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Osundolire S, Mbrah A, Liu SH, Lapane KL. Association Between Patient and Facility Characteristics and Rehabilitation Outcomes After Joint Replacement Surgery in Different Rehabilitation Settings for Older Adults: A Systematic Review. J Geriatr Phys Ther 2024; 47:E1-E18. [PMID: 36598848 PMCID: PMC10318119 DOI: 10.1519/jpt.0000000000000369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND PURPOSE In the United States, an exponential increase in total hip arthroplasty (THA) and total knee arthroplasty (TKA) demand has occurred over the last 2 decades. Evidence suggesting patients receiving inpatient rehabilitation following a TKA or THA experience similar outcomes as those with rehabilitation in other settings led to dramatic shifts in postsurgical care settings owing to Centers for Medicare & Medicaid Services (CMS) payment reforms. A contemporary synthesis of evidence about the association between patient and facility factors and outcomes from older adults undergoing THA or TKA in the United States is needed. METHODS To identify eligible studies, we searched PubMed, Scopus, and CINAHL. We followed PRISMA guidelines to identify articles evaluating either patient or facility factors associated with outcomes after THA or TKA for older adults who may have been cared for in inpatient settings (ie, inpatient rehabilitation or skilled nursing facility [SNF]). Eligible articles were conducted in the United States and were published between January 1, 2000, and December 31, 2021. RESULTS We included 8 articles focused on patient factors and 9 focused on facility factors. Most included older adults and the majority were White (in those reporting race/ethnicity). Most studies evaluated outcomes at discharge and showed that patients admitted to inpatient rehabilitation facilities had either similar or better functional outcomes (mobility, self-care, and functional independence measure (FIM) score) and lower length of stay compared with those in SNFs. Few studies focused on home health care. CONCLUSIONS The systematic review focused on older adults showed that findings in these patients are consistent with previous research. Older adults undergoing THA/TKA had acceptable outcomes regardless of postsurgical, inpatient setting of care. Research conducted after CMS payment reforms, in home health care settings, and in more diverse samples is needed. Given the known racial/ethnic disparities in THA/TKA and the shifts to postsurgical home health care with little regulatory oversight of care quality, contemporary research on outcomes of postsurgical THA/TKA outcomes is warranted.
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Affiliation(s)
- Seun Osundolire
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Attah Mbrah
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Shao-Hsien Liu
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Kate L. Lapane
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
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Travers S, Martin S, Litofsky NS. The effects of anaemia and transfusion on patients with traumatic brain injury: A review. Brain Inj 2016; 30:1525-1532. [PMID: 27680103 DOI: 10.1080/02699052.2016.1199907] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Anaemia in traumatic brain injury (TBI) is frequently encountered. Neurosurgical texts continue to recommend transfusion for hematocrit below 30%, despite clear evidence to do so. Transfusion should increase oxygen delivery to the brain, but it may also increase morbidity and mortality. METHODS This study reviewed the relevant literature to better understand the risks of anaemia and benefits of correction of anaemia by transfusion. RESULTS Of the 21 studies reviewed, eight found that anaemia was harmful to patients with TBI; five found no significant outcome; seven found transfusion was associated with higher rates of morbidity and mortality; two found that transfusion lowered mortality and increased brain tissue oxygen levels; and ten found no correlation between transfusion and outcome. However, the levels of anaemia severity and the outcome measurements varied widely and the majority of outcomes focused on crude measurements rather than detailed functional assessments. CONCLUSIONS No division of response based on gender difference or impact of anaemia in the post-hospital treatment setting was observed. A randomized control trial is recommended to determine the impact of anaemia and transfusion on detailed outcome assessment in comparison of transfusion thresholds ranging from ≤ 7 g dL-1 to ≤ 9 g dL-1 in patients with moderate-to-severe TBI.
