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Objective. Rigorously trained physical therapy researchers are essential for the generation of knowledge that guides the profession. However, there is a current and projected dearth of physical therapy researchers capable of sustaining research programs in part due to perceived financial barriers associated with pursuit of a doctor of philosophy (PhD) degree, with and without postdoctoral training, following doctor of physical therapy (DPT) degree completion. This study aimed to evaluate the financial impact of PhD and postdoctoral training, including opportunity cost, years to break even, and long-term earnings. Methods. Clinical and academic salaries were obtained via the 2016 APTA Median Income of Physical Therapist Summary Report and 2019 CAPTE Annual Accreditation Report. Salaries were adjusted to total compensation to account for benefits and compared over a 30-year period starting after DPT education. Total compensations were also adjusted to the present value, placing greater weight on early career earnings due to inflation and potential investments. Results. Relative to work as a clinical physical therapist, 4 years of PhD training result in an earnings deficit of $264,854 rising to $357,065 after 2 years of additional postdoctoral training. These deficits do not persist as evidenced by a clinical physical therapist career earning $449,372 less than a nonmajority scholarship academic career (DPT to PhD to academia pathway) and $698,704 less than a majority scholarship academic career (DPT to PhD to postdoctoral training to academia pathway) over a 30-year period. Greater long-term earnings for PhD careers persist when adjusting to present value. Conclusions. Although there is an initial opportunity cost of PhD and postdoctoral training represented by a relative earnings deficit, advanced research training results in greater long-term earnings. Impact. The findings of this study allow physical therapists interested in pursuing PhD and postdoctoral training to be better informed about the associated financial ramifications. Keywords: Cost-Benefit Analysis, Education: Faculty, Education: Professional, Physical Therapists, Introduction Physical therapy is an evidence-based profession that relies on the generation of new knowledge from a breadth of sources to guide our practice within ever-changing health and practice environments. [...]

Range of motion (ROM) and pain often define successful recovery after total knee arthroplasty (TKA), but these routine clinical outcomes correlate poorly or not at all to functional capacity after TKA. The purpose of this Perspective is to underscore the importance of muscle strength and performance-based functional tests in addition to knee ROM and patient-reported outcome (PRO) measures to evaluate outcomes after TKA. Specifically: (1) muscle strength is the rate-limiting step for recovery of function after TKA; (2) progressive rehabilitation targeting early quadriceps muscle strengthening improves outcomes and does not compromise ROM after TKA; (3) ROM and PROs fail to fully capture functional limitations after TKA; and (4) performance-based functional tests are critical to evaluate function objectively after TKA. This Perspective also addresses studies that question the need for or benefit of physical therapy after TKA because their conclusions focus only on ROM and PRO measures. Future research is needed to determine the optimal timing, delivery, intensity, and content of physical therapy. Keywords: Function, Range of Motion, Rehabilitation, Strength, Total Knee Arthroplasty, Introduction Patients after total knee arthroplasty (TKA) rarely meet agematched norms for strength, function, or activity levels. (1-4) Muscle weakness, ubiquitous prior to and further amplified following TKA, (3,5-8) is [...]

Objective. Medicare beneficiaries are increasingly using home health (HH) as the first postacute care setting after hospital discharge following total joint arthroplasty (TJA). Yet, prior research has shown that changes in payment models for TJA may negatively influence functional outcomes for Medicare beneficiaries. The purpose of this study was to evaluate the impact of poor functional outcomes during an HH episode of care on hospitalization risk for older recipients of TJA. Methods. For this study, 5822 Medicare beneficiaries who underwent elective TJA and subsequently participated in HH care following hospital discharge were identified using Medicare hospitalizations records and HH claims. Recovery of activitiesof-daily-living (ADL) function was evaluated using patient assessment data completed at HH admission and discharge from the Medicare Outcomes and Assessment Information Set (OASIS). Hospitalization outcomes were captured from Medicare hospital claims. Cox proportional hazards regression was used to evaluate the hazard ratio for hospitalization after HH discharge. Results. The 5822 Medicare beneficiaries who received a TJA and subsequently were discharged to HH were evaluated (n = 3989 [68.6%] following total knee replacement, n = 1883 [31.4%]) following total hip replacement). Nearly 9% (n =534) of patients did not improve their ability to perform ADLs during the HH episode; this lack of improvement was associated with a more than 2-fold increase in hospital readmission rate following HH discharge (2.3% vs 4.9%). In adjusted models, there was a significant 77% increase (hazard ratio = 1.77; 95% CI = 1.1 4 -2.74) in hospitalization risk during the 90-day postsurgical period. Conclusion. Poor recovery of ADL function in HH settings following TJA is strongly associated with elevated risk of future hospitalizations. Impact. Medicare beneficiaries who fail to make substantive improvements in basic ADL function during HH care episodes following TJA may need intensive monitoring from interdisciplinary team members across the continuum of care, especially during transitions from home care to outpatient care. Lay Summary. An increasing number of patients receive home health care after joint replacement surgery, but outcomes after home health are unclear. These findings suggest that improvements in basic tasks such as walking or bathing are associated with a lower likelihood of hospitalization. Keywords: Activities of Daily Living, Disability, Home Care Services, Hospitalization, Orthopedics, Introduction Use of home health (HH) care after total joint arthroplasty (TJA)is increasing for Medicare beneficiaries. (1-3 )This increase is driven in part by enactment of alternative payment models for [...]