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Jolliffe L, Andrew NE, Srikanth V, Beare R, Noeske KE, Snowdon DA. Development of an implementation strategy for routine collection of generic patient reported outcome measures: a qualitative study in multidisciplinary community rehabilitation. Disabil Rehabil 2023:1-10. [PMID: 37735798 DOI: 10.1080/09638288.2023.2258334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 09/07/2023] [Indexed: 09/23/2023]
Abstract
PURPOSE To explore staff perceptions of barriers and enablers towards implementing the EQ-5D-5L in community rehabilitation, and develop a theory-informed implementation approach for routine administration of generic patient-reported outcome measures (PROMs) using implementation science frameworks. MATERIALS AND METHODS A qualitative study was conducted at three sites. Multidisciplinary rehabilitation staff completed individual semi-structured interviews, which were transcribed and coded against the Theoretical Domains Framework (TDF). We identified and selected potentially effective behaviour change techniques using the Behavior Change Wheel. Hypothetical strategies were operationalised. RESULTS Twenty-one interviews were conducted, and four themes emerged: (1) The Impact of PROMs on patient centered-care; (2) Considerations for validity of PROMs; (3) Service-level impact of embedding PROMs; (4) Practical issues of embedding PROMs within the service. Barriers and enablers were mapped to seven of the TDF domains; relating most to clinicians' "belief about consequences", "reinforcement", and "environmental context and resources". Five hypothetical strategies were developed to overcome identified barriers and strengthen enablers. Key behaviour change techniques underpinning the strategies include: restructuring the physical environment, incentivisation, persuasion and education, enablement, and, social support. CONCLUSIONS Our implementation approach highlights the importance of automating processes, engaging site champions, routinely reporting, and using PROM data to inform service provision.
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Affiliation(s)
- Laura Jolliffe
- National Centre for Healthy Ageing (NCHA), Melbourne, Australia
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Australia
- Department of Occupational Therapy, School of Primary and Allied Health Care, Monash University, Melbourne, Australia
- Peninsula Health, Melbourne, Australia
| | - Nadine E Andrew
- National Centre for Healthy Ageing (NCHA), Melbourne, Australia
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Australia
- Peninsula Health, Melbourne, Australia
| | - Velandai Srikanth
- National Centre for Healthy Ageing (NCHA), Melbourne, Australia
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Australia
- Peninsula Health, Melbourne, Australia
| | - Richard Beare
- National Centre for Healthy Ageing (NCHA), Melbourne, Australia
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Australia
- Peninsula Health, Melbourne, Australia
| | - Kate E Noeske
- National Centre for Healthy Ageing (NCHA), Melbourne, Australia
- Peninsula Health, Melbourne, Australia
| | - David A Snowdon
- National Centre for Healthy Ageing (NCHA), Melbourne, Australia
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Australia
- Peninsula Health, Melbourne, Australia
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Inkk Trial .Çô Intraoperative ketamine for perioperative pain management following total knee endoprosthetic replacement in oncology: a double-blinded randomized trial. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2021; 73:78-84. [PMID: 34332009 PMCID: PMC9801218 DOI: 10.1016/j.bjane.2021.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 06/24/2021] [Accepted: 07/10/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND There has been a growing interest in the use of ketamine following orthopedic surgeries. We hypothesized that low dose intravenous ketamine during surgery would help in mobilization following total knee replacement (TKR) in oncology patients as assessed by the timed to up and go (TUG) test at 72.áhours post-surgery. Our secondary objectives were to compare the opioid requirement at the end of 72.áhours, pain scores, satisfaction with pain management, adverse effects, range of joint movement achieved in the post-operative period and the functional recovery at the end of 1 month. METHODS After the ethics commitee approval, registration of the trial with the Clinical Trial Registry - India (CTRI), and informed consent, this double-blinded trial was conducted. Using computer generated randomization chart, an independent team randomized the patients into ketamine group which received at induction, a ketamine bolus dose of 0.5.ámg.kg-1 before the incision followed by 10.á..g.kg-1min-1 infusion which was maintained intraoperatively till skin closure and the saline group received an equivalent volume of saline. Postoperatively, patient controlled morphine pumps were attached and the pain score with morphine usage were recorded for 72.áhours. The TUG tests and range of motion were assessed by the physiotherapists until 72.áhours. RESULTS Fifty-two patients were enrolled in the trial. Demographics were comparable. No significant intraoperative hemodynamic changes and post-operative adverse events were noted between the groups. A decrease in the TUG test, along with decreased opioid usage with a better range of movements was noted in the ketamine group, but this was not statistically significant. Day of discharge, patient satisfaction score, and functional recovery assessed by Oxford Knee Score (OKS) were comparable between the groups. CONCLUSION In conclusion, low dose intraoperative ketamine infusion does not provide clinical benefit in perioperative pain management and postoperative rehabilitation following total knee endoprosthetic replacement in oncology.
