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Rhim HC, Schon JM, Xu R, Nolan D, Ahn J, Short K, Schon LC. Prehabilitation for Patients Undergoing Elective Foot and Ankle Surgery: A Contemporary Review. FOOT & ANKLE ORTHOPAEDICS 2024; 9:24730114241255136. [PMID: 38812567 PMCID: PMC11135079 DOI: 10.1177/24730114241255136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024] Open
Affiliation(s)
- Hye Chang Rhim
- Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, MA, USA
- Foot & Ankle Research and Innovation Lab (FARIL), Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Jason M. Schon
- Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Raylin Xu
- Harvard Medical School, Boston, MA, USA
| | - David Nolan
- Department of Physical Therapy, Movement, and Rehabilitation Science, Northeastern University, Boston, MA, USA
- Sports Physical Therapy Service, Massachusetts General Hospital, Boston, MA, USA
| | - Jiyong Ahn
- Foot & Ankle Research and Innovation Lab (FARIL), Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kelly Short
- Center for Restorative Therapies, Mercy Medical Center, Baltimore, MD, USA
| | - Lew C. Schon
- Director of Orthopaedic Innovation, Institute for Foot and Ankle Reconstruction, Mercy Medical Center, Baltimore, MD, USA
- Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, New York University Langone Health, NY, USA
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Nozaki K, Nanri Y, Kawabata M, Shibuya M, Nihei M, Shirota T, Masuma H, Maeda T, Fukushima K, Uchiyama K, Takahira N, Takaso M. Association of affected and non-affected side ability with postoperative outcomes in patients undergoing total hip arthroplasty. Hip Int 2024; 34:33-41. [PMID: 37720956 DOI: 10.1177/11207000231199169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
BACKGROUND Although several reports have examined the association between preoperative function and postoperative outcomes in patients undergoing total hip arthroplasty (THA), it is unclear whether the ability of the affected or non-affected side particularly impacts on outcomes. We aimed to investigate the association between affected and non-affected side ability and walking independence. METHODS We prospectively enrolled 721 consecutive patients who underwent THA. Preoperatively, quadriceps isometric strength (QIS) and one-leg standing time (OLST) were measured. The endpoints were walking independence within 3, 5, 7, 10, and 14 days postoperatively. The associations between preoperative abilities and outcomes were examined using multivariate Cox hazard model, and the area under the curves (AUCs) for outcomes were compared. RESULTS We analysed 540 patients after excluding patients who met the exclusion criteria. Both affected and non-affected QIS predicted walking independence within 3 (p = 0.006 and 0.001, respectively), 5, 7, 10, and 14 (both p < 0.001) days postoperatively. For OLST, only the affected side did not predict walking independence within 3 days postoperatively (p = 0.154 and 0.012, respectively), and both sides did at days 5 (p = 0.019 and <0.001, respectively), 7, 10, and 14 (both p < 0.001). The AUCs of the non-affected side ability for walking independence were significantly greater than those of the affected side on postoperative days 3 (0.66 vs. 0.73; p = 0.021) and 5 (0.67 vs. 0.71; p = 0.040), with no significant difference after day 7. CONCLUSIONS Both sides abilities were associated with walking independence after THA, but non-affected side was found to be particularly crucial for early walking independence.
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Affiliation(s)
- Kohei Nozaki
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Yuta Nanri
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Masashi Kawabata
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Manaka Shibuya
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Manami Nihei
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Takehiro Shirota
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Hiroyoshi Masuma
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Takuya Maeda
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Kensuke Fukushima
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Katsufumi Uchiyama
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Sagamihara, Japan
- Department of Patient Safety and Healthcare Administration, Kitasato University School of Medicine, Sagamihara, Japan
| | - Naonobu Takahira
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Masashi Takaso
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Sagamihara, Japan
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Punnoose A, Claydon-Mueller LS, Weiss O, Zhang J, Rushton A, Khanduja V. Prehabilitation for Patients Undergoing Orthopedic Surgery: A Systematic Review and Meta-analysis. JAMA Netw Open 2023; 6:e238050. [PMID: 37052919 PMCID: PMC10102876 DOI: 10.1001/jamanetworkopen.2023.8050] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2023] Open
Abstract
Importance Prehabilitation programs for patients undergoing orthopedic surgery have been gaining popularity in recent years. However, the current literature has produced varying results. Objective To evaluate whether prehabilitation is associated with improved preoperative and postoperative outcomes compared with usual care for patients undergoing orthopedic surgery. Data Sources Bibliographic databases (MEDLINE, CINAHL [Cumulative Index to Nursing and Allied Health Literature], AMED [Allied and Complementary Medicine], Embase, PEDRO [Physiotherapy Evidence Database], and Cochrane Central Register of Controlled Trials) were searched for published trials, and the Institute for Scientific Information Web of Science, System for Information on Grey Literature in Europe, and European clinical trials registry were searched for unpublished trials from January 1, 2000, to June 30, 2022. Study Selection Randomized clinical trials (RCTs) comparing prehabilitation with standard care for any orthopedic surgical procedure were included. Data Extraction and Synthesis Two independent reviewers screened trials. Data were pooled using a random-effects model. Recommendations were determined using the Grading of Recommendations Assessment, Development and Evaluation system and the study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline. Main Outcomes and Measures Pain, function, muscle strength, and health-related quality of life (HRQOL). Results Forty-eight unique trials involving 3570 unique participants (2196 women [61.5%]; mean [SD] age, 64.1 [9.1] years) were analyzed. Preoperatively, moderate-certainty evidence favoring prehabilitation was reported for patients undergoing total knee replacement (TKR) for function (standardized mean difference [SMD], -0.70 [95% CI, -1.08 to -0.32]) and muscle strength and flexion (SMD, 1.00 [95% CI, 0.23-1.77]) and for patients undergoing total hip replacement (THR) for HRQOL on the 36-item Short Form Health Survey (weighted mean difference [WMD], 7.35 [95% CI, 3.15-11.54]) and muscle strength and abduction (SMD, 1.03 [95% CI, 0.03-2.02]). High-certainty evidence was reported for patients undergoing lumbar surgery for back pain (WMD, -8.20 [95% CI, -8.85 to -7.55]) and moderate-certainty evidence for HRQOL (SMD, 0.46 [95% CI, 0.13-0.78]). Postoperatively, moderate-certainty evidence favoring prehabilitation was reported for function at 6 weeks in patients undergoing TKR (SMD, -0.51 [95% CI, -0.85 to -0.17]) and at 6 months in those undergoing lumbar surgery (SMD, -2.35 [95% CI, -3.92 to -0.79]). Other differences in outcomes favoring prehabilitation were of low to very low quality of evidence. Conclusions and Relevance In this systematic review and meta-analysis of RCTs, moderate-certainty evidence supported prehabilitation over usual care in improving preoperative function and strength in TKR and HRQOL and muscle strength in THR, high-certainty evidence in reducing back pain, and moderate-certainty evidence in improving HRQOL in lumbar surgery. Postoperatively, moderate-certainty evidence supported prehabilitation for function following TKR at 6 weeks and lumbar surgery at 6 months. Prehabilitation showed promising results for other outcomes, although high risk of bias and heterogeneity affected overall quality of evidence. Additional RCTs with a low risk of bias investigating preoperative and postoperative outcomes for all orthopedic surgical procedures are required.
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Affiliation(s)
- Anuj Punnoose
- Young Adult Hip Service, Physiotherapy Department, Addenbrooke's-Cambridge University Hospitals NHS (National Health Service) Trust, Cambridge, United Kingdom
- School of Allied Health, Anglia Ruskin University, Chelmsford and Cambridge, United Kingdom
| | | | - Ori Weiss
- Department of Orthopedics, Meir Medical Centre, Kfar-Saba, Israel
| | - Jufen Zhang
- School of Medicine, Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Chelmsford, United Kingdom
| | - Alison Rushton
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Vikas Khanduja
- Young Adult Hip Service, Department of Trauma and Orthopedics, Addenbrooke's-Cambridge University Hospital NHS Foundation Trust, Cambridge, United Kingdom
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The impact of waiting time for orthopaedic consultation on pain levels in individuals with osteoarthritis: a systematic review and meta-analysis. Osteoarthritis Cartilage 2022; 30:1561-1574. [PMID: 35961505 DOI: 10.1016/j.joca.2022.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/30/2022] [Accepted: 07/27/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Time spent waiting for access to orthopaedic specialist health services has been suggested to result in increased pain in individuals with osteoarthritis (OA). We assessed whether time spent on an orthopaedic waiting list resulted in a detrimental effect on pain levels in patients with knee or hip OA. METHODS We searched Ovid MEDLINE, EMBASE and EBSCOhost databases from inception until September 2021. Eligible articles included individuals with OA on an orthopaedic waitlist and not receiving active treatment, and reported pain measures at two or more time points. Random-effects meta-analysis was used to estimate the pooled effect of waiting time on pain levels. Meta-regression was used to determine predictors of effect size. RESULTS Thirty-three articles were included (n = 2,490 participants, 67 ± 3 years and 62% female). The range of waiting time was 2 weeks to 2 years (20.8 ± 18.8 weeks). There was no significant change in pain over time (effect size = 0.082, 95% CI = -0.009, 0.172), nor was the length of time associated with longitudinal changes in pain over time (β = 0.004, 95% CI = -0.005, 0.012). Body mass index was a significant predictor of pain (β = -0.043, 95% CI = -0.079, 0.006), whereas age and sex were not. CONCLUSIONS Pain remained stable for up to 1 year in patients with OA on an orthopaedic waitlist. Future research is required to understand whether pain increases in patients waiting longer than 1 year.
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Sarpong N, Boettner F, Cushner F, Krell E, Premkumar A, Valle AGD, Hanreich C. Is there a difference in mobility and inpatient physical therapy need after primary total hip and knee arthroplasty? A decade-by-decade analysis from 60 to 99 years. Arch Orthop Trauma Surg 2022:10.1007/s00402-022-04624-w. [PMID: 36258048 DOI: 10.1007/s00402-022-04624-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 09/10/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Extended inpatient rehabilitation (PT) after total hip (THA) and knee arthroplasty (TKA) has a significant impact on total care costs. As patients age, extended PT might be required following THA and TKA. This study examined the relationship between patient age, functional mobility, inpatient PT need, and discharge disposition in THA and TKA patients. MATERIALS AND METHODS This retrospective study included patients aged 60 + undergoing primary THA or TKA between 2018 and 2020 at an orthopedic hospital. Comparing by age-decade, 7374 (3600 THA, 3774 TKA) sexagenarians, 5350 (2367 THA, 2983 TKA) septuagenarians, 1356 (652 THA, 704 TKA) octogenarians, and 78 (52 THA, 26 TKA) nonagenarians were analyzed. We compared the number of PT sessions needed for discharge clearance and the postoperative functional mobility using the Activity Measure for Post-Acute Care (AM-PAC) tool. Statistical analyses included ANOVA with post-hoc Tukey's HSD for continuous data and Chi-squared test for categorical variables. RESULTS The number of PT sessions required for discharge clearance increased with age after THA (3.3 ± 1.9 sessions vs 3.8 ± 2.1 vs 5.0 ± 2.7 vs 6.2 ± 3.0; p < 0.01) and TKA (4.0 ± 2.1 vs 4.7 ± 3.1 vs 5.2 ± 2.8 vs 5.0 ± 1.6; p < 0.01). The functional mobility improvement as measured by AM-PAC was significantly lower for nonagenarians after THA (4.9 ± 2.8 vs 5.1 ± 2.8 vs 4.6 ± 3.3 vs 3.3 ± 3.9; p < 0.01) and TKA (5.0 ± 2.9 vs 4.7 ± 3.2 vs 3.9 ± 3.4 vs 3.2 ± 2.6; p < 0.01). CONCLUSION Patients in their eighth and ninth decade had less improvement in functional mobility during in-hospital rehabilitation and utilized more PT services. However, clinical results in the elderly are still satisfying and the data may be helpful for resource utilization planning and risk-adjustment in value-based payment models.
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Affiliation(s)
- Nana Sarpong
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA
| | - Friedrich Boettner
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA.
| | - Fred Cushner
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA
| | - Ethan Krell
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA
| | - Ajay Premkumar
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA
| | - Alejandro Gonzalez Della Valle
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA
| | - Carola Hanreich
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA
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Preoperative Patient Education Programs for Orthopaedic Surgery: What Do the Programs Include? How Are They Delivered? What Are the Knowledge Gaps? A Scoping Review of 46 Studies. J Orthop Sports Phys Ther 2022; 52:572-585. [PMID: 35802819 DOI: 10.2519/jospt.2022.10614] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To (1) describe the nature and content of the current literature on preoperative education programs for patients preparing for orthopaedic surgery, (2) assess the completeness of reporting program descriptions, and (3) report gaps within the literature. DESIGN Scoping review. LITERATURE SEARCH We searched the CINAHL, Embase, PubMed, Cochrane Reviews, PsycINFO, Web of Science, and Google Scholar databases for studies that (1) addressed preoperative education in elective orthopaedic surgery or (2) provided descriptions or evaluations of a preoperative program, including the content or outcomes of the program. STUDY SELECTION CRITERIA Articles were included if they addressed preoperative patient education focused on an elective orthopaedic surgery and any of the (1) descriptions of an education program including any theoretical frameworks, content, or delivery, or (2) evaluations of the process of a preoperative educational program. Studies were excluded if they were treatment programs with the goal of resolving the problem occurring prior to surgery (eg, rehabilitation or pain management prior to surgery). DATA SYNTHESIS We used the template for intervention description and replication (TIDieR) checklist and guide to assess the completeness of reporting of the content of educational programs. Content was synthesized descriptively and by intervention mapping. The results informed of a draft operational definition of preoperative education that we refined based on expert consultation. RESULTS Forty-six articles were included. There was variation in study designs, target populations, and intervention content. Preoperative education was defined in 1 out of 5 studies. Thirteen studies used a platform of video-based modules to deliver their program; 3 studies implemented virtual platforms. Results from the TIDieR checklist indicated that 30% of studies tracked adherence to and fidelity of their programs. A definition and conceptual map indicated that the length of stay, functional abilities, patient knowledge, and satisfaction were expected benefits. CONCLUSION Poor reporting of content, rationale, and frameworks for preoperative programs in orthopedics may explain why systematic reviews have not found support for their value. Future trials must improve rigor in design and reporting. J Orthop Sports Phys Ther 2022;52(9):572-585. Epub: 9 July 2022. doi:10.2519/jospt.2022.10614.
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Widmer P, Oesch P, Bachmann S. Effect of Prehabilitation in Form of Exercise and/or Education in Patients Undergoing Total Hip Arthroplasty on Postoperative Outcomes—A Systematic Review. Medicina (B Aires) 2022; 58:medicina58060742. [PMID: 35744005 PMCID: PMC9228426 DOI: 10.3390/medicina58060742] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 05/27/2022] [Accepted: 05/27/2022] [Indexed: 12/04/2022] Open
Abstract
Background and Objectives: The aim of this systematic review was to determine whether prehabilitation before total hip arthroplasty, in the form of exercise therapy, education alone, or both together, improves postoperative outcomes, such as physical functioning, compared with no intervention. Materials and Methods: A systematic literature search was performed in the online databases PubMed, PEDro and Cochrane Library using the following search keywords: “prehabilitation”, “preoperative care”, and “total hip replacement”. Results: A total of 400 potentially relevant studies were identified. After title, abstract and full-text screening, 14 studies fulfilled all inclusion criteria and were included in this systematic review. Patients who completed exercise-based prehabilitation before their operation showed significant postoperative improvements compared with no intervention in the following tests: six-minute walk test, Timed Up and Go test, chair-rise test, and stair climbing. For various other assessments, such as the widely used Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Hip disability and Osteoarthritis Outcome Score (HOOS), 36-item Short Form Survey (SF-36) and Barthel Index, no significant differences in outcomes regarding exercise therapy were reported in the included studies. Education alone had no effect on postoperative outcomes. Conclusions: Prehabilitation in the form of a prehabilitation exercise therapy is an effective prehabilitation measure with regard to postoperative physical functioning, while prehabilitation in the form of education has no significant effects. No negative effects of prehabilitation on the outcomes examined were reported.
