehabilitation program has demonstrated good results in reducing the uncertain outcome .