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Briggs MS, Rethman KK, Crookes J, Cheek F, Pottkotter K, McGrath S, DeWitt J, Harmon-Matthews LE, Quatman-Yates CC. Implementing Patient-Reported Outcome Measures in Outpatient Rehabilitation Settings: A Systematic Review of Facilitators and Barriers Using the Consolidated Framework for Implementation Research. Arch Phys Med Rehabil 2020; 101:1796-1812. [PMID: 32416149 DOI: 10.1016/j.apmr.2020.04.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 04/14/2020] [Accepted: 04/15/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE This systematic review examines the facilitators and barriers to the use of patient-reported outcome measures (PROMs) in outpatient rehabilitation settings and provides strategies to improve care to maximize patient outcomes. DATA SOURCES Eleven databases were systematically searched from November 2018 to May 2019. STUDY SELECTION Two reviewers independently assessed articles based on the following inclusion criteria: English text, evaluate barriers and facilitators, include PROMs, and occur in an outpatient rehabilitation setting (physical therapy, occupational therapy, speech language pathology, or athletic training). Of the 10,164 articles initially screened, 15 articles were included in this study. DATA EXTRACTION Data were extracted from the selected articles by 2 independent reviewers and put into an extraction template and into the Consolidated Framework for Implementation Research (CFIR) model. The Appraisal Tool for Cross-Sectional Studies (AXIS) was conducted on each study to assess study design, risk of bias, and reporting quality of the eligible studies. DATA SYNTHESIS Ten studies were identified as high quality, according to the AXIS. Based on the CFIR model, the top barriers identified focused on clinician training and time in the implementation process, lack of recognized value and knowledge at the individual level, lack of access and support in the inner setting, and inability of patients to complete PROMs in the intervention process. Facilitators were identified as education in the implementation process, support and availability of PROMs in the inner setting, and recognized value at the individual level. CONCLUSIONS More barriers than facilitators have been identified, which is consistent with PROM underuse. Clinicians and administrators should find opportunities to overcome the barriers identified and leverage the facilitators to improve routine PROM use and maximize patient outcomes.
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Affiliation(s)
- Matthew S Briggs
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Jameson Crane Sports Medicine Institute, Columbus, Ohio; OSU Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio; Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio.
| | - Katherine Kozak Rethman
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Jameson Crane Sports Medicine Institute, Columbus, Ohio; OSU Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Justin Crookes
- Division of Physical Therapy, School of Health and Rehabilitation Sciences, College of Medicine Ohio State University, Columbus, Ohio
| | - Fern Cheek
- Health Sciences Library, The Ohio State University, Columbus, Ohio
| | - Kristy Pottkotter
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Jameson Crane Sports Medicine Institute, Columbus, Ohio; OSU Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Shana McGrath
- OSUWMC Outpatient Rehabilitation, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - John DeWitt
- OSU Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio; Division of Physical Therapy, School of Health and Rehabilitation Sciences, College of Medicine Ohio State University, Columbus, Ohio
| | - Lindsay E Harmon-Matthews
- OSU Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio; OSUWMC Outpatient Rehabilitation, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Catherine C Quatman-Yates
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Jameson Crane Sports Medicine Institute, Columbus, Ohio; Division of Physical Therapy, School of Health and Rehabilitation Sciences, College of Medicine Ohio State University, Columbus, Ohio
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Kittelson AJ, Hoogeboom TJ, Schenkman M, Stevens-Lapsley JE, van Meeteren NLU. Person-Centered Care and Physical Therapy: A "People-Like-Me" Approach. Phys Ther 2019; 100:99-106. [PMID: 31608928 PMCID: PMC8204876 DOI: 10.1093/ptj/pzz139] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 06/09/2019] [Indexed: 01/18/2023]
Abstract
In health care, "person centeredness" is a valued (though nebulous) concept. In physical therapy, clinical interactions often strive to be person-centered, for example, by focusing on participation and valuing patient empowerment. However, the available evidence has mostly been constructed around populations (or study samples) rather than individuals. In this perspective, an alternative evidence framework is described, constructed around measurements in routine practice. Specifically, the authors propose developing "people-like-me" reference charts, generated with historical outcomes data, to provide real-time information on an individual's status relative to similar people. The authors present an example of how this could work using their experience with people rehabilitating after total knee arthroplasty. They also describe several challenges that must be addressed to bring this innovation into practice. First, the most important outcome measures for stakeholders (eg, patients, clinicians) need to be identified and monitored longitudinally to ensure that "people-like-me" estimates are useful and support the goals of person-centered care. Statistical methods for selecting "people-like-me" need to be examined and refined. Finally, the "people-like-me" information needs to be packaged in such a way that it is accessible, intuitive, and helpful at the point of care. Ideally, the entire process should recognize from the outset that practice patterns evolve, so databases, statistical models, and decision tools should be dynamic by design. Ultimately, the authors propose this framework as a practical mechanism to advance person-centered decisions in physical therapy according to the ideals of evidence-based practice.
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Affiliation(s)
| | | | - Margaret Schenkman
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado
| | - Jennifer E Stevens-Lapsley
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado; Geriatric Research Education and Clinical Center, VA Eastern Colorado Healthcare System, Denver, Colorado
| | - Nico L U van Meeteren
- Department of Epidemiology and CAPHRI Research School, Maastricht University Medical Centre, Maastricht, the Netherlands; and Top Sector Life Sciences & Health, Health-Holland, the Hague, the Netherlands
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Are priorities of younger patients with knee pain addressed by PROMs? A qualitative study. Phys Ther Sport 2019; 40:160-168. [PMID: 31569057 DOI: 10.1016/j.ptsp.2019.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 09/14/2019] [Accepted: 09/16/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To describe the impact of knee pain and dysfunction in young adults and determine whether current patient reported outcome measures (PROMs) address their recovery priorities. DESIGN Qualitative. SETTING Outpatient rehabilitation center. PARTICIPANTS Young adults, 23-30 years. MAIN OUTCOME MEASURES 1:1 semi-structured interviews were held and analyzed with NVivo version