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Affiliation(s)
- Patrick Widmer
- Klinik Für Muskuloskelettale und Internistische Rehabilitation, Rehabilitationszentrum Walenstadtberg, Kliniken Valens, 8881 Walenstadtberg, Switzerland;
| | - Peter Oesch
- Research Department, Rehabilitationszentrum Valens, Kliniken Valens, 7317 Valens, Switzerland;
| | - Stefan Bachmann
- Klinik Für Muskuloskelettale und Internistische Rehabilitation, Rehabilitationszentrum Walenstadtberg, Kliniken Valens, 8881 Walenstadtberg, Switzerland;
- Research Department, Rehabilitationszentrum Valens, Kliniken Valens, 7317 Valens, Switzerland;
- Department of Geriatrics, Faculty of Medicine, Inselspital, University of Bern, 3010 Bern, Switzerland
- Correspondence:
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A Systematic Review and Meta-Analysis on Randomized Control Trials for Preoperative Rehabilitation in Patients Planning for Joint Replacement Surgery for Better Outcomes. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:4287555. [PMID: 35310174 PMCID: PMC8930231 DOI: 10.1155/2022/4287555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/21/2022] [Accepted: 02/11/2022] [Indexed: 11/24/2022]
Abstract
Background The clinical influence of the preoperative and postoperative therapies for recovery after the joint replacement surgery is still questionable. This study of systematic review and meta-analysis focuses on analyzing the clinical effects of preoperative rehabilitation among the patients who are planning to opt for joint replacement surgery for enhanced results. Objective Randomized clinical trials were selected where preoperative therapeutic exercises were performed by adults for preoperative rehabilitation in patients who were planning for replacement surgery for better outcomes and identified through databases and screening. Two reviewers were responsible for extracting appropriate studies, relevant data, assessing the risks, therapeutic validity, etc. Material and Methods. We performed random-effects meta-analysis for calculation of risk ratios and odds ratios, for knee and hip surgery cases. Analysis of length of hospital stay, short-term-based recovery period during hospital stay, total hip replacement functional recovery during hospital stay, short-term recovery of self-reported functioning, etc. was performed. Results Functional scores, postoperative pain, recovery time, length of hospital stay, and quality of life were studied. Of the seven studies included, the data of 614 patients were studied. The total number of participants in both exercise and control groups was analyzed to assess the bias of the study where the risk ratio was 0.96 and (0.74–1.25) was the 95% CI. Short-term-based recovery period during hospital stay for knee replacement was analyzed where 0.87 was the risk ratio and (0.61–1.23) was the 95% CI and for hip replacement where 0.99 was the risk ratio and (0.68–1.44) was the 95% CI. The RR for total hip replacement functional recovery during hospital stay was 0.80 with 95% CI (0.54–1.19). The RR for short-term recovery of self-reported functioning was 0.98 with 95% CI (0.76–1.26). Outcome analysis for pain and functionality evaluation was performed and assessed using WOMAC, HOOS, and HHS scores where the standardized mean difference was 0.38 and (0.20–0.57) was the 95% CI in hip surgery pain analysis and in knee surgery, 0.00 was the standardized mean difference and (−0.18–0.19) was the 95% CI. Conclusion Long-term outcomes were not affected by the preoperative rehabilitation. Though there was a slight improvement in early postoperative pain, this is not much of clinical significance.
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Nambiar M, Cheng TE, Onggo JR, Maingard J, Troupis J, Pope A, Armstrong MS, Singh PJ. No Difference in Functional, Radiographic, and Survivorship Outcomes Between Direct Anterior or Posterior Approach THA: 5-Year Results of a Randomized Trial. Clin Orthop Relat Res 2021; 479:2621-2629. [PMID: 34237041 PMCID: PMC8726547 DOI: 10.1097/corr.0000000000001855] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 05/13/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Both the direct anterior approach (DAA) and posterior approach (PA) to THA have known advantages and disadvantages. The comparison between DAA and PA THA has been widely explored during the early postoperative period. However, few randomized trials have compared these approaches at a minimum follow-up of 5 years; doing so would be important to establish any differences in mid-term outcomes or complications. QUESTIONS/PURPOSES We performed a randomized trial comparing DAA and PA in THA in terms of (1) patient-reported outcome scores, (2) quality of life and functional outcomes assessed by the EQ-5D and 10-meter walk test results, (3) radiographic analysis, and (4) survivorship and surgical complications at a minimum of 5 years follow-up. METHODS Two hip specialist surgeons performed both DAA and PA THA using the same THA components at two hospital sites. One hundred twelve patients on the elective THA surgical waitlist were invited to participate in the study. Thirty-four patients did not meet the study's inclusion criteria and were excluded, and three patients declined to participate in the study. The remaining 75 patients who were eligible were randomized into DAA and PA groups. Thirty-seven patients were initially randomized to receive DAA THA, but two did not and were excluded, resulting in 48% (35 of 73) of patients who received DAA THA; 52% (38 of 73) of patients were randomized into and received PA THA. Over a minimum 5 years of follow-up, 3% (1 of 35) of DAA patients were lost to follow-up, and none of the patients undergoing PA THA were lost. A per-protocol analysis was adopted, resulting in further patients being excluded from analysis. Of the 73 study patients, 99% (72; DAA: 35, PA: 37) were analyzed at 1 year, 95% (69; DAA: 34, PA: 35) were analyzed at 2 years, and 72% (52; DAA: 23, PA: 29) were analyzed at 5 years. The primary outcome was the Oxford Hip Score (OHS) and WOMAC score. Secondary outcomes included the EQ-5D and EQ-5D VAS scores, 10-meter walk test results, radiographic evidence of loosening (femoral: lucency > 2 mm at the implant-bone interface, subsidence > 2 mm; acetabular: migration or change in inclination), 5-year survivorship analysis from all-cause revisions, and surgical complications. The study was powered to detect a 10-point difference in the WOMAC score, which is equivalent to the minimum clinically important difference (MCID). RESULTS There were no differences in primary outcomes (OHS and WOMAC scores) or secondary outcomes (EQ-5D scores, EQ-5D VAS scores, and 10-meter walk test result) between the DAA and PA groups at the 5-year follow-up interval. The median (range) OHS at 5 years was 46 (16 to 48) for DAA and 47 (18 to 48) for PA groups (p = 0.93), and the median WOMAC score was 6 (0 to 81) for DAA and 7 (0 to 59) for PA groups (p = 0.96). The median EQ-5D score was 1 (0.1 to 1) for DAA and 1 (0.5 to 1) for PA groups (p = 0.45), and the median EQ-5D VAS score was 85 (60 to 100) for DAA and 95 (70 to 100) for PA groups (p = 0.29). There were no cases of component loosening on radiographs. There was no difference in component survival between the two approaches at 5 years (DAA: 97% [95% CI 85% to 100%] versus PA: 97% [95% CI 87% to 100%]). Eight of 23 patients in the DAA group reported decreased sensation in the lateral femoral cutaneous nerve distribution. CONCLUSION DAA and PA are both effective approaches in performing primary THA. Each approach has its associated risks and complications. The choice of THA should be based on individual patient factors, surgeon experience, and shared decision-making. Early registry data indicate DAA and PA THA are comparable, but longer-term data with larger numbers of patients will be required before one can safely conclude equal survivorship between both approaches. LEVEL OF EVIDENCE Level I, therapeutic study.
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Affiliation(s)
- Mithun Nambiar
- Department of Orthopaedic Surgery, Box Hill Hospital, Box Hill, Victoria, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
| | - Tze E. Cheng
- Department of Orthopaedic Surgery, Box Hill Hospital, Box Hill, Victoria, Australia
- Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
| | - James R. Onggo
- Department of Orthopaedic Surgery, Box Hill Hospital, Box Hill, Victoria, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
| | - Julian Maingard
- Monash Imaging, Monash Medical Centre, Clayton, Victoria, Australia
| | - John Troupis
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
- Monash Imaging, Monash Medical Centre, Clayton, Victoria, Australia
| | - Alun Pope
- Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
| | - Michael S. Armstrong
- Department of Orthopaedic Surgery, Box Hill Hospital, Box Hill, Victoria, Australia
| | - Parminder J. Singh
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
- Department of Orthopaedic Surgery, Maroondah Hospital, Ringwood, Victoria, Australia
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Kawano T, Nankaku M, Murao M, Goto K, Kuroda Y, Kawai T, Ikeguchi R, Matsuda S. Functional characteristics associated with hip abductor torque in severe hip osteoarthritis. Musculoskelet Sci Pract 2021; 55:102431. [PMID: 34329871 DOI: 10.1016/j.msksp.2021.102431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 07/12/2021] [Accepted: 07/17/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Hip abductor weakness due to the progression of hip osteoarthritis (OA) commonly causes poor functional mobility. The hip abductor strength has also been identified as a clinically relevant factor for successful functional outcomes after total hip arthroplasty. OBJECTIVES This study aimed to examine the functional characteristics related to hip abductor torque in patients with hip OA. DESIGN A cross-sectional survey study. METHODS One hundred and eight female patients with severe unilateral hip OA participated in this study. Hip abductor torque and pain were measured. The muscle cross-sectional area (CSA) and skeletal muscle density (SMD) of the gluteal muscles were also measured using computed tomography. To identify the hip parameters associated with hip abductor torque, multiple regression analysis was performed. The healthy model included the CSA and SMD of gluteus maximus, gluteus medius, and gluteus minimus; range of motion in hip abduction; age; and body mass index. The affected model included hip pain in addition to the healthy model. RESULTS In the affected limb, multiple regression analysis identified pain and angle of hip abduction as factors that determine hip abductor torque (Adjusted R2 = 0.39). In contrast, our analysis identified CSA and SMD of the gluteus medius and SMD of the gluteus minimus as the significant variables related to hip abductor torque in the healthy limb (Adjusted R2 = 0.40). CONCLUSION The findings of this study indicated that it is necessary to consider that hip pain may inhibit muscle exertion and contraction while training to improve the hip abductor torque in the affected limb.
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Affiliation(s)
- Takumi Kawano
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan.
| | - Manabu Nankaku
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
| | - Masanobu Murao
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
| | - Koji Goto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yutaka Kuroda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toshiyuki Kawai
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ryosuke Ikeguchi
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan; Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shuichi Matsuda
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan; Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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11
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Green G, Abbott S, Vyrides Y, Afzal I, Kader D, Radha S. The impact of the COVID-19 pandemic on the length of stay following total hip and knee arthroplasty in a high volume elective orthopaedic unit. Bone Jt Open 2021; 2:655-660. [PMID: 34404226 PMCID: PMC8384441 DOI: 10.1302/2633-1462.28.bjo-2021-0022.r1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Aims Elective orthopaedic services have had to adapt to significant system-wide pressures since the emergence of COVID-19 in December 2019. Length of stay is often recognized as a key marker of quality of care in patients undergoing arthroplasty. Expeditious discharge is key in establishing early rehabilitation and in reducing infection risk, both procedure-related and from COVID-19. The primary aim was to determine the effects of the COVID-19 pandemic length of stay following hip and knee arthroplasty at a high-volume, elective orthopaedic centre. Methods A retrospective cohort study was performed. Patients undergoing primary or revision hip or knee arthroplasty over a six-month period, from 1 July to 31 December 2020, were compared to the same period in 2019 before the COVID-19 pandemic. Demographic data, American Society of Anesthesiologists (ASA) grade, wait to surgery, COVID-19 status, and length of hospital stay were recorded. Results A total of 1,311 patients underwent hip or knee arthroplasty in the six-month period following recommencement of elective services in 2020 compared to 1,527 patients the year before. Waiting time to surgery increased in post-COVID-19 group (137 days vs 78; p < 0.001). Length of stay also significantly increased (0.49 days; p < 0.001) despite no difference in age or ASA grade. There were no cases of postoperative COVID-19 infection. Conclusion Time to surgery and length of hospital stay were significantly higher following recommencement of elective orthopaedic services in the latter part of 2020 in comparison to a similar patient cohort from the year before. Longer waiting times may have contributed to the clinical and radiological deterioration of arthritis and general musculoskeletal conditioning, which may in turn have affected immediate postoperative rehabilitation and mobilization, as well as increasing hospital stay. Cite this article: Bone Jt Open 2021;2(8):655–660.
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Affiliation(s)
| | | | | | - Irrum Afzal
- South West London Elective Orthopaedic Centre, London, UK
| | - Deiary Kader
- South West London Elective Orthopaedic Centre, London, UK
| | - Sarkhell Radha
- Croydon University Hospital, London, UK.,South West London Elective Orthopaedic Centre, London, UK
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12
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Brown-Taylor L, Beckner A, Scaff KE, Fritz JM, Buys MJ, Patel S, Bayless K, Brooke BS. Relationships between physical therapy intervention and opioid use: A scoping review. PM R 2021; 14:837-854. [PMID: 34153178 DOI: 10.1002/pmrj.12654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 05/27/2021] [Accepted: 06/01/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To synthesize available evidence that has examined the relationship between physical therapy (PT) and opioid use. TYPE: Scoping Review LITERATURE SURVEY: Data sources including Google Scholar, Embase, PubMed, Cochrane Library, and CINAHL were searched for English articles up to October 24, 2019 using terms ("physical therapy"[Title/Abstract] OR physiotherapy[Title/Abstract] OR rehabilitation[Title/Abstract]) AND (opiate*[Title/Abstract] OR opioid*[Title/Abstract]). METHODOLOGY Included studies evaluated a PT intervention and reported an opioid-use outcome. Data were extracted to describe the PT intervention, patient sample, opioid-use measurement, and results of any time or group comparisons. Study quality was evaluated with Joanna Briggs checklists based on study design. SYNTHESIS Thirty studies were included that evaluated PT in at least one of these seven categories: interdisciplinary program (n = 8), modalities (n = 3), treatment (n = 3), utilization (n = 2), content (n = 3), timing (n = 13), and location (n = 2). Mixed results were reported for reduced opioid-use after interdisciplinary care and after PT modalities. Utilizing PT was associated with lower odds (ranging from 0.2-0.8) of using opioid medication for persons with low back pain (LBP) and injured workers; however, guideline-adherent care did not further reduce opioid use for persons with LBP. Early PT utilization after index visit for spine or joint pain and after orthopedic surgery was also associated with lower odds of using opioid medications (ranging from 0.27-0.93). Emergency department PT care was not associated with fewer opioid prescriptions than standard emergency department care. PT in a rehabilitation center after total knee replacement was not associated with lower opioid use than inpatient PT. CONCLUSIONS The relationship between timing of PT and opioid use was evaluated in 13 of 30 studies for a variety of patient populations. Eight of these 13 studies reported a relationship between early PT and reduced subsequent opioid use, making the largest sample of studies in this scoping review with supporting evidence. There is limited and inconclusive evidence to establish whether the content and/or location of PT interventions improves outcomes because of heterogeneity between studies.
