The RAPT is a short preoperative tool used to help plan discharge after joint replacement. This page explains what the RAPT is, what it measures, the items it contains, how it is scored, and how it is used.
What is the RAPT?
The RAPT (Risk Assessment and Prediction Tool) is a brief preoperative questionnaire designed to predict discharge disposition after total joint arthroplasty, that is, whether a patient is likely to be discharged home or to need extended inpatient rehabilitation or a skilled facility. It was developed by Oldmeadow and colleagues in an Australian joint-replacement population and published in 2003, and it has since been studied in hip and knee arthroplasty and in some spine populations.
What does the RAPT measure?
Rather than measuring symptoms or function like most PROMs, the RAPT estimates the risk that a patient will require more intensive post-discharge support. It combines patient characteristics and social circumstances known to influence recovery and discharge destination.
What questions are included in the RAPT?
The RAPT contains six items: age, sex, preoperative walking distance, use of a gait aid (such as a cane or walker), availability of community supports, and whether the patient will have a caregiver at home after surgery. The items are weighted differently based on how strongly each relates to discharge destination.
How is the RAPT scored?
Responses are combined into a total score from 1 to 12, with higher scores indicating a greater likelihood of a straightforward discharge home. A commonly used interpretation places patients into risk bands: a score above 9 suggests low risk (likely home discharge), 6 to 9 suggests intermediate risk, and below 6 suggests high risk for extended length of stay or discharge to a rehabilitation or skilled facility. The intermediate band is the least precise and often warrants additional clinical judgement.
How is the RAPT used in clinical practice?
The RAPT is completed before surgery so that care teams can plan discharge early, set patient expectations, and arrange appropriate post-acute support. Early discharge planning is associated with reduced length of stay, and studies have linked RAPT scores to discharge destination, length of stay, and aspects of postoperative mobility. It is intended to support, not replace, shared decision-making between the surgeon, care team, and patient.
Strengths and limitations
Strengths include brevity, ease of preoperative administration, and demonstrated association with discharge outcomes. Limitations include reduced accuracy in the intermediate score range, variation in performance across different health systems and populations, and the fact that it predicts discharge logistics rather than clinical or surgical outcomes.
Frequently asked questions
What is the RAPT used for? To predict, before surgery, whether a joint-replacement patient is likely to be discharged home or need extended rehabilitation.
What is the RAPT score range? Scores range from 1 to 12; higher scores indicate a greater likelihood of home discharge.
Is a higher RAPT score better? Generally yes, in that higher scores are associated with a more straightforward discharge home.
References
- Oldmeadow LB, McBurney H, Robertson VJ. Predicting risk of extended inpatient rehabilitation after hip or knee arthroplasty. Journal of Arthroplasty. 2003;18(6):775-779.
- Hansen VJ, Gromov K, Lebrun LM, Rubash HE, Malchau H, Freiberg AA. Does the Risk Assessment and Prediction Tool predict discharge disposition after joint replacement? Clinical Orthopaedics and Related Research. 2015;473(2):597-601.
- LeBrun DG, Nguyen JT, Fisher C, et al. The Risk Assessment and Prediction Tool (RAPT) Score Predicts Discharge Destination, Length of Stay, and Postoperative Mobility After Total Joint Arthroplasty. Journal of Arthroplasty. 2023;38(7):S121-S129.