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Affiliation(s)
- Sarah Travers
- a Division of Neurological Surgery , University of Missouri School of Medicine , Columbia , MO , USA
| | - Simon Martin
- a Division of Neurological Surgery , University of Missouri School of Medicine , Columbia , MO , USA
| | - N Scott Litofsky
- a Division of Neurological Surgery , University of Missouri School of Medicine , Columbia , MO , USA
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Everink IHJ, van Haastregt JCM, van Hoof SJM, Schols JMGA, Kempen GIJM. Factors influencing home discharge after inpatient rehabilitation of older patients: a systematic review. BMC Geriatr 2016; 16:5. [PMID: 26755206 PMCID: PMC4709872 DOI: 10.1186/s12877-016-0187-4] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 01/03/2016] [Accepted: 01/05/2016] [Indexed: 12/24/2022] Open
Abstract
Background Although rehabilitation for older patients has the potential to improve function and prevent admission to nursing homes, returning home after discharge is not possible for all patients. Better understanding of patient factors related to discharge home may lead to more realistic rehabilitation goals, more targeted rehabilitation interventions and better preparation of both patient and informal caregiver for discharge. Various studies provided insight into factors related to home discharge after stroke rehabilitation, but we still lack insight into factors related to home discharge in non-stroke patients. Therefore, the aim of this review is to provide an overview of factors influencing home discharge in older non-stroke patients admitted to an inpatient rehabilitation unit. Methods A systematic literature search was executed in the databases PubMed, EMBASE, CINAHL and Web of Science to retrieve articles published between January 2000 and October 2015. The search focused on factors related to home discharge after rehabilitation for older patients. Studies were included if home discharge after rehabilitation was assessed as an outcome measure and if the non-stroke population was, on average, 65 years or older and admitted to an inpatient rehabilitation unit. Results Eighteen studies were included. The methodological quality was moderate to good in 15 studies. The factors significantly associated with home discharge are younger age, non-white ethnicity, being married, better functional and cognitive status, and the absence of depression. Conclusions Because various factors are significantly associated with home discharge of older non-stroke patients after rehabilitation, we recommend assessing these factors at admission to the rehabilitation unit. Further research into the factors that lack sufficient evidence concerning their association with home discharge is recommended. Electronic supplementary material The online version of this article (doi:10.1186/s12877-016-0187-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Irma H J Everink
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences and CAHPRI School for Public Health and Primary care, Maastricht University, Maastricht, The Netherlands.
| | - Jolanda C M van Haastregt
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences and CAHPRI School for Public Health and Primary care, Maastricht University, Maastricht, The Netherlands.
| | - Sofie J M van Hoof
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences and CAHPRI School for Public Health and Primary care, Maastricht University, Maastricht, The Netherlands.
| | - Jos M G A Schols
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences and CAHPRI School for Public Health and Primary care, Maastricht University, Maastricht, The Netherlands. .,Department of Family Medicine, Faculty of Health, Medicine and Life Sciences and CAHPRI School for Public Health and Primary care, Maastricht University, Maastricht, The Netherlands.
| | - Gertrudis I J M Kempen
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences and CAHPRI School for Public Health and Primary care, Maastricht University, Maastricht, The Netherlands.
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Abstract
IntroductionThis study evaluates the need for adaptive equipment following total knee replacement. There are no recent studies to guide occupational therapists in the optimum time adaptive equipment is required following total knee replacement.MethodA non-experimental, concurrent mixed methods approach was used. The study population was patients attending for total knee replacement at a large general hospital. Outcome measures were the Oxford Knee Score, the United Kingdom Functional Independence Measure and a weekly diary.ResultsA total of 19 patients were included in the study. Following assessment, 53% ( n = 10) required adaptive equipment following total knee replacement. No significant difference was found in pre-operative pain or function scores, gender or surgical pathway when comparing those who did and did not need adaptive equipment post-operatively. Patients who required adaptive equipment post-operatively had significantly worse pain ( p = 0.030) and function ( p = 0.040) at 6 weeks post-operatively and had significantly longer inpatient stay ( p = 0.041).ConclusionAlthough there are resource implications, patients requiring adaptive equipment following total knee replacement should be assessed by occupational therapy staff 6 weeks post-operatively to ensure optimal functional outcomes following surgery.
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Affiliation(s)
- Jamie McNaught
- Senior Occupational Therapist, Royal Alexandra Hospital, Paisley, UK
| | - Lorna Paul
- Reader in Rehabilitation, University of Glasgow, Glasgow, UK
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Nielsen K, Johansson PI, Dahl B, Wagner M, Frausing B, Børglum J, Jensen K, Stürup J, Hvolris J, Rasmussen LS. Perioperative transfusion threshold and ambulation after hip revision surgery--a randomized trial. BMC Anesthesiol 2014; 14:89. [PMID: 25337035 PMCID: PMC4203913 DOI: 10.1186/1471-2253-14-89] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Accepted: 09/29/2014] [Indexed: 11/17/2022] Open
Abstract
Background Transfusion with red blood cells (RBC) may be needed during hip revision surgery but the appropriate haemoglobin concentration (Hb) threshold for transfusion has not been well established. We hypothesized that a higher transfusion threshold would improve ambulation after hip revision surgery. Methods The trial was registered at Clinicaltrials.gov (
NCT00906295). Sixty-six patients aged 18 years or older undergoing hip revision surgery were randomized to receive RBC at a Hb threshold of either 7.3 g/dL (restrictive group) or 8.9 g/dL (liberal group). Postoperative ambulation was assessed using Timed Up and Go-test (TUG) and ability to walk was also assessed daily by a physiotherapist blinded to the allocation. Results Fifty-three patients were able to perform the TUG and included in the analysis. The TUG could be completed in a median of 36 sec vs. 30 sec in the restrictive group and the liberal group, respectively (P = 0.02). The mean difference in TUG was 14.5 sec (95% CI 2.8-26.2 sec). No difference was found in the day patients could perform TUG or walk 10 meters. The Hb at the day of testing was 10.2 g/dL in the restrictive group and 9.9 g/dL in the liberal group. Only 26 patients received RBC. Conclusions A Hb transfusion threshold of 8.9 g/dL was associated with a statistically significantly faster TUG after hip revision surgery compared to a threshold of 7.3 g/dL but the clinical importance is questionable and the groups did not differ in Hb at the time of testing.