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Affiliation(s)
- Lindsey Brown-Taylor
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA.,Medpace Inc., Cincinnati, Ohio, USA
| | - Aaron Beckner
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA.,Ochsner Health System, New Orleans, Louisiana, USA
| | - Katie E Scaff
- Jonathan M. Wainwright Memorial VA Medical Center, Walla Walla, Washington, USA
| | - Julie M Fritz
- Department of Physical Therapy and Athletic Training, College of Health, University of Utah, Salt Lake City, Utah, USA
| | - Michael J Buys
- Department of Anesthesiology, University of Utah School of Medicine, Salt Lake City, Utah, USA.,Department of Anesthesiology, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
| | - Shardool Patel
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA.,Department of Anesthesiology, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
| | - Kim Bayless
- Department of Anesthesiology, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
| | - Benjamin S Brooke
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA.,Division of Vascular Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
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13
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Giovannini S, Coraci D, Brau F, Galluzzo V, Loreti C, Caliandro P, Padua L, Maccauro G, Biscotti L, Bernabei R. Neuropathic Pain in the Elderly. Diagnostics (Basel) 2021; 11:diagnostics11040613. [PMID: 33808121 PMCID: PMC8066049 DOI: 10.3390/diagnostics11040613] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/18/2021] [Accepted: 03/25/2021] [Indexed: 02/06/2023] Open
Abstract
Neuropathic pain due to a lesion or a disease of the somatosensory system often affects older people presenting several comorbidities. Moreover, elderly patients are often poly-medicated, hospitalized and treated in a nursing home with a growing risk of drug interaction and recurrent hospitalization. Neuropathic pain in the elderly has to be managed by a multidimensional approach that involves several medical, social and psychological professionals in order to improve the quality of life of the patients and, where present, their relatives.
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Affiliation(s)
- Silvia Giovannini
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (D.C.); (F.B.); (V.G.); (C.L.); (P.C.); (L.P.); (G.M.); (L.B.); (R.B.)
- Correspondence: ; Tel.: +39-063015-4341
| | - Daniele Coraci
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (D.C.); (F.B.); (V.G.); (C.L.); (P.C.); (L.P.); (G.M.); (L.B.); (R.B.)
- Department of Neurosciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Fabrizio Brau
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (D.C.); (F.B.); (V.G.); (C.L.); (P.C.); (L.P.); (G.M.); (L.B.); (R.B.)
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Vincenzo Galluzzo
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (D.C.); (F.B.); (V.G.); (C.L.); (P.C.); (L.P.); (G.M.); (L.B.); (R.B.)
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Claudia Loreti
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (D.C.); (F.B.); (V.G.); (C.L.); (P.C.); (L.P.); (G.M.); (L.B.); (R.B.)
| | - Pietro Caliandro
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (D.C.); (F.B.); (V.G.); (C.L.); (P.C.); (L.P.); (G.M.); (L.B.); (R.B.)
| | - Luca Padua
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (D.C.); (F.B.); (V.G.); (C.L.); (P.C.); (L.P.); (G.M.); (L.B.); (R.B.)
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Giulio Maccauro
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (D.C.); (F.B.); (V.G.); (C.L.); (P.C.); (L.P.); (G.M.); (L.B.); (R.B.)
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Lorenzo Biscotti
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (D.C.); (F.B.); (V.G.); (C.L.); (P.C.); (L.P.); (G.M.); (L.B.); (R.B.)
- Presiding Officer of Geriatric Care Promotion and Development Centre (C.E.P.S.A.G), Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Roberto Bernabei
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (D.C.); (F.B.); (V.G.); (C.L.); (P.C.); (L.P.); (G.M.); (L.B.); (R.B.)
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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14
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Saueressig T, Owen PJ, Zebisch J, Herbst M, Belavy DL. Evaluation of Exercise Interventions and Outcomes After Hip Arthroplasty: A Systematic Review and Meta-analysis. JAMA Netw Open 2021; 4:e210254. [PMID: 33635329 PMCID: PMC7910817 DOI: 10.1001/jamanetworkopen.2021.0254] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
IMPORTANCE Preoperative and postoperative exercise interventions are commonly used in patients with total hip arthroplasty despite a lack of established efficacy. OBJECTIVE To explore clinical outcomes associated with exercise training before and after hip arthroplasty. DATA SOURCES PubMed, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, EMBASE, and Google Scholar were searched from their inception to March 2020. Reference lists of included trials and related reviews were also searched. STUDY SELECTION Randomized clinical trials of land-based exercise interventions before or after total hip arthroplasty were included. DATA EXTRACTION AND SYNTHESIS This systematic review and meta-analysis is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Data extraction was independently performed in duplicate. Random-effects meta-analyses with restricted maximum likelihood were performed for pooling the data. MAIN OUTCOMES AND MEASURES The primary prespecified outcome was self-reported physical function. Secondary prespecified outcomes were self-reported pain intensity, quality of life, gait speed, lower body muscle strength, lower body flexibility, anxiety, hospital length of stay, and adverse events. RESULTS A total of 32 randomized clinical trials with 1753 patients were included in the qualitative synthesis, and 26 studies with 1004 patients were included in the meta-analysis. Compared with usual care or no or minimal intervention, postoperative exercise training was not associated with improved self-reported physical function, with a moderate level of certainty, at 4 weeks (standardized mean difference [SMD], 0.01; 95% CI, -0.18 to 0.20), 12 weeks (SMD, -0.08; 95% CI, -0.23 to 0.07) and 26 weeks (SMD, -0.04; 95% CI, -0.31 to 0.24) postoperatively, and low level of certainty at 1 year after surgical treatment (SMD, 0.01; 95% CI, -0.09 to 0.12). For preoperative exercise interventions, there was no association of exercised training with self-reported physical function compared with the control at the 12-week (SMD, -0.14; 95% CI, -0.61 to 0.32) or 1-year follow-ups (SMD, 0.01; 95% CI, -0.37 to 0.40) with very low certainty, and no association with length of stay (mean difference, -0.21; 95% CI, -0.74 to 0.31) at moderate certainty. Results for postoperative hip muscle strength were rated at very low certainty, with no statistical significance. Meta-analysis could not be performed for other outcomes. CONCLUSIONS AND RELEVANCE This systematic review and meta-analysis found low- to moderate-quality evidence that postoperative exercise interventions were not associated with improved self-reported physical function compared with usual care or no or minimal intervention. Furthermore, there was very low-quality evidence that preoperative exercise programs were not associated with higher self-reported physical function and hospital length of stay compared with usual care or no or minimal intervention.
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Affiliation(s)
| | - Patrick J. Owen
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | | | | | - Daniel L. Belavy
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
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15
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Aprile I, Iacovelli C, Cruciani A, Simbolotti C, Loreti S, Galli G, Vulpiani MC, Padua L. Technological rehabilitation versus conventional rehabilitation following hip replacement: A prospective controlled study. J Back Musculoskelet Rehabil 2020; 33:561-568. [PMID: 31743982 DOI: 10.3233/bmr-181211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Among new technological rehabilitation systems, there are proprioceptive platforms. These could be useful to improve static and dynamic balance. OBJECTIVE To evaluate technological proprioceptive rehabilitation compared to conventional rehabilitation in patients after total hip arthroplasty (THA). METHODS Sixty-four patients after THA were divided in two groups: a conventional group (CG) and a technological group (TG) treated with proprioceptive platforms. Before (T0) and after 20 sessions (T1), we recorded static and dynamic balance. Clinical and disability scales (Modified Harris Hip Score, Barthel Index, Deambulation Index), pain scales (ID-PAIN, DN4, VAS) and QoL scale (SF-36) were administered to patients during T0 and T1. Mann-Whitney U test was used for stabilometric and dynamic assessments to detect differences between groups of patients and healthy subjects. The Wilcoxon signed-rank test was used for the within-group analysis and the ANCOVA test for the analysis between groups of patients. RESULTS All scales improved significantly in both groups after treatment (p< 0.05). Static balance improved in both groups, but there were greater improvements in the TG than in the CG. All dynamic balance indexes showed significant improvements only in the TG after treatment. CONCLUSIONS Both treatments improved the clinical, disability, pain, and QoL scales, as well as static balance, but only proprioceptive technological rehabilitation improved dynamic balance. Rehabilitation through proprioceptive platforms can indeed improve static and dynamic balance, which are both crucial for the patient's safety and autonomy.
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Affiliation(s)
- Irene Aprile
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | | | | | | | - Simona Loreti
- Physical Medicine and Rehabilitation Unit, Sant'Andrea Hospital, University of Rome - "La Sapienza", Rome, Italy
| | - Giulia Galli
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Maria Chiara Vulpiani
- Physical Medicine and Rehabilitation Unit, Sant'Andrea Hospital, University of Rome - "La Sapienza", Rome, Italy
| | - Luca Padua
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart, Rome, Italy
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16
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Chen L, Chen G. The Effect of Resistance Training on the Function after Hip Replacement: A Meta-analysis of Randomized Controlled Trials. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2020; 159:383-390. [PMID: 33296947 DOI: 10.1055/a-1154-8949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The efficacy of resistance training for hip replacement remains controversial. We conducted a systematic review and meta-analysis to explore the influence of resistance training on functional recovery for hip replacement. METHODS We searched PubMed, EMbase, Web of Science, EBSCO, and Cochrane Library databases through April 2018 for randomized controlled trials (RCTs) assessing the effect of resistance training on hip replacement. RESULTS Five RCTs involving 251 patients are included in the meta-analysis. Overall, compared with the control group for post-hip replacement patients, resistance training can significantly improve hip-related quality of life (standard mean difference [SMD] = 0.35; 95% CI = 0.02 to 0.68; p = 0.04), symptoms (SMD = 0.41; 95% CI = 0.08 to 0.74; p = 0.02), sports and recreation (SMD = 0.41; 95% CI = 0.08 to 0.75; p = 0.01), and reduce pain scores (SMD = 0.41; 95% CI = 0.08 to 0.74; p = 0.02), but has no remarkable impact on activities of daily living function (SMD = 0.48; 95% CI = 0 to 0.96; p = 0.05), sit to stand (SMD = 0.17; 95% CI = - 0.25 to 0.59; p = 0.44), stair climb performance (SMD = 0.06; 95% CI = - 0.36 to 0.48; p = 0.77), and leg extension power (SMD = 0.42; 95% CI = - 0.17 to 1.01; p = 0.17). CONCLUSIONS Resistance training is associated with significantly improved hip-related quality of life, symptoms, and sports and recreation, and decreased pain scores in post-hip replacement patients.
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Affiliation(s)
- Langxin Chen
- Surgery Department of Joint and Extremities Osteopathy, Maoming People Hospital, Guangdong, China
| | - Guanlin Chen
- Surgery Department of Joint and Extremities Osteopathy, Maoming People Hospital, Guangdong, China
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17
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Gränicher P, Stöggl T, Fucentese SF, Adelsberger R, Swanenburg J. Preoperative exercise in patients undergoing total knee arthroplasty: a pilot randomized controlled trial. Arch Physiother 2020; 10:13. [PMID: 32774889 PMCID: PMC7405420 DOI: 10.1186/s40945-020-00085-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 07/15/2020] [Indexed: 01/20/2023] Open
Abstract
Background The purpose of this study was to assess the effect of preoperative physiotherapy (PT) on functional, subjective and socio-economic parameters after total knee arthroplasty (TKA). Methods 20 patients (mean ± SD: age 67 ± 7 years) scheduled for TKA at Balgrist University Hospital between July 2016 and March 2017 were randomly assigned to a control (CG) or intervention (IG) group. 3 to 4 weeks prior to surgery the IG completed 5 to 9 sessions of PT containing proprioceptive neuromuscular facilitation (PNF) techniques, endurance training and individually indicated interventions. Measurements were executed at baseline, preoperative and 3 months after TKA. The primary outcome measure was the Stair Climbing Test (SCT), secondary outcome measures were the knee range of motion (ROM) and the level of physical activity using Lysholm Score (LS) and Tegner Activity Scale (TAS). The subjective and socio-economic parameters were the Patients’ Global Impression of Change (PGIC) scale, inpatient rehabilitation time, preoperative pain levels and metabolic equivalent (MET), postoperative intake of analgesics and overall costs. Results No difference between IG and CG was found for SCT (F (2/36) = 0.016, p = 0.984, η2 = 0.004). An interaction between group and time was shown for TAS (F (18/1) = 13.890) with an increase in the IG (p = 0.002, η2 = 0.536). The sub-item “pain” within the LS presented a higher pain-level in CG (F (18/1) = 4.490, p = 0.048, η2 = 0.974), while IG showed a higher preoperative MET compared to CG (p = 0.035). There were no other significant changes. The CG produced 21.4% higher overall costs, took more analgesics and showed higher preoperative pain levels than the IG. Conclusions Findings show that preoperative therapy improved the level of physical activity before and after TKA and resulted in a clinically relevant gain in TAS. Trial registration ClinicalTrials.gov Identifier; NCT03160534. Registered 19 May 2017
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Affiliation(s)
- Pascale Gränicher
- The University Center for Prevention and Sports Medicine (UCePS), Balgrist University Hospital, Forchstrasse 319, 8008 Zurich, Switzerland.,Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Maastricht University, Peter Debyeplein 1, 6229 HA Maastricht, The Netherlands
| | - Thomas Stöggl
- Department of Sport and Exercise Science, University of Salzburg, Schlossallee 49, 5400 Hallein/Rif, Austria
| | - Sandro F Fucentese
- Department of Orthopaedic Surgery, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zurich, Switzerland
| | - Rolf Adelsberger
- Wearable Computing Lab Zurich, ETH Zurich, Gloriastrasse 35, 8092 Zurich, Switzerland
| | - Jaap Swanenburg
- Integrative Spinal Research ISR, Department of Chiropractic Medicine, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland
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18
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van Doormaal MCM, Meerhoff GA, Vliet Vlieland TPM, Peter WF. A clinical practice guideline for physical therapy in patients with hip or knee osteoarthritis. Musculoskeletal Care 2020; 18:575-595. [PMID: 32643252 DOI: 10.1002/msc.1492] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 05/15/2020] [Accepted: 05/16/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The purpose of this paper is to revise the 2010 Dutch guideline for physical therapy (PT) in patients with hip or knee osteoarthritis (OA), issued by the Royal Dutch Society for Physical Therapy (KNGF). METHOD This revised guideline was developed according to the Appraisal of Guidelines for Research and Evaluation (AGREE) and Guidelines International Network (G-I-N) standards. A multidisciplinary guideline panel formulated clinical questions based on perceived barriers to current care. A narrative or systematic literature review was undertaken in response to each clinical question. The panel formulated recommendations based on evidence and additional considerations, as described in the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Evidence-to-Decision framework. RESULTS A comprehensive assessment should be based on the International Classification of Functioning Disability and Health (ICF) core set for OA, including the identification of OA-related red flags. Based on the assessment, four treatment profiles were distinguished: (1) education and instructions for unsupervised exercises, (2) education and short-term supervised exercise therapy, (3) education and longer term supervised exercise therapy, and (4) education and exercise therapy before and/or after total hip or knee surgery. Education included individualized information, advice, instructions, and self-management support. Exercise programs were tailored to individual OA-related issues, were adequately dosed, and were in line with public health recommendations for physical activity. Recommended measurement instruments included the Patient-Specific Complaints Instrument, the Numeric Pain Rating Scale, the Hip Disability and Osteoarthritis Outcome Score/the Knee Injury Osteoarthritis Outcome Score, and the Six Minute Walk Test. CONCLUSION An evidence-based PT guideline for the management of patients with hip or knee OA was developed. To improve quality of care for these patients, an extensive implementation strategy is necessary.
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Affiliation(s)
| | - Guus A Meerhoff
- Royal Dutch Society for Physical Therapy (KNGF), Amersfoort, The Netherlands.,Radboud Institute for Health Sciences, IQ healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Thea P M Vliet Vlieland
- Department of Orthopaedics, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Wilfred F Peter
- Department of Orthopaedics, Leiden University Medical Center (LUMC), Leiden, The Netherlands.,Amsterdam Rehabilitation Research Center, Amsterdam, The Netherlands
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Haas R, Bowles KA, O'Brien L, Haines T. The effect of transferring weekend physical therapy services from the acute to sub-acute setting in patients following hip and knee arthroplasty: a quasi-experimental study. Physiother Theory Pract 2020; 38:648-660. [PMID: 32568601 DOI: 10.1080/09593985.2020.1777604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Weekend physical therapy services in the acute and/or sub-acute setting may optimize postoperative recovery following hip and knee arthroplasty, though evidence supporting these services is limited. PURPOSE To explore the change in patient and service outcomes of transferring a weekend physical therapy service from the acute to the sub-acute setting following hip and knee arthroplasty. METHODS This was a quasi-experimental research design nested within two stepped-wedge cluster randomized controlled trials. Acute weekend physical therapy services were sequentially discontinued and reallocated to the sub-acute setting in a random order from one ward at a time within the broader trial. Patient and service outcomes for participants 6 weeks following hip and knee arthroplasty (N = 247) were compared during 6 months of acute weekend physical therapy services (Phase 1, n = 117) followed by 6 months of sub-acute services (Phase 2, n = 130). Intention-to-treat statistical analyses were conducted. RESULTS The intervention had a negligible effect on medium-term outcomes. The only statistically significant difference observed was slightly higher ratings of "worst pain experienced over the past week" [coefficient 0.865 (0.123 to 1.606), p = .022] during Phase 2. No interaction effects were observed despite a 2.4-day reduction in length of stay amongst complex patients during Phase 2 (18.28 and 15.86 days in Phase 1 and 2, respectively). CONCLUSIONS No comparative advantage or disadvantage was observed by reallocating a weekend physical therapy budget from the acute to sub-acute setting following hip and knee arthroplasty. Further research investigating the cost-effectiveness of these services in the sub-acute setting may be warranted for complex patients.
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Affiliation(s)
- Romi Haas
- Monash Department of Clinical Epidemiology, Cabrini Institute, Malvern, Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Department of Physiotherapy, Monash University and Monash Health Allied Health Research Unit, Frankston, Australia
| | - Kelly-Ann Bowles
- Department of Community Emergency Health and Paramedics, Monash University and Monash Health Allied Health Research Unit, Frankston, Australia
| | - Lisa O'Brien
- Department of Occupational Therapy, Monash University and Monash Health Allied Health Research Unit, Frankston, Australia
| | - Terry Haines
- School of Primary and Allied Health Care, Monash University and Monash Health Allied, Health Research Unit, Frankston, Australia
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The Influence of Preoperative Physical Activity on Postoperative Outcomes of Knee and Hip Arthroplasty Surgery in the Elderly: A Systematic Review. J Clin Med 2020; 9:jcm9040969. [PMID: 32244426 PMCID: PMC7231073 DOI: 10.3390/jcm9040969] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/11/2020] [Accepted: 03/26/2020] [Indexed: 01/20/2023] Open
Abstract
Total hip arthroplasty (THA) and total knee arthroplasty (TKA) represent two of the most common procedures in orthopedic surgery. The growing need to avoid physical impairment in elderly patients undergoing this kind of surgery puts the focus on the possibility to undertake a preoperative physical activity program to improve their fit and physical health at the time of surgery. A systematic review has been carried out with online databases including PubMed-Medline, Cochrane Central and Google Scholar. The aim was to retrieve available evidence concerning preoperative physical activity and exercise, before total knee or total hip arthroplasty in patients older than 65 years, and to clarify the role of this practice in improving postoperative outcomes. Results of the present systematic analysis showed that, for TKA, most of the studies demonstrated a comparable trend of postoperative improvement of Visual Analogue Scale (VAS), range of movement (ROM) and functional scores, and those of quality of life. There is insufficient evidence in the literature to draw final conclusions on the topic. Prehabilitation for patients undergoing TKA leads to shorter length of stay but not to an enhanced postoperative recovery. Concerning THA, although currently available data showed better outcomes in patients who underwent prehabilitation programs, there is a lack of robust evidence with appropriate methodology.
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Relative Efficacy of Different Exercises for Pain, Function, Performance and Quality of Life in Knee and Hip Osteoarthritis: Systematic Review and Network Meta-Analysis. Sports Med 2020; 49:743-761. [PMID: 30830561 PMCID: PMC6459784 DOI: 10.1007/s40279-019-01082-0] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Guidelines recommend exercise as a core treatment for osteoarthritis (OA). However, it is unclear which type of exercise is most effective, leading to inconsistency between different recommendations. Objectives The aim of this systematic review and network meta-analysis was to investigate the relative efficacy of different exercises (aerobic, mind–body, strengthening, flexibility/skill, or mixed) for improving pain, function, performance and quality of life (QoL) for knee and hip OA at, or nearest to, 8 weeks. Methods We searched nine electronic databases up until December 2017 for randomised controlled trials that compared exercise with usual care or with another exercise type. Bayesian network meta-analysis was used to estimate the relative effect size (ES) and corresponding 95% credibility interval (CrI) (PROSPERO registration: CRD42016033865). Findings We identified and analysed 103 trials (9134 participants). Aerobic exercise was most beneficial for pain (ES 1.11; 95% CrI 0.69, 1.54) and performance (1.05; 0.63, 1.48). Mind–body exercise, which had pain benefit equivalent to that of aerobic exercise (1.11; 0.63, 1.59), was the best for function (0.81; 0.27, 1.36). Strengthening and flexibility/skill exercises improved multiple outcomes at a moderate level. Mixed exercise was the least effective for all outcomes and had significantly less pain relief than aerobic and mind–body exercises. The trend was significant for pain (p = 0.01), but not for function (p = 0.07), performance (p = 0.06) or QoL (p = 0.65). Conclusion The effect of exercise varies according to the type of exercise and target outcome. Aerobic or mind–body exercise may be the best for pain and function improvements. Strengthening and flexibility/skill exercises may be used for multiple outcomes. Mixed exercise is the least effective and the reason for this merits further investigation. Electronic supplementary material The online version of this article (10.1007/s40279-019-01082-0) contains supplementary material, which is available to authorized users.
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No association between preoperative physical activity level and time to return to work in patients after total hip or knee arthroplasty: A prospective cohort study. PLoS One 2019; 14:e0221932. [PMID: 31479493 PMCID: PMC6719850 DOI: 10.1371/journal.pone.0221932] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 08/19/2019] [Indexed: 11/19/2022] Open
Abstract
Purpose It is important for patients of working age to resume work after total hip or knee arthroplasty (THA/TKA). A higher preoperative level of physical activity is presumed to lead to a better or faster recovery. Aim is to examine the association between preoperative physical activity (PA) level (total and leisure-time) and time to return-to-work (RTW). Methods A prospective multicenter survey study. Time to RTW was defined as the length of time (days) from surgery to RTW. PA level was assessed with the SQUASH questionnaire. Questionnaires were filled in before surgery and 6 weeks and 3, 6 and 12 months post-surgery. Multiple regression analyses were conducted separately for THA and TKA patients. Results 243 patients were enrolled. Median age was 56 years; 58% had undergone a THA. Median time to RTW was 85 (THA) and 93 (TKA) days. In the multiple regression analysis, neither preoperative total PA level nor leisure-time PA level were significantly associated with time to RTW. Conclusions Preoperative physical activity level is not associated with a shorter time to RTW in either THA or TKA patients. Neither preoperative total PA level nor leisure-time PA level showed an association with time to RTW, even after adjusting for covariates. Trial registry Dutch Trial Register: NTR3497.
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Torisho C, Mohaddes M, Gustafsson K, Rolfson O. Minor influence of patient education and physiotherapy interventions before total hip replacement on patient-reported outcomes: an observational study of 30,756 patients in the Swedish Hip Arthroplasty Register. Acta Orthop 2019; 90:306-311. [PMID: 30994040 PMCID: PMC6718188 DOI: 10.1080/17453674.2019.1605669] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - It is unclear whether physiotherapy interventions or patient education before total hip replacement (THR) is beneficial for patients postoperatively. Utilizing the Swedish Hip Arthroplasty Register (SHAR), we retrospectively studied the influence of preoperative self-reported exposure to physiotherapy and/or patient education on patient-reported outcomes 1 year after THR. Patients and methods - Data covering all THRs performed in Sweden for osteoarthritis, between the years 2012 and 2015, was obtained from SHAR. There were 30,756 patients with complete data. Multiple linear regression modelling was performed with 1-year postoperative PROMs (hip pain on a visual analogue scale [VAS], with the quality of life measures EQ-5D index and EQ VAS, and surgery satisfaction VAS) as dependent variables. Self-reported physiotherapy and patient education (yes or no) were used as independent variables. Results - Physiotherapy was associated with slightly less pain VAS (-0.7, 95% CI -1.1 to -0.3), better EQ-5D index (0.01, CI 0.00-0.01), EQ VAS (0.8, CI 0.4-1.2), and better satisfaction VAS (-0.7, CI -1.2 to -0.2). Patient education was associated with slightly better EQ-5D index (0.01, CI 0.00-0.01) and EQ VAS (0.7, CI 0.2-1.1). Interpretation - Even though we found statistically significant differences in favor of physiotherapy and patient education, the magnitude of those were too small and inconsistent to conclude a truly positive influence. Further research is needed with more specific and demarcated physiotherapy interventions.
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Affiliation(s)
- Christopher Torisho
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg;; ,Correspondence:
| | - Maziar Mohaddes
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg;; ,Swedish Hip Arthroplasty Register, Gothenburg;;
| | - Kristin Gustafsson
- Division of Physiotherapy, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Ola Rolfson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg;; ,Swedish Hip Arthroplasty Register, Gothenburg;;
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Moyer R, Ikert K, Long K, Marsh J. The Value of Preoperative Exercise and Education for Patients Undergoing Total Hip and Knee Arthroplasty: A Systematic Review and Meta-Analysis. JBJS Rev 2019; 5:e2. [PMID: 29232265 DOI: 10.2106/jbjs.rvw.17.00015] [Citation(s) in RCA: 121] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Existing evidence regarding the value of preoperative education and/or exercise (prehabilitation) for patients undergoing total joint replacement is conflicting. The purpose of this study was to conduct an updated, comprehensive systematic review with meta-analyses to determine the longitudinal effects and efficacy of prehabilitation on postoperative outcomes in patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA). METHODS We searched 11 electronic databases (MEDLINE, AMED, CINAHL, Embase, Scopus, ProQuest, PEDro, SportDiscus, PsycINFO, and Cochrane) from their inception to May 2016 for randomized controlled trials that compared changes in pain, function, strength, anxiety, and hospital length of stay following THA or TKA. Two reviewers independently determined study eligibility, rated study quality, and extracted data. There were no restrictions on study dates, patient characteristics, or the follow-up time point at which postoperative outcomes were measured. We excluded trials comparing 2 interventions. Methodological quality assessments were performed using the Cochrane risk-of-bias tool. We calculated pooled estimates, with 95% confidence intervals (CIs), of standardized mean differences (SMDs). RESULTS Thirty-five studies with 2,956 patients were included. After a preoperative program, patients undergoing THA, but not TKA, had significantly less postoperative pain than controls (SMD = 0.15, 95% CI = 0.03 to 0.27, p = 0.017). Postoperative function was also significantly improved compared with controls, with similar improvement after THA (SMD = 0.32, 95% CI = 0.15 to 0.50, p < 0.001) and TKA (SMD = 0.32, 95% CI = 0.06 to 0.57, p = 0.015). Significantly greater quadriceps strength was observed after TKA (SMD = 0.42, 95% CI = 0.16 to 0.68, p = 0.002). No significant differences in hamstring strength were observed between groups after TKA (p = 0.132). Small-to-moderate but nonsignificant improvements in anxiety (SMD = 0.17, 95% CI = -0.05 to 0.39; p = 0.128) were observed after THA, and length of stay was significantly shorter after TKA (SMD = 0.54, 95% CI = 0.24 to 0.84, p < 0.001) and THA (p = 0.027). CONCLUSIONS Overall effect sizes for prehabilitation were small to moderate. In patients undergoing TKA, significant improvements were observed in function, quadriceps strength, and length of stay. In patients undergoing THA, significant improvements were observed in pain, function, and length of stay. Included studies were inconsistent with regard to the types of outcome measures reported, and the quality of the interventions varied. A more standardized approach to reporting of clinical trial interventions and patient compliance is needed to thoroughly evaluate the effects of prehabilitation on postoperative outcomes. LEVEL OF EVIDENCE Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Rebecca Moyer
- School of Physiotherapy, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kathy Ikert
- Strathroy Middlesex General Hospital, Strathroy, Ontario, Canada
| | - Kristin Long
- Eramosa Physiotherapy Associates, Guelph, Ontario, Canada
| | - Jacquelyn Marsh
- School of Physical Therapy and Bone and Joint Institute, Faculty of Health Sciences, The University of Western Ontario, London, Ontario, Canada
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Louw A, Puentedura EJ, Reed J, Zimney K, Grimm D, Landers MR. A controlled clinical trial of preoperative pain neuroscience education for patients about to undergo total knee arthroplasty. Clin Rehabil 2019; 33:1722-1731. [DOI: 10.1177/0269215519857782] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: The aim of this study was to determine if a preoperative pain neuroscience education program would result in superior outcomes compared to usual preoperative education for total knee arthroplasty. Design: Controlled clinical trial with alternating allocation. Setting: Community-based hospital. Subjects: Consecutive sample of 120 patients scheduled for total knee arthroplasty. Intervention: Traditional hospital preoperative total knee arthroplasty education program on its own, or with an additional 30-minute group pain neuroscience education session. Main measures: Primary outcomes were measurements at one, three, and six months for pain, function, fear of movement, and pain catastrophization. We also compared opioid usage, healthcare expenses, and patient satisfaction between groups. Results: There were no statistically significant differences in any outcome measures between the two groups over time, except for patient satisfaction. Those in the experimental group had more agreement with statements about “preparation for surgery” ( P = .038), “would do again” ( P = .032), and “met expectations” ( P = .033) compared to those in the control group averaged over the three measurement times. Patients improved in several outcome measures over time regardless of group assignment, with a 34% improvement in pain, 36% improvement in function, 16% improvement in fear of movement, and 23% improvement in pain catastrophization scores. Conclusion: Adding a brief 30-minute pain neuroscience education session to a traditional preoperative total knee arthroplasty education program did not result in any significant improvements, except patient satisfaction.
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Affiliation(s)
- Adriaan Louw
- International Spine Pain Institute, Story City, IA, USA
| | - Emilio J Puentedura
- International Spine Pain Institute, Story City, IA, USA
- Department of Physical Therapy, Baylor University, Waco, TX, USA
| | - Jordan Reed
- Department of Physical Therapy, Spencer Hospital, Spencer, IA, USA
| | - Kory Zimney
- International Spine Pain Institute, Story City, IA, USA
- Department of Physical Therapy, University of South Dakota, Vermillion, SD, USA
| | - Derek Grimm
- Department of Pharmacy Services, Spencer Hospital, Spencer, IA, USA
| | - Merrill R Landers
- Department of Physical Therapy, University of Nevada, Las Vegas, Las Vegas, NV, USA
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Eastwood D, Manson N, Bigney E, Darling M, Richardson E, Paixao R, Underwood T, Ellis K, Abraham E. Improving postoperative patient reported benefits and satisfaction following spinal fusion with a single preoperative education session. Spine J 2019; 19:840-845. [PMID: 30471460 DOI: 10.1016/j.spinee.2018.11.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 11/16/2018] [Accepted: 11/19/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Patient expectations have been demonstrated to influence recovery following spine surgery. Addressing patient expectations specifically in regards to pain and postsurgical healing is an important factor in improving recovery patterns. Presurgical education can potentially help manage patient expectations. PURPOSE The primary objective was to determine if participation in a single preoperative multidisciplinary educational session would result in reduced patient dissatisfaction with surgical expectations. A secondary objective was to determine if participation resulted in improvements in postsurgical pain, disability, and reductions in emergency room visits following surgery. STUDY DESIGN A retrospective cohort study utilizing data from the Canadian Spine Outcomes and Research Network (CSORN) registry and hospital electronic medical records. PATIENT SAMPLE Participants were patients receiving elective spinal fusion for 2-5 levels (N=206). Cohort 1 included patients who participated in preoperative multidisciplinary education (n=103). Cohort 2 included patients who opted out of the educational session (n=103). OUTCOME MEASURES Outcomes measured included the Oswestry Disability Index (ODI), NRS scales for back and leg pain (NRS-B/NRS-L), CSORN questions pertaining to patient satisfaction with surgery and whether or not the surgery met expectations. Electronic chart review quantified emergency room visits following surgery. METHODS Spinal fusion patients are encouraged to attend a one time, two-hour education session 3-6 weeks prior to their surgery. The education session includes interactive discussions with nursing, physiotherapy, and occupational therapy staff concentrating on what patients should expect, how to best prepare for surgery and proper care postsurgery. A one-way ANOVA was conducted for continuous variables of interest (age, number of levels operated on, ASA score, and number of visits to the emergency room following surgery). Chi-squared analysis was conducted for categorical variables of interest (pathology, gender, patient satisfaction, and patient expectations). A two (Cohort; education: no education) × 2 (Time; baseline: follow-up) repeated measure ANOVA was conducted for NRS-B, NRS-L, and ODI. Significance was set at p<.05. RESULTS Patients (n=103) who took part in the presurgical education sessions were significantly more satisfied with their surgery compared to the control cohort (p=.014). Patients (n=103) who did not participate in the education session failed to have their expectations met in terms of improvement in daily activities (p=.03), improvement in walking capacity (p=.03) and their expectation of back pain reduction (p=.001). There was a statistically significant effect of participation in the educational session reducing postoperative back pain (p=0.03), although this improvement did not reach a minimally clinically important difference. Number of visits to the emergency room in the 12 weeks following spine surgery was significantly lower (p=.04) for patients in the education cohort. CONCLUSIONS Reduced emergency room utilization, improved patient satisfaction, achievement of expected improvements and alleviation of back pain were documented with greater success following participation in a single 2-hour educational session prior to surgery. A single education session is a viable tool for improving patient outcomes due to its low administrative burden.