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Affiliation(s)
- Kamilla Nielsen
- Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Kragujevac, Denmark
| | - Pär I Johansson
- Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital, Rigshospitalet, Kragujevac, Denmark
| | - Benny Dahl
- Department of Orthopaedic Surgery, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Kragujevac, Denmark
| | - Michael Wagner
- Department of Occupational Therapy and Physiotherapy, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Kragujevac, Denmark
| | - Britt Frausing
- Department of Occupational Therapy and Physiotherapy, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Kragujevac, Denmark
| | - Jens Børglum
- Department of Anaesthesia and Intensive Care Medicine, Copenhagen University Hospital, Bispebjerg, Denmark
| | - Kenneth Jensen
- Department of Anaesthesia and Intensive Care Medicine, Copenhagen University Hospital, Bispebjerg, Denmark
| | - Jens Stürup
- Department of Orthopaedic Surgery, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Kragujevac, Denmark
| | - Jesper Hvolris
- Department of Orthopedic Surgery, Copenhagen University Hospital, Bispebjerg, Denmark
| | - Lars S Rasmussen
- Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Kragujevac, Denmark
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Controllable Home Health Rehabilitation Variables That Contribute to Positive Patient Outcomes Following Total Knee Arthroplasty. TOPICS IN GERIATRIC REHABILITATION 2013. [DOI: 10.1097/tgr.0b013e3182765694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Maniar RN, Baviskar JV, Singhi T, Maniar P, Nayak R. Influence of bilateral sequential total knee arthroplasty on functional recovery. Indian J Orthop 2013; 47:23-30. [PMID: 23532139 PMCID: PMC3601229 DOI: 10.4103/0019-5413.106890] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Main concerns of patients undergoing bilateral surgery is the quantum of pain and the progress of functional recovery. We studied functional recovery in terms of pain, range of motion (ROM), SF12, WOMAC scores and a unique TUG (timed up and go) test for patients undergoing unilateral total knee arthroplasty (U/L-TKA) and sequential bilateral total knee arthroplasty (B/L-TKA). MATERIALS AND METHODS Three groups of 77 consecutive patients (91 knees) were retrospectively compared. They were B/L TKA group (28 knees: 14 patients), Unilateral TKA group with contralateral knee nonoperated i.e., U/L-TKA group (42 knees) and Unilateral TKA with contralateral TKA already done i.e., U/L + C/L TKA group (21 knees). Patients were assessed preoperatively and on postoperative days 3, 5, 14, 42, 90 and 1 year. RESULTS The WOMAC score was statistically better preoperatively in the U/L + C/L TKA group, and SF12 MCS score was statistically better preoperatively in the B/L-TKA group. The TUG test time in the B/L-TKA group was statistically longer on days 3 and 5 as compared to other groups and became comparable by day 14. The TUG score became better than the preoperative value by day 42 in the B/L-TKA group, which took 90 days in other groups. CONCLUSION The early functional recovery of bilateral TKA patient lags behind that of unilateral TKA patient for the first 5 days, becomes equal by the 14(th) day and remains equal till 1 year after surgery. Bilateral TKA patients regain their preoperative functional status by 6 weeks against 3 months for unilateral TKA. The operative status of the contralateral knee makes no difference to early functional recovery after unilateral TKA. With bilateral TKA, there is no difference in pain and ROM parameters.
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Affiliation(s)
- Rajesh N Maniar
- Department of Orthopaedics, Lilavati Hospital and Research Centre, Bandra, India,Address for correspondence: Dr. Rajesh N. Maniar, The Nook Apartment, 51/B, S.V. Road, Santacruz (W), Mumbai - 400 054, India. E-mail:
| | - Jayesh V Baviskar
- Department of Orthopaedics, Lilavati Hospital and Research Centre, Bandra, India
| | - Tushar Singhi
- Department of Orthopaedics, Lilavati Hospital and Research Centre, Bandra, India
| | - Parul Maniar
- Consultant Opthalmologist, Nook Apartments, Santacruz, Mumbai, India
| | - Ravi Nayak
- Department of Orthopaedics, Lilavati Hospital and Research Centre, Bandra, India
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