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Affiliation(s)
- Donna Eastwood
- Saint John Regional Hospital, Horizon Health Network, 400 University Ave, PO Box 2100, Saint John, New Brunswick, Canada, E2L 4L4
| | - Neil Manson
- Canada East Spine Centre, Saint John Regional Hospital, 400 University Ave, PO Box 2100, Saint John, New Brunswick, Canada, E2L 4L4; Saint John Regional Hospital, Horizon Health Network, 400 University Ave, PO Box 2100, Saint John, New Brunswick, Canada, E2L 4L4; Department of Surgery, Dalhousie University, 100 Tucker Park Rd, Saint John, New Brunswick, Canada, E2K 5E2.
| | - Erin Bigney
- Canada East Spine Centre, Saint John Regional Hospital, 400 University Ave, PO Box 2100, Saint John, New Brunswick, Canada, E2L 4L4
| | - Mariah Darling
- Canada East Spine Centre, Saint John Regional Hospital, 400 University Ave, PO Box 2100, Saint John, New Brunswick, Canada, E2L 4L4
| | - Eden Richardson
- Canada East Spine Centre, Saint John Regional Hospital, 400 University Ave, PO Box 2100, Saint John, New Brunswick, Canada, E2L 4L4
| | - Richard Paixao
- Saint John Regional Hospital, Horizon Health Network, 400 University Ave, PO Box 2100, Saint John, New Brunswick, Canada, E2L 4L4
| | - Tracy Underwood
- Saint John Regional Hospital, Horizon Health Network, 400 University Ave, PO Box 2100, Saint John, New Brunswick, Canada, E2L 4L4
| | - Kate Ellis
- Canada East Spine Centre, Saint John Regional Hospital, 400 University Ave, PO Box 2100, Saint John, New Brunswick, Canada, E2L 4L4
| | - Edward Abraham
- Canada East Spine Centre, Saint John Regional Hospital, 400 University Ave, PO Box 2100, Saint John, New Brunswick, Canada, E2L 4L4; Saint John Regional Hospital, Horizon Health Network, 400 University Ave, PO Box 2100, Saint John, New Brunswick, Canada, E2L 4L4; Department of Surgery, Dalhousie University, 100 Tucker Park Rd, Saint John, New Brunswick, Canada, E2K 5E2
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McIsaac DI, Saunders C, Hladkowicz E, Bryson GL, Forster AJ, Gagne S, Huang A, Lalu M, Lavallee LT, Moloo H, Nantel J, Power B, Scheede-Bergdahl C, Taljaard M, van Walraven C, McCartney CJL. PREHAB study: a protocol for a prospective randomised clinical trial of exercise therapy for people living with frailty having cancer surgery. BMJ Open 2018; 8:e022057. [PMID: 29934394 PMCID: PMC6020976 DOI: 10.1136/bmjopen-2018-022057] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Exercise prehabilitation may improve outcomes after surgery. Frailty is a key predictor of adverse postoperative outcomes in older people; the multidimensional nature of frailty makes this a population who may derive substantial benefit from exercise prehabilitation. The objective of this trial is to test the efficacy of exercise prehabilitation to improve postoperative functional outcomes for people living with frailty having cancer surgery with curative intent. METHODS AND ANALYSIS We will conduct a single-centre, parallel-arm randomised controlled trial of home-based exercise prehabilitation versus standard care among consenting patients >60 years having elective cancer surgery (intra-abdominal and intrathoracic) and who are frail (Clinical Frailty Scale >4). The intervention consists of > 3 weeks of exercise prehabilitation (strength, aerobic and stretching). The primary outcome is the 6 min walk test at the first postoperative clinic visit. Secondary outcomes include the short physical performance battery, health-related quality of life, disability-free survival, complications and health resource utilisation. The primary outcome will be analysed by intention to treat using analysis of covariance. Outcomes up to 1 year after surgery will be ascertained through linkage to administrative data. ETHICS AND DISSEMINATION Ethical approval has been granted by our ethics review board (Protocol Approval #2016009-01H). Results will be disseminated through presentation at scientific conferences, through peer-reviewed publication, stakeholder organisations and engagement of social and traditional media. TRIAL REGISTRATION NUMBER NCT02934230; Pre-results.
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Affiliation(s)
- Daniel I McIsaac
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Chelsey Saunders
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Emily Hladkowicz
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Gregory L Bryson
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Alan J Forster
- Division of General Internal Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Sylvain Gagne
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Allen Huang
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Division of Geriatric Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Manoj Lalu
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Luke T Lavallee
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Division of Urology, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Husein Moloo
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Division of General Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Julie Nantel
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Barbara Power
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Division of Geriatric Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Celena Scheede-Bergdahl
- Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada
| | - Monica Taljaard
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology, Population Health and Preventative Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Carl van Walraven
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada
| | - Colin J L McCartney
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Louw A, Zimney K, Reed J, Landers M, Puentedura EJ. Immediate preoperative outcomes of pain neuroscience education for patients undergoing total knee arthroplasty: A case series. Physiother Theory Pract 2018; 35:543-553. [PMID: 29589782 DOI: 10.1080/09593985.2018.1455120] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Standard preoperative education for total knee arthroplasty (TKA) has been shown to have no effect on postoperative outcomes. This may be because such education programs fail to educate patients about pain. Pain neuroscience education (PNE) focuses on teaching people more about pain from a neurobiological and neurophysiological perspective. DESIGN AND SETTING Case Series. AIM To determine the immediate effects, if any, of providing PNE before TKA surgery on patient self-report measures. PARTICIPANTS Twelve patients (female = 10) prior to TKA for knee osteoarthritis (OA). INTERVENTION Preoperative educational session by a physical therapist on the neuroscience of pain, accompanied by an evidence-based booklet. MAIN OUTCOME MEASURES Comparison of pre- and post-PNE self-report measures on knee pain (NPRS), Pain Catastrophization Scale (PCS), fear of movement (TSK), and beliefs about TKA; as well as three physical performance measures - knee flexion active range of motion, 40 m self-paced walk, and pressure pain threshold (PPT). RESULTS Immediately following the PNE, patients had statistically significant lower TSK scores, increased PPT, and improved beliefs about their upcoming surgery. There were no significant changes in knee pain, function, or flexion active range of motion. CONCLUSIONS Results appear to suggest that immediately after PNE, patients scheduled for TKA had statistically significant changes in fear of movement, decreased sensitivity to pain and positive shifts in their beliefs about their future knee surgery. Larger trials with control/comparison groups are warranted to determine the true effects of preoperative PNE for patients about to undergo TKA.
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Affiliation(s)
- Adriaan Louw
- a International Spine and Pain Institute , Story City , IA , USA
| | - Kory Zimney
- b Department of Physical Therapy, School of Health Sciences , University of South Dakota , Vermillion , SD , USA
| | - Jordan Reed
- c Rehabilitation Services , Spencer Hospital , Spencer , IA , USA
| | - Merrill Landers
- d Department of Physical Therapy, School of Allied Health Sciences , University of Nevada Las Vegas , Las Vegas , NV , USA
| | - Emilio J Puentedura
- d Department of Physical Therapy, School of Allied Health Sciences , University of Nevada Las Vegas , Las Vegas , NV , USA
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The Impact of Prehabilitation on Postoperative Functional Status, Healthcare Utilization, Pain, and Quality of Life: A Systematic Review. Orthop Nurs 2018; 35:224-37. [PMID: 27441877 DOI: 10.1097/nor.0000000000000264] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND "Preoperative rehabilitation" or prehabilitation has been increasingly studied alongside the deleterious effects of surgery and functional decline. Prehabilitation is the preoperative optimization of physical functionality to enable the individual to maintain a normal level of function during and after surgery. This systematic review evaluates the effectiveness of prehabilitation on functional status, healthcare utilization, quality of life, and pain postoperatively. METHODS Trials registries and databases of published and unpublished literature were extensively searched. All studies were assessed independently for relevance, eligibility, and quality. Seventeen studies were included in the review: 13 in orthopaedics (mainly knee or hip arthroplasty for osteoarthritis), 2 in abdominal surgery, and 2 in cardiac surgery. FINDINGS There is no evidence to show that prehabilitation has significant benefits in function, quality of life, and pain; however, it may reduce admission to rehabilitation after knee or hip arthroplasty for osteoarthritis. There is insufficient evidence to make inferences in other surgical populations, notwithstanding initial evidence does not demonstrate advantages.
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Cabilan CJ, Hines S, Munday J. The effectiveness of prehabilitation or preoperative exercise for surgical patients: a systematic review. ACTA ACUST UNITED AC 2018; 13:146-87. [PMID: 26447015 DOI: 10.11124/jbisrir-2015-1885] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Major surgery can induce functional decline and pain, which can also have negative implications on health care utilization and quality of life. Prehabilitation is the process of optimizing physical functionality preoperatively to enable the individual to maintain a normal level of function during and after surgery. Prehabilitation training can be a combination of aerobic exercises, strength training, and functional task training to suit individual needs. OBJECTIVES To evaluate the impact of prehabilitation on physical functional status, health care utilization, quality of life, and pain after surgery. INCLUSION CRITERIA Studies of adult surgical patients, excluding day surgery patients.Any preoperative exercise interventions identified in the study as part of a prehabilitation or preoperative exercise program, versus usual care.Randomized controlled trials.Functional status, health care utilization, quality of life and pain. SEARCH STRATEGY Published (CINAHL, CENTRAL, EMBASE, MEDLINE, PEDro) and unpublished studies between 1996 and March 2013 were searched extensively. METHODOLOGICAL QUALITY All studies were assessed independently by two reviewers for relevance, eligibility and methodological quality. DATA COLLECTION Data from included papers were extracted using a modified data extraction tool. DATA SYNTHESIS Where possible, study results were pooled in statistical meta-analysis. Alternatively, results are presented in narrative and table form. RESULTS A total of 3167 citations were identified; after removal of duplicates, assessment for relevance and eligibility, 33 studies underwent critical appraisal. Seventeen studies met the quality criteria and were included in quantitative synthesis. Thirteen studies were conducted in orthopedics (mainly knee or hip arthroplasty for osteoarthritis), one in colorectal, two in cardiac and one in upper gastrointestinal/hepatobiliary. Function, pain and quality of life were quantified according to prehabilitation dose and postoperative months. Prehabilitation, at any dose, did not demonstrate benefits in objective and self-reported function at any of the postoperative time points. Prehabilitation did not demonstrate benefits in quality of life or pain; however, there was significant evidence that prehabilitation doses of more than 500 minutes reduced the need for postoperative rehabilitation, but no significant reduction was found in readmissions or nursing home placement. CONCLUSIONS Results from this review reveal that prehabilitation has no significant postoperative benefits in function, quality of life and pain in patients who have had knee or hip arthroplasty for osteoarthritis; however, there is evidence that prehabilitation may reduce admission to rehabilitation in this population. The evidence on postoperative benefits of prehabilitation in other surgical populations is limited; however, preliminary evidence does not demonstrate better outcomes. IMPLICATIONS FOR PRACTICE There is no evidence that prehabilitation provides benefits in function, pain or quality of life in patients who have had arthroplasty for osteoarthritis; however prehabilitation doses of more than 500 minutes might reduce acute rehabilitation admissions. The evidence is insufficient to provide recommendations on the benefits of prehabilitation in other surgical populations. IMPLICATIONS FOR RESEARCH Future prehabilitation studies are not recommended in patients with osteoarthritis for whom arthroplasty is planned. However, should prehabilitation be tested in other surgical populations, programs must consider patient suitability, setting, delivery of intervention and clinical effectiveness. It is also recommended that the exercises prescribed should be maintained and adhered to after surgery. Most importantly, prehabilitation studies must have adequately powered sample sizes.
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Affiliation(s)
- C J Cabilan
- 1 Nursing Research Centre, Mater Health Services; Nursing Research Centre, Mater Health Services; the Queensland Centre for Evidence Based Nursing and Midwifery: a Collaborating Centre of the Joanna Briggs Institute
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Cheng TE, Wallis JA, Taylor NF, Holden CT, Marks P, Smith CL, Armstrong MS, Singh PJ. A Prospective Randomized Clinical Trial in Total Hip Arthroplasty-Comparing Early Results Between the Direct Anterior Approach and the Posterior Approach. J Arthroplasty 2017; 32:883-890. [PMID: 27687805 DOI: 10.1016/j.arth.2016.08.027] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 07/25/2016] [Accepted: 08/22/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND We report a prospective randomized study comparing early clinical results between the direct anterior approach (DAA) and posterior approach (PA) in primary hip arthroplasty. METHODS Surgeries were performed by 2 senior hip arthroplasty surgeons. Seventy-two patients with complete data were assessed preoperatively 2, 6, and 12 weeks postoperatively. The primary outcomes were the Western Ontario McMasters Arthritis Index and Oxford Hip Scores. Secondary outcome measures included the EuroQoL, 10-meter walk test, and clinical and radiographic parameters. RESULTS Data analyses showed no difference between DAA (n = 35) and PA (n = 37) groups when comparing total scores for primary outcomes. No significant differences were observed for 10-meter walk test, EuroQoL, and radiographic analyses. Subgroup analysis for surgeon 1 identified that the DAA group had shorter acute hospital stay, less postoperative opiate requirements, and smaller wounds. However, this was offset by increased operative time, higher intraoperative blood loss, and weaker hip flexion at 2 and 6 weeks. Subgroup analysis of items on the Western Ontario McMasters Arthritis Index and Oxford Hip Score identified that hip flexion activity favored the DAA group up to 6 weeks postoperatively. There was an 83% incidence of lateral cutaneous nerve of thigh neuropraxia at the 12-week mark in the DAA group. No neuropraxias occurred in the PA group. One dislocation occurred in each group. A single patient from the DAA group required reoperation for leg-length discrepancy. CONCLUSION DAA total hip arthroplasty (THA) has comparable results with PA THA. Choice of surgical approach for THA should be based on patient factors, surgeon preference, and experience.
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Affiliation(s)
- Tze E Cheng
- Eastern Health Clinical School, Monash University, Victoria, Australia
| | - Jason A Wallis
- Department of Physiotherapy, Eastern Health, Victoria, Australia
| | - Nicholas F Taylor
- Department of Physiotherapy, Eastern Health, Victoria, Australia; Department of Rehabilitation, Nutrition and Sports, La Trobe University, Victoria, Australia
| | | | - Paul Marks
- Imaging Associates Box Hill, Victoria, Australia
| | - Catherine L Smith
- Department of Epidemiology, School of Public Health and Preventive Medicine Monash University, The Alfred Centre, Victoria, Australia
| | - Michael S Armstrong
- Department of Orthopaedics, Eastern Health, Monash University, Victoria, Australia
| | - Parminder J Singh
- Department of Orthopaedics, Eastern Health, Monash University, Victoria, Australia
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Effects of a tele-prehabilitation program or an in-person prehabilitation program in surgical candidates awaiting total hip or knee arthroplasty: Protocol of a pilot single blind randomized controlled trial. Contemp Clin Trials Commun 2016; 4:192-198. [PMID: 29736482 PMCID: PMC5935896 DOI: 10.1016/j.conctc.2016.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 09/23/2016] [Accepted: 10/03/2016] [Indexed: 01/22/2023] Open
Abstract
Background The accessibility for total joint arthroplasty often comes up against long wait lists, and may lead to deleterious effects for the awaiting patients. This pilot single blind randomized controlled trial aims to evaluate the impact of a telerehabilitation prehabilitation program before a hip or knee arthroplasty compared to in-person prehabilitation or to usual wait for surgery. Methods/design Thirty-six patients on a wait list for a total hip or knee arthroplasty will be recruited and randomly assigned to one of three groups. The in-person prehabilitation group (n = 12) will receive a 12-week rehabilitation program (2 sessions/week) including education, exercises of the lower limb and cardiovascular training. Patients in the tele-prehabilitation group (n = 12) will receive the same intervention using a telecommunication software. The control group (n = 12) will be provided with the hospital's usual documentation before surgery. The Lower Extremity Functional Scale (LEFS) will be the primary outcome measure taken at baseline and at 12 weeks. Secondary measures will include self-reported function and quality of life as well as performance tests. A mixed-model, 2-way repeated-measure ANOVA will be used to analyse the effects of the rehabilitation programs. Discussion This pilot study is the first to evaluate the feasibility and the impact of a telerehabilitation prehabilitation program for patients awaiting a total joint arthroplasty. The results of this pilot-RCT will set the foundations for further research in the fields of rehabilitation and tele-medicine for patients suffering from lower limb osteoarthritis. Trial registration ClinicalTrials.gov: NCT02636751.
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Key Words
- ANOVA, Analysis of variance
- Arthroplasty
- FRSQ, Fonds de recherche du Québec – Santé
- GRS, Global Rating Scale
- Hip
- ICC, Intraclass correlation coefficient
- Knee
- LEFS, Lower Extremity Functional Scale
- Prehabilitation
- RCT, Randomized clinical trial
- SF-36, The Short Form (36) Health Survey
- SPW, Self-paced Walk
- ST, Stair Test
- THA, Total hip arthroplasty
- TJA, Total joint arthroplasty
- TKA, Total knee arthroplasty
- TUG, Timed Up and Go
- Telemedicine
- WOMAC, Western Ontario & McMaster Universities Osteoarthritis Index
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Preoperative exercise therapy in surgical care: a scoping review. J Clin Anesth 2016; 33:476-90. [DOI: 10.1016/j.jclinane.2016.06.032] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 05/18/2016] [Accepted: 06/07/2016] [Indexed: 12/15/2022]
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Blom AW, Artz N, Beswick AD, Burston A, Dieppe P, Elvers KT, Gooberman-Hill R, Horwood J, Jepson P, Johnson E, Lenguerrand E, Marques E, Noble S, Pyke M, Sackley C, Sands G, Sayers A, Wells V, Wylde V. Improving patients’ experience and outcome of total joint replacement: the RESTORE programme. PROGRAMME GRANTS FOR APPLIED RESEARCH 2016. [DOI: 10.3310/pgfar04120] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BackgroundTotal hip replacements (THRs) and total knee replacements (TKRs) are common elective procedures. In the REsearch STudies into the ORthopaedic Experience (RESTORE) programme, we explored the care and experiences of patients with osteoarthritis after being listed for THR and TKR up to the time when an optimal outcome should be expected.ObjectiveTo undertake a programme of research studies to work towards improving patient outcomes after THR and TKR.MethodsWe used methodologies appropriate to research questions: systematic reviews, qualitative studies, randomised controlled trials (RCTs), feasibility studies, cohort studies and a survey. Research was supported by patient and public involvement.ResultsSystematic review of longitudinal studies showed that moderate to severe long-term pain affects about 7–23% of patients after THR and 10–34% after TKR. In our cohort study, 10% of patients with hip replacement and 30% with knee replacement showed no clinically or statistically significant functional improvement. In our review of pain assessment few research studies used measures to capture the incidence, character and impact of long-term pain. Qualitative studies highlighted the importance of support by health and social professionals for patients at different stages of the joint replacement pathway. Our review of longitudinal studies suggested that patients with poorer psychological health, physical function or pain before surgery had poorer long-term outcomes and may benefit from pre-surgical interventions. However, uptake of a pre-operative pain management intervention was low. Although evidence relating to patient outcomes was limited, comorbidities are common and may lead to an increased risk of adverse events, suggesting the possible value of optimising pre-operative management. The evidence base on clinical effectiveness of pre-surgical interventions, occupational therapy and physiotherapy-based rehabilitation relied on small RCTs but suggested short-term benefit. Our feasibility studies showed that definitive trials of occupational therapy before surgery and post-discharge group-based physiotherapy exercise are feasible and acceptable to patients. Randomised trial results and systematic review suggest that patients with THR should receive local anaesthetic infiltration for the management of long-term pain, but in patients receiving TKR it may not provide additional benefit to femoral nerve block. From a NHS and Personal Social Services perspective, local anaesthetic infiltration was a cost-effective treatment in primary THR. In qualitative interviews, patients and health-care professionals recognised the importance of participating in the RCTs. To support future interventions and their evaluation, we conducted a study comparing outcome measures and analysed the RCTs as cohort studies. Analyses highlighted the importance of different methods in treating and assessing hip and knee osteoarthritis. There was an inverse association between radiographic severity of osteoarthritis and pain and function in patients waiting for TKR but no association in THR. Different pain characteristics predicted long-term pain in THR and TKR. Outcomes after joint replacement should be assessed with a patient-reported outcome and a functional test.ConclusionsThe RESTORE programme provides important information to guide the development of interventions to improve long-term outcomes for patients with osteoarthritis receiving THR and TKR. Issues relating to their evaluation and the assessment of patient outcomes are highlighted. Potential interventions at key times in the patient pathway were identified and deserve further study, ultimately in the context of a complex intervention.Study registrationCurrent Controlled Trials ISRCTN52305381.FundingThis project was funded by the NIHR Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 4, No. 12. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Ashley W Blom
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Neil Artz
- School of Health Professions, Faculty of Health and Human Sciences, Plymouth University, Plymouth, UK
| | - Andrew D Beswick
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Amanda Burston
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Paul Dieppe
- Medical School, University of Exeter, Exeter, UK
| | - Karen T Elvers
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Rachael Gooberman-Hill
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Jeremy Horwood
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Paul Jepson
- School of Sport, Exercise and Rehabilitation Sciences, Birmingham, UK
| | - Emma Johnson
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Erik Lenguerrand
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Elsa Marques
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Sian Noble
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Mark Pyke
- North Bristol NHS Trust, Bristol, UK
| | | | - Gina Sands
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Adrian Sayers
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Victoria Wells
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Vikki Wylde
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
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Powell R, Scott NW, Manyande A, Bruce J, Vögele C, Byrne‐Davis LMT, Unsworth M, Osmer C, Johnston M. Psychological preparation and postoperative outcomes for adults undergoing surgery under general anaesthesia. Cochrane Database Syst Rev 2016; 2016:CD008646. [PMID: 27228096 PMCID: PMC8687603 DOI: 10.1002/14651858.cd008646.pub2] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND In a review and meta-analysis conducted in 1993, psychological preparation was found to be beneficial for a range of outcome variables including pain, behavioural recovery, length of stay and negative affect. Since this review, more detailed bibliographic searching has become possible, additional studies testing psychological preparation for surgery have been completed and hospital procedures have changed. The present review examines whether psychological preparation (procedural information, sensory information, cognitive intervention, relaxation, hypnosis and emotion-focused intervention) has impact on the outcomes of postoperative pain, behavioural recovery, length of stay and negative affect. OBJECTIVES To review the effects of psychological preparation on postoperative outcomes in adults undergoing elective surgery under general anaesthetic. SEARCH METHODS We searched the Cochrane Register of Controlled Trials (CENTRAL 2014, Issue 5), MEDLINE (OVID SP) (1950 to May 2014), EMBASE (OVID SP) (1982 to May 2014), PsycINFO (OVID SP) (1982 to May 2014), CINAHL (EBESCOhost) (1980 to May 2014), Dissertation Abstracts (to May 2014) and Web of Science (1946 to May 2014). We searched reference lists of relevant studies and contacted authors to identify unpublished studies. We reran the searches in July 2015 and placed the 38 studies of interest in the `awaiting classification' section of this review. SELECTION CRITERIA We included randomized controlled trials of adult participants (aged 16 or older) undergoing elective surgery under general anaesthesia. We excluded studies focusing on patient groups with clinically diagnosed psychological morbidity. We did not limit the search by language or publication status. We included studies testing a preoperative psychological intervention that included at least one of these seven techniques: procedural information; sensory information; behavioural instruction; cognitive intervention; relaxation techniques; hypnosis; emotion-focused intervention. We included studies that examined any one of our postoperative outcome measures (pain, behavioural recovery, length of stay, negative affect) within one month post-surgery. DATA COLLECTION AND ANALYSIS One author checked titles and abstracts to exclude obviously irrelevant studies. We obtained full reports of apparently relevant studies; two authors fully screened these. Two authors independently extracted data and resolved discrepancies by discussion.Where possible we used random-effects meta-analyses to combine the results from individual studies. For length of stay we pooled mean differences. For pain and negative affect we used a standardized effect size (the standardized mean difference (SMD), or Hedges' g) to combine data from different outcome measures. If data were not available in a form suitable for meta-analysis we performed a narrative review. MAIN RESULTS Searches identified 5116 unique papers; we retrieved 827 for full screening. In this review, we included 105 studies from 115 papers, in which 10,302 participants were randomized. Mainly as a result of updating the search in July 2015, 38 papers are awaiting classification. Sixty-one of the 105 studies measured the outcome pain, 14 behavioural recovery, 58 length of stay and 49 negative affect. Participants underwent a wide range of surgical procedures, and a range of psychological components were used in interventions, frequently in combination. In the 105 studies, appropriate data were provided for the meta-analysis of 38 studies measuring the outcome postoperative pain (2713 participants), 36 for length of stay (3313 participants) and 31 for negative affect (2496 participants). We narratively reviewed the remaining studies (including the 14 studies with 1441 participants addressing behavioural recovery). When pooling the results for all types of intervention there was low quality evidence that psychological preparation techniques were associated with lower postoperative pain (SMD -0.20, 95% confidence interval (CI) -0.35 to -0.06), length of stay (mean difference -0.52 days, 95% CI -0.82 to -0.22) and negative affect (SMD -0.35, 95% CI -0.54 to -0.16) compared with controls. Results tended to be similar for all categories of intervention, although there was no evidence that behavioural instruction reduced the outcome pain. However, caution must be exercised when interpreting the results because of heterogeneity in the types of surgery, interventions and outcomes. Narratively reviewed evidence for the outcome behavioural recovery provided very low quality evidence that psychological preparation, in particular behavioural instruction, may have potential to improve behavioural recovery outcomes, but no clear conclusions could be reached.Generally, the evidence suffered from poor reporting, meaning that few studies could be classified as having low risk of bias. Overall,we rated the quality of evidence for each outcome as 'low' because of the high level of heterogeneity in meta-analysed studies and the unclear risk of bias. In addition, for the outcome behavioural recovery, too few studies used robust measures and reported suitable data for meta-analysis, so we rated the quality of evidence as `very low'. AUTHORS' CONCLUSIONS The evidence suggested that psychological preparation may be beneficial for the outcomes postoperative pain, behavioural recovery, negative affect and length of stay, and is unlikely to be harmful. However, at present, the strength of evidence is insufficient to reach firm conclusions on the role of psychological preparation for surgery. Further analyses are needed to explore the heterogeneity in the data, to identify more specifically when intervention techniques are of benefit. As the current evidence quality is low or very low, there is a need for well-conducted and clearly reported research.
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Affiliation(s)
- Rachael Powell
- University of ManchesterSchool of Psychological Sciences and Manchester Centre for Health PsychologyCoupland 1 BuildingOxford RoadManchesterUKM13 9PL
| | - Neil W Scott
- University of AberdeenMedical Statistics TeamPolwarth BuildingForesterhillAberdeenScotlandUKAB 25 2 ZD
| | - Anne Manyande
- University of West LondonSchool of Human and Social SciencesBoston Manor RoadBrentfordLondonUKTW8 9GA
| | - Julie Bruce
- University of WarwickWarwick Clinical Trials UnitGibbet Hill RdCoventryUKCV4 7AL
| | - Claus Vögele
- University of LuxembourgInstitute for Health and Behaviour, Research Unit INSIDERoute de Diekirch ‐ B.P. 2Esch‐sur‐AlzetteLuxembourgL‐4366
| | - Lucie MT Byrne‐Davis
- University of ManchesterManchester Medical SchoolStopford BuildingOxford RoadManchesterUKM13 9PT
| | - Mary Unsworth
- School of Life and Health Sciences, Aston UniversityPsychologyAston TriangleBirminghamUKB4 7ET
| | | | - Marie Johnston
- University of AberdeenInstitute of Applied Health SciencesHealth Sciences Building, 2nd floorForesterhillAberdeenScotlandUKAB25 2ZD
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Wang L, Lee M, Zhang Z, Moodie J, Cheng D, Martin J. Does preoperative rehabilitation for patients planning to undergo joint replacement surgery improve outcomes? A systematic review and meta-analysis of randomised controlled trials. BMJ Open 2016; 6:e009857. [PMID: 26839013 PMCID: PMC4746481 DOI: 10.1136/bmjopen-2015-009857] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES The clinical impact of preoperative physiotherapy on recovery after joint replacement remains controversial. This systematic review aimed to assess the clinical impact of prehabilitation before joint replacement. DESIGN We searched PubMed, Embase and Cochrane CENTRAL up to November 2015 for randomised controlled trials comparing prehabilitation versus no prehabilitation before joint replacement surgery. Postoperative pain and function scores were converted to Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and function subscales (0-100, high scores indicate worse outcome). Random effects meta-analysis was performed to calculate weighted mean differences (WMD, 95% CI), subgrouped by hip and knee surgery. PRIMARY AND SECONDARY OUTCOMES Postoperative pain and function scores, time to resume activities of daily living, quality of life, length of hospital stay, total cost, patient satisfaction, postoperative complications, any adverse events and discontinuations. RESULTS Of 22 studies (1492 patients), 18 had high risk of bias. Prehabilitation slightly reduced pain scores within 4 weeks postoperatively (WMD -6.1 points, 95% CI -10.6 to -1.6 points, on a scale of 0-100), but differences did not remain beyond 4 weeks. Prehabilitation slightly improved WOMAC function score at 6-8 and 12 weeks (WMD -4.0, 95% CI -7.5 to -0.5), and time to climbing stairs (WMD -1.4 days, 95% CI -1.9 to -0.8 days), toilet use (-0.9 days, 95% CI -1.3 to -0.5 days) and chair use (WMD -1.2 days, 95% CI -1.7 to -0.8 days). Effects were similar for knee and hip surgery. Differences were not found for SF-36 scores, length of stay and total cost. Other outcomes of interest were inadequately reported. CONCLUSIONS Existing evidence suggests that prehabilitation may slightly improve early postoperative pain and function among patients undergoing joint replacement; however, effects remain too small and short-term to be considered clinically-important, and did not affect key outcomes of interest (ie, length of stay, quality of life, costs).
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Affiliation(s)
- Li Wang
- Centre for Medical Evidence, Decision Integrity and Clinical Impact (MEDICI), University of Western Ontario, London, Ontario, Canada
- Chinese Cochrane Centre, West China Hospital, Sichuan University, Chengdu, China
- Michael G DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada
| | - Myeongjong Lee
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Chungju, South Korea
| | - Zhe Zhang
- Department of Anesthesiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jessica Moodie
- Centre for Medical Evidence, Decision Integrity and Clinical Impact (MEDICI), University of Western Ontario, London, Ontario, Canada
| | - Davy Cheng
- Centre for Medical Evidence, Decision Integrity and Clinical Impact (MEDICI), University of Western Ontario, London, Ontario, Canada
- Department of Anesthesia & Perioperative Medicine, University of Western Ontario, London, Ontario, Canada
| | - Janet Martin
- Centre for Medical Evidence, Decision Integrity and Clinical Impact (MEDICI), University of Western Ontario, London, Ontario, Canada
- Department of Anesthesia & Perioperative Medicine, University of Western Ontario, London, Ontario, Canada
- Department of Epidemiology & Biostatistics, University of Western Ontario, London, Ontario, Canada
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Hermann A, Holsgaard-Larsen A, Zerahn B, Mejdahl S, Overgaard S. Preoperative progressive explosive-type resistance training is feasible and effective in patients with hip osteoarthritis scheduled for total hip arthroplasty--a randomized controlled trial. Osteoarthritis Cartilage 2016; 24:91-8. [PMID: 26285180 DOI: 10.1016/j.joca.2015.07.030] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 07/19/2015] [Accepted: 07/30/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the efficacy and feasibility of progressive explosive-type resistance training (RT) in patients with osteoarthritis (OA) of the hip scheduled for total hip arthroplasty (THA). METHOD Randomized controlled trial (1:1) in patients diagnosed with hip OA and scheduled for THA. The intervention group (IG) performed supervised preoperative progressive explosive-type RT twice a week for 10 weeks; four exercises (hip/thigh) performed in three series each (8-12 repetition maximum). The control group (CG) received 'care as usual'. Efficacy was reported as the between-group difference in the Hip Osteoarthritis Outcome Score (HOOS) (primary endpoint; ADL function), and leg muscle power at post intervention follow-up immediate before surgery. Intention-to-treat analyses were performed in a multilevel regression model adjusting for baseline, sex, age and weight. Feasibility was reported as adherence, exercise related pain and adverse effects. Post-surgical follow up will be reported separately. ClinicalTrials.gov registration: NCT01164111. RESULTS Eighty patients (age 70.4 ± 7.6 years, BMI 27.8 ± 4.6, 52 females (65%) were included. Adherence was high (93%) with acceptable exercise related pain (VAS score ≤ 5) reported in 83% of sessions and no adverse events. Changes in HOOS 'function' was 10.0 points 95%CI [4.7; 15.3] higher in IG compared to CG (P < 0.001). For all the remaining HOOS subscales IG scored significantly better (P < 0.03) and had higher leg extension muscle power (P < 0.0001) compared to CG. CONCLUSION Progressive explosive-type RT was feasible in the included group of hip OA patients scheduled for THA and resulted in significant improvement in self-reported outcomes and increased leg muscle power.
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Affiliation(s)
- A Hermann
- Orthopedic Research Unit, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Denmark; Department of Orthopedic Surgery, Herlev University Hospital, Denmark; Institute of Clinical Research, University of Southern Denmark, Denmark.
| | - A Holsgaard-Larsen
- Orthopedic Research Unit, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Denmark
| | - B Zerahn
- Department of Clinical Physiology and Nuclear Medicine, Herlev University Hospital, Denmark
| | - S Mejdahl
- Department of Orthopedic Surgery, Herlev University Hospital, Denmark
| | - S Overgaard
- Orthopedic Research Unit, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Denmark; Institute of Clinical Research, University of Southern Denmark, Denmark
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Beumer L, Wong J, Warden SJ, Kemp JL, Foster P, Crossley KM. Effects of exercise and manual therapy on pain associated with hip osteoarthritis: a systematic review and meta-analysis. Br J Sports Med 2015; 50:458-63. [PMID: 26612846 DOI: 10.1136/bjsports-2015-095255] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2015] [Indexed: 11/04/2022]
Abstract
AIM To explore the effects of exercise (water-based or land-based) and/or manual therapies on pain in adults with clinically and/or radiographically diagnosed hip osteoarthritis (OA). METHODS A systematic review and meta-analysis was performed, with patient reported pain assessed using a visual analogue scale (VAS) or the Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain subscale. Data were grouped by follow-up time (0-3 months=short term; 4-12 months=medium term and; >12 months=long term), and standardised mean differences (SMD) with 95% CIs were used to establish intervention effect sizes. Study quality was assessed using modified PEDro scores. RESULTS 19 trials were included. Four studies showed short-term benefits favouring water-based exercise over minimal control using the WOMAC pain subscale (SMD -0.53, 95% CI -0.96 to -0.10). Six studies supported a short-term benefit of land-based exercise compared to minimal control on VAS assessed pain (SMD -0.49, 95% CI -0.70 to -0.29). There were no medium (SMD -0.23, 95% CI -0.48 to 0.03) or long (SMD -0.22, 95% CI -0.51 to 0.06) term benefits of exercise therapy, or benefit of combining exercise therapy with manual therapy (SMD -0.38, 95% CI -0.88 to 0.13) when compared to minimal control. CONCLUSIONS Best available evidence indicates that exercise therapy (whether land-based or water-based) is more effective than minimal control in managing pain associated with hip OA in the short term. Larger high-quality RCTs are needed to establish the effectiveness of exercise and manual therapies in the medium and long term.
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Affiliation(s)
- Lucy Beumer
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Jennie Wong
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Stuart J Warden
- School of Health and Rehabilitation Sciences, Indiana University, Indianapolis, Indiana, USA
| | - Joanne L Kemp
- Australian Centre for Research into Injury and Sport and its Prevention (ACRISP), Federation University Australia, Ballarat, Victoria, Australia
| | - Paul Foster
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Kay M Crossley
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria, Australia
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López-Liria R, Padilla-Góngora D, Catalan-Matamoros D, Rocamora-Pérez P, Pérez-de la Cruz S, Fernández-Sánchez M. Home-Based versus Hospital-Based Rehabilitation Program after Total Knee Replacement. BIOMED RESEARCH INTERNATIONAL 2015; 2015:450421. [PMID: 25961017 PMCID: PMC4415465 DOI: 10.1155/2015/450421] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 01/26/2015] [Accepted: 03/08/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To compare home-based rehabilitation with the standard hospital rehabilitation in terms of improving knee joint mobility and recovery of muscle strength and function in patients after a total knee replacement. MATERIALS AND METHODS A non-randomised controlled trial was conducted. Seventy-eight patients with a prosthetic knee were included in the study and allocated to either a home-based or hospital-based rehabilitation programme. Treatment included various exercises to restore strength and joint mobility and to improve patients' functional capacity. The primary outcome of the trial was the treatment effectiveness measured by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). RESULTS The groups did not significantly differ in the leg side (right/left) or clinical characteristics (P > 0.05). After the intervention, both groups showed significant improvements (P < 0.001) from the baseline values in the level of pain (visual analogue scale), the range of flexion-extension motion and muscle strength, disability (Barthel and WOMAC indices), balance, and walking. CONCLUSIONS This study reveals that the rehabilitation treatments offered either at home or in hospital settings are equally effective.
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Affiliation(s)
- Remedios López-Liria
- Department of Nursing, Physiotherapy and Medicine, University of Almería, La Cañada de San Urbano, 04120 Almería, Spain
| | - David Padilla-Góngora
- Department of Psychology, University of Almería, La Cañada de San Urbano, 04120 Almería, Spain
| | | | - Patricia Rocamora-Pérez
- Department of Nursing, Physiotherapy and Medicine, University of Almería, La Cañada de San Urbano, 04120 Almería, Spain
| | - Sagrario Pérez-de la Cruz
- Department of Nursing, Physiotherapy and Medicine, University of Almería, La Cañada de San Urbano, 04120 Almería, Spain
| | - Manuel Fernández-Sánchez
- Department of Nursing, Physiotherapy and Medicine, University of Almería, La Cañada de San Urbano, 04120 Almería, Spain
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Zeng R, Lin J, Wu S, Chen L, Chen S, Gao H, Zheng Y, Ma H. A randomized controlled trial: preoperative home-based combined Tai Chi and Strength Training (TCST) to improve balance and aerobic capacity in patients with total hip arthroplasty (THA). Arch Gerontol Geriatr 2015; 60:265-71. [PMID: 25533574 DOI: 10.1016/j.archger.2014.11.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 10/16/2014] [Accepted: 11/21/2014] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To investigate the effect of a 12-week balance training program, combined TCST, on balance activity and aerobic capacity in patients with hip osteoarthritis. METHODS Single-blind randomized grouping cohort study was conducted at our hospital from December 2008 to December 2011. A total of 81 patients aged from 60 to 69 years old diagnosed with end-stage hip osteoarthritis were recruited. They were randomly divided into two groups: training group (TG) and control group (CG). Participants in TG should do the TCST program under family's supervision for 12 weeks. Parameters including WOMAC score, 6 min walk test, stand up, walk test, situation of the hip mobility were compared between TG and CG by one-way ANOVA. RESULTS There was no significant difference of baseline characteristics between these two groups (P>0.05). Participants in TG could complete 87.1% of movements of TCST. After training, the distance of 6-min walk was obviously increased from 409.59±51.31 m to 478.10±52.46 m (P<0.01), and the time for up and go was significantly shorten from 18.53±3.90 s to 14.61±2.60 s (P<0.01), and self-reported functional status scores evaluated by WOMAC was improved from 40.97±5.65 to 36.28±5.11 (P<0.01). However, there were no significant changes in pain WOMAC and side hip motion. CONCLUSION The 12-week TCST program have good adherence, and can effectively improve balance and aerobic capacity status in patients with end-stage osteoarthritis, while this training can not effectively alleviate the pain and improve hip motion of patients. Hence, further THA is necessary to solve the problems. PRACTICE Patients with osteoarthritis can do this training program under family's supervision. IMPLICATIONS Providing a good advice on rehabilitation for patients preparing to do THA.
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Affiliation(s)
- Runming Zeng
- Department of Orthopedic Surgery, Chaonan Minsheng Hospital of Shantou, Shantou, China.
| | - Jing Lin
- Department of Oncology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Shengrong Wu
- Department of Orthopedic Surgery, Chaonan Minsheng Hospital of Shantou, Shantou, China
| | - Lihan Chen
- Department of Rehabilitation, Chaonan Minsheng Hospital of Shantou, Shantou, China
| | - Shuxian Chen
- Department of Orthopedic Surgery, Chaonan Minsheng Hospital of Shantou, Shantou, China
| | - Hanxiong Gao
- Department of Rehabilitation, Chaonan Minsheng Hospital of Shantou, Shantou, China
| | - Yongyi Zheng
- Department of Orthopedic Surgery, Chaonan Minsheng Hospital of Shantou, Shantou, China
| | - Huanlin Ma
- Department of Orthopedic Surgery, Chaonan Minsheng Hospital of Shantou, Shantou, China
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Czyżewska A, Glinkowski WM, Walesiak K, Krawczak K, Cabaj D, Górecki A. Effects of preoperative physiotherapy in hip osteoarthritis patients awaiting total hip replacement. Arch Med Sci 2014; 10:985-91. [PMID: 25395951 PMCID: PMC4223143 DOI: 10.5114/aoms.2014.46218] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Revised: 05/07/2012] [Accepted: 06/11/2012] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The World Health Organization (WHO) claimed osteoarthritis as a civilization-related disease. The effectiveness of preoperative physiotherapy among patients suffering hip osteoarthritis (OA) at the end of their conservative treatment is rarely described in the literature. The aim of this study was to assess the quality of life and musculoskeletal health status of patients who received preoperative physiotherapy before total hip replacement (THR) surgery within a year prior to admission for a scheduled THR and those who did not. MATERIAL AND METHODS Forty-five patients, admitted to the Department of Orthopaedics and Traumatology of Locomotor System for elective total hip replacement surgery, were recruited for this study. The assessment consisted of a detailed interview using various questionnaires: the Harris Hip Score (HHS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the 36-Item Short Form Health Survey (SF-36), and the Hip disability and Osteoarthritis Outcome Score (HOOS), as well as physical examination. Patients were assigned to groups based on their attendance of preoperative physiotherapy within a year prior to surgery. RESULTS Among patients who received preoperative physiotherapy a significant improvement was found for pain, daily functioning, vitality, psychological health, social life, and (active and passive) internal rotation (p < 0.05). CONCLUSIONS Patients are not routinely referred to physiotherapy within a year before total hip replacement surgery. This study confirmed that pre-operative physiotherapy may have a positive influence on selected musculoskeletal system status indicators and quality of life in hip osteoarthritis patients awaiting surgery.
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Affiliation(s)
- Anna Czyżewska
- Chair and Department of Orthopaedics and Traumatology of Locomotor System, Centre of Excellence "TeleOrto", Medical University of Warsaw, Warsaw, Poland
| | - Wojciech M Glinkowski
- Chair and Department of Orthopaedics and Traumatology of Locomotor System, Centre of Excellence "TeleOrto", Medical University of Warsaw, Warsaw, Poland
| | - Katarzyna Walesiak
- Chair and Department of Orthopaedics and Traumatology of Locomotor System, Centre of Excellence "TeleOrto", Medical University of Warsaw, Warsaw, Poland
| | - Karolina Krawczak
- Chair and Department of Orthopaedics and Traumatology of Locomotor System, Centre of Excellence "TeleOrto", Medical University of Warsaw, Warsaw, Poland
| | - Dominika Cabaj
- Chair and Department of Orthopaedics and Traumatology of Locomotor System, Centre of Excellence "TeleOrto", Medical University of Warsaw, Warsaw, Poland
| | - Andrzej Górecki
- Chair and Department of Orthopaedics and Traumatology of Locomotor System, Centre of Excellence "TeleOrto", Medical University of Warsaw, Warsaw, Poland
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McDonald S, Page MJ, Beringer K, Wasiak J, Sprowson A. Preoperative education for hip or knee replacement. Cochrane Database Syst Rev 2014; 2014:CD003526. [PMID: 24820247 PMCID: PMC7154584 DOI: 10.1002/14651858.cd003526.pub3] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Hip or knee replacement is a major surgical procedure that can be physically and psychologically stressful for patients. It is hypothesised that education before surgery reduces anxiety and enhances clinically important postoperative outcomes. OBJECTIVES To determine whether preoperative education in people undergoing total hip replacement or total knee replacement improves postoperative outcomes with respect to pain, function, health-related quality of life, anxiety, length of hospital stay and the incidence of adverse events (e.g. deep vein thrombosis). SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (2013, Issue 5), MEDLINE (1966 to May 2013), EMBASE (1980 to May 2013), CINAHL (1982 to May 2013), PsycINFO (1872 to May 2013) and PEDro to July 2010. We handsearched the Australian Journal of Physiotherapy (1954 to 2009) and reviewed the reference lists of included trials and other relevant reviews. SELECTION CRITERIA Randomised or quasi-randomised trials of preoperative education (verbal, written or audiovisual) delivered by a health professional within six weeks of surgery to people undergoing hip or knee replacement compared with usual care. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and extracted data. We analysed dichotomous outcomes using risk ratios. We combined continuous outcomes using mean differences (MD) or standardised mean differences (SMD) with 95% confidence intervals (CI). Where possible, we pooled data using a random-effects meta-analysis. MAIN RESULTS We included 18 trials (1463 participants) in the review. Thirteen trials involved people undergoing hip replacement, three involved people undergoing knee replacement and two included both people with hip and knee replacements. Only six trials reported using an adequate method of allocation concealment, and only two trials blinded participants. Few trials reported sufficient data to analyse the major outcomes of the review (pain, function, health-related quality of life, global assessment, postoperative anxiety, total adverse events and re-operation rate). There did not appear to be an effect of time on any outcome, so we chose to include only the latest time point available per outcome in the review.In people undergoing hip replacement, preoperative education may not offer additional benefits over usual care. The mean postoperative anxiety score at six weeks with usual care was 32.16 on a 60-point scale (lower score represents less anxiety) and was 2.28 points lower with preoperative education (95% confidence interval (CI) -5.68 to 1.12; 3 RCTs, 264 participants, low-quality evidence), an absolute risk difference of -4% (95% CI -10% to 2%). The mean pain score up to three months postoperatively with usual care was 3.1 on a 10-point scale (lower score represents less pain) and was 0.34 points lower with preoperative education (95% CI -0.94 to 0.26; 3 RCTs, 227 participants; low-quality evidence), an absolute risk difference of -3% (95% CI -9% to 3%). The mean function score at 3 to 24 months postoperatively with usual care was 18.4 on a 68-point scale (lower score represents better function) and was 4.84 points lower with preoperative education (95% CI -10.23 to 0.66; 4 RCTs, 177 participants; low-quality evidence), an absolute risk difference of -7% (95% CI -15% to 1%). The number of people reporting adverse events, such as infection and deep vein thrombosis, did not differ between groups, but the effect estimates are uncertain due to very low quality evidence (23% (17/75) reported events with usual care versus 18% (14/75) with preoperative education; risk ratio (RR) 0.79; 95% CI 0.19 to 3.21; 2 RCTs, 150 participants). Health-related quality of life, global assessment of treatment success and re-operation rates were not reported.In people undergoing knee replacement, preoperative education may not offer additional benefits over usual care. The mean pain score at 12 months postoperatively with usual care was 80 on a 100-point scale (lower score represents less pain) and was 2 points lower with preoperative education (95% CI -3.45 to 7.45; 1 RCT, 109 participants), an absolute risk difference of -2% (95% CI -4% to 8%). The mean function score at 12 months postoperatively with usual care was 77 on a 100-point scale (lower score represents better function) and was no different with preoperative education (0; 95% CI -5.63 to 5.63; 1 RCT, 109 participants), an absolute risk difference of 0% (95% CI -6% to 6%). The mean health-related quality of life score at 12 months postoperatively with usual care was 41 on a 100-point scale (lower score represents worse quality of life) and was 3 points lower with preoperative education (95% CI -6.38 to 0.38; 1 RCT, 109 participants), an absolute risk difference of -3% (95% CI -6% to 1%). The number of people reporting adverse events, such as infection and deep vein thrombosis, did not differ between groups (18% (11/60) reported events with usual care versus 13% (7/55) with preoperative education; RR 0.69; 95% CI 0.29 to 1.66; 1 RCT, 115 participants), an absolute risk difference of -6% (-19% to 8%). Global assessment of treatment success, postoperative anxiety and re-operation rates were not reported. AUTHORS' CONCLUSIONS Although preoperative education is embedded in the consent process, we are unsure if it offers benefits over usual care in terms of reducing anxiety, or in surgical outcomes, such as pain, function and adverse events. Preoperative education may represent a useful adjunct, with low risk of undesirable effects, particularly in certain patients, for example people with depression, anxiety or unrealistic expectations, who may respond well to preoperative education that is stratified according to their physical, psychological and social need.
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Affiliation(s)
- Steve McDonald
- School of Public Health & Preventive Medicine, Monash UniversityAustralasian Cochrane CentreLevel 1, 549 St Kilda RoadMelbourneVictoriaAustralia3004
| | - Matthew J Page
- Monash UniversitySchool of Public Health & Preventive MedicineLevel 1, 549 St Kilda RoadMelbourneVictoriaAustralia3004
| | - Katherine Beringer
- University of MelbourneFlorey Institute of Neuroscience and Mental HealthKenneth Myer BuildingRoyal ParadeMelbourneVictoriaAustralia3010
| | - Jason Wasiak
- The Epworth HospitalDepartment of Radiation Oncology89 Bridge RdRichmondAustralia3121
| | - Andrew Sprowson
- University Hospitals Coventry and Warwickshire NHS TrustClifford Bridge RoadCoventryWarwickshireUKCV2 2DX
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Santa Mina D, Clarke H, Ritvo P, Leung YW, Matthew AG, Katz J, Trachtenberg J, Alibhai SMH. Effect of total-body prehabilitation on postoperative outcomes: a systematic review and meta-analysis. Physiotherapy 2013; 100:196-207. [PMID: 24439570 DOI: 10.1016/j.physio.2013.08.008] [Citation(s) in RCA: 232] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 08/23/2013] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To systematically review the evidence of pre-operative exercise, known as 'prehabilitation', on peri- and postoperative outcomes in adult surgical populations. DESIGN Systematic review and meta-analysis. DATA SOURCES CENTRAL, Medline, EMBASE, CINAHL, PsycINFO and PEDro were searched from 1950 to 2011. METHODS Two reviewers independently examined relevant, English-language articles that examined the effects of pre-operative total-body exercise with peri- and postoperative outcome analysis. Given the nascence of this field, controlled and uncontrolled trials were included. Risk of bias was assessed using the Cochrane Risk of Bias Assessment tool. Only data on length of stay were considered eligible for meta-analysis due to the heterogeneity of measures and methodologies for assessing other outcomes. RESULTS In total, 4597 citations were identified by the search strategy, of which 21 studies were included. Trials were generally small (median=54 participants) and of moderate to poor methodological quality. Compared with standard care, the majority of studies found that total-body prehabilitation improved postoperative pain, length of stay and physical function, but it was not consistently effective in improving health-related quality of life or aerobic fitness in the studies that examined these outcomes. The meta-analysis indicated that prehabilitation reduced postoperative length of stay with a small to moderate effect size (Hedges' g=-0.39, P=0.033). Intervention-related adverse events were reported in two of 669 exercising participants. CONCLUSION The literature provides early evidence that prehabilitation may reduce length of stay and possibly provide postoperative physical benefits. Cautious interpretation of these findings is warranted given modest methodological quality and significant risk of bias.
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Affiliation(s)
- D Santa Mina
- Department of Surgical Oncology, Princess Margaret Cancer Center, Toronto, Ontario, Canada; Kinesiology Program, University of Guelph-Humber, Toronto, Ontario, Canada; School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada.
| | - H Clarke
- University of Toronto, Toronto, Ontario, Canada; University Health Network, Toronto, Ontario, Canada
| | - P Ritvo
- Kinesiology Program, University of Guelph-Humber, Toronto, Ontario, Canada; Cancer Care Ontario, Toronto, Ontario, Canada
| | - Y W Leung
- University of Toronto, Toronto, Ontario, Canada; University Health Network, Toronto, Ontario, Canada
| | - A G Matthew
- Department of Surgical Oncology, Princess Margaret Cancer Center, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - J Katz
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada; University Health Network, Toronto, Ontario, Canada
| | - J Trachtenberg
- Department of Surgical Oncology, Princess Margaret Cancer Center, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - S M H Alibhai
- University of Toronto, Toronto, Ontario, Canada; University Health Network, Toronto, Ontario, Canada
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Lemanu DP, Singh PP, MacCormick AD, Arroll B, Hill AG. Effect of preoperative exercise on cardiorespiratory function and recovery after surgery: a systematic review. World J Surg 2013; 37:711-20. [PMID: 23292047 DOI: 10.1007/s00268-012-1886-4] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND This systematic review aims to investigate the extent to which preoperative conditioning (PREHAB) improves physiologic function and whether it correlates with improved recovery after major surgery. METHODS An electronic database search identified randomized controlled trials (RCTs) investigating the safety and efficacy of PREHAB. The outcomes studied were changes in cardiorespiratory physiologic function, clinical outcomes (including length of hospital stay and rates of postoperative complications), and measures of changes in functional capacity (physical and psychological). RESULTS Eight low- to medium-quality RCTs were included in the final analysis. The patients were elderly (mean age >60 years), and the exercise programs were significantly varied. Adherence to PREHAB was low. Only one study found that PREHAB led to significant improvement in physiologic function correlating with improved clinical outcomes. CONCLUSION There are only limited data to suggest that PREHAB confers any measured physiologic improvement with subsequent clinical benefit. Further data are required to investigate the efficacy and safety of PREHAB in younger patients and to identify interventions that may help improve adherence to PREHAB.
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Affiliation(s)
- Daniel P Lemanu
- Department of Surgery, South Auckland Clinical School, University of Auckland, Private Bag 93311, Auckland, 1640, New Zealand.
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Salmon P, Hunt GR, Murthy BVS, O'Brien S, Beverland D, Lynch MC, Hall GM. Patient evaluation of early discharge after hip arthroplasty: development of a measure and comparison of three centres with differing durations of stay. Clin Rehabil 2013; 27:854-63. [PMID: 23543343 DOI: 10.1177/0269215513481686] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE We compared patients' evaluation of care between a surgical unit with a rapid discharge policy and two comparison units to test the hypothesis that the centre with rapid discharge has outcomes that are not inferior to those of the comparison sites. DESIGN Cross-sectional cohort study. SUBJECTS Consecutive consenting patients undergoing primary hip arthroplasty during 12 months in: a unit that had reduced postoperative stay to median three days; a specialised orthopaedic surgery treatment centre with median stay of five days; a traditional unit with median stay of six days (N = 316, 125, 119, respectively). METHODS Six weeks postoperatively, patients completed a specially developed questionnaire measuring their evaluation of care and recovery, together with measures of function and quality of life for validation purposes. RESULTS Factor analysis of questionnaire responses identified two independent components of patients' evaluation: problems in staff care and problems in physical recovery. Neither component was impaired in the unit with rapid discharge: similar proportions of patients reported recovery problems in each site (odds radios (ORs) for the two comparators versus unit with rapid discharge: 0.96, 1.18); and more patients reported care problems in the two comparator sites (ORs 2.97, 2.16). CONCLUSION Duration of stay after primary hip arthroplasty can be reduced to three days without intensive pre- or postoperative care, without detriment to patient evaluation.
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Affiliation(s)
- Peter Salmon
- Division of Clinical Psychology, University of Liverpool, Liverpool L69 3GB, UK.
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Mak JCS, Fransen M, Jennings M, March L, Mittal R, Harris IA. Evidence-based review for patients undergoing elective hip and knee replacement. ANZ J Surg 2013; 84:17-24. [PMID: 23496209 DOI: 10.1111/ans.12109] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2013] [Indexed: 12/27/2022]
Abstract
BACKGROUND The objective of this study was to evaluate the evidence for different interventions in the preoperative, perioperative and post-operative care for people undergoing elective total hip (THR) and knee (TKR) replacement surgery. METHOD A multidisciplinary working group comprising consumers, managers and clinicians from the areas of orthopaedics, rheumatology, aged care and rehabilitation evaluated randomized controlled trials (RCTs) and systematic reviews/meta-analyses concerning aspects of preoperative, perioperative and post-operative clinical care periods for THR/TKR through systematic searching of Medline, Embase, CENTRAL and the Cochrane Database of Systematic Reviews from May 2007 to April 2011. Multiple reviewers determined study eligibility and one or more members extracted primary study findings. The body of evidence were assessed and specific recommendations made according to NHMRC guidelines. RESULTS Twenty-five aspects were identified for review. Recommendations for 16 of 25 areas of care were made: impact of waiting, multidisciplinary preparation, preoperative exercise, smoking cessation, interventions for comorbid conditions, predictors of outcome, clinical pathways, implementation of a blood management programme, antibiotic prophylaxis, regional anaesthesia and analgesia, use of a tourniquet in knee replacement, venous thromboembolism prophylaxis, early post-operative cryotherapy, early mobilization and continuous passive motion. In the post-operative period, study heterogeneity across all aspects of care precluded specific recommendations. CONCLUSIONS There was a deficiency in the quality of the evidence supporting key aspects of the continuum of care for primary THR/TKR surgery. Consequently, recommendations were limited. Prioritization and funding for research into areas likely to impact clinical practice and patient outcomes after elective joint replacement surgery are the next important steps.
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Affiliation(s)
- Jenson C S Mak
- Department of Geriatric Medicine, Gosford Hospital, Gosford, New South Wales, Australia; Department of Medicine, Ryde Hospital, Eastwood, New South Wales, Australia
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Louw, A, Diener, I, Butler DS, Puentedura EJ. Preoperative education addressing postoperative pain in total joint arthroplasty: Review of content and educational delivery methods. Physiother Theory Pract 2012; 29:175-94. [DOI: 10.3109/09593985.2012.727527] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
Fast-track hip and knee arthroplasty aims at giving the patients the best available treatment at all times, being a dynamic entity. Fast-track combines evidence-based, clinical features with organizational optimization including a revision of traditions resulting in a streamlined pathway from admission till discharge – and beyond. The goal is to reduce morbidity, mortality and functional convalescence with an earlier achievement of functional milestones including functional discharge criteria with subsequent reduced length of stay and high patient satisfaction. Outcomes are traditionally measured as length of stay; safety aspects in the form of morbidity/mortality; patient satisfaction; and – as a secondary parameter – economic savings. Optimization of the clinical aspects include focusing on analgesia; DVT-prophylaxis; mobilization; care principles including functional discharge criteria; patient-characteristics to predict outcome; and traditions which may be barriers in optimizing outcomes. Patients should be informed and motivated to be active participants and their expectations should be modulated in order to improve satisfaction. Also, organizational aspects need to be analyzed and optimized. New logistical approaches should be implemented; the ward ideally (re)structured to only admit arthroplasties; the staff educated to have a uniform approach; extensive preoperative information given including discharge criteria and intended length of stay. This thesis includes 9 papers on clinical and organizational aspects of fast-track hip and knee arthroplasty (I–IX). A detailed description of the fast-track set-up and its components is provided. Major results include identification of patient characteristics to predict length of stay and satisfaction with different aspects of the hospital stay (I); how to optimize analgesia by using a compression bandage in total knee arthroplasty (II); the clinical and organizational set-up facilitating or acting as barriers for early discharge (III); safety aspects following fast-track in the form of few readmissions in general (IV) and few thromboembolic complications in particular (V); feasibility studies showing excellent outcomes following fast-track bilateral simultaneous total knee arthroplasty (VI) and non-septic revision knee arthroplasty (VII); how acute pain relief in total hip arthroplasty is not enhanced by the use of local infiltration analgesia when multi-modal opioid-sparing analgesia is given (VIII); and a detailed description of which clinical and organizational factors detain patients in hospital following fast-track hip and knee arthroplasty (IX). Economic savings following fast-track hip and knee arthroplasty is also documented in studies, reviews, metaanalyses and Cochrane reviews – including the present fast-track (ANORAK). In conclusion, the published results (I–IX) provide substantial, important new knowledge on clinical and organizational aspects of fast-track hip and knee arthroplasty – with concomitant documented high degrees of safety (morbidity/mortality) and patient satisfaction. Future research strategies are multiple and include both research strategies as efforts to implement the fast-track methodology on a wider basis. Research areas include improvements in pain treatment, blood saving strategies, fluid plans, reduction of complications, avoidance of tourniquet and concomitant blood loss, improved early functional recovery and muscle strengthening. Also, improvements in information and motivation of the patients, preoperative identification of patients needing special attention and detailed economic studies of fast- track are warranted.
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Affiliation(s)
- Henrik Husted
- Department of Orthopaedic Surgery 333, University Hospital of Hvidovre, Copenhagen, Kettegaard Alle 30 DK-2650 Hvidovre, Denmark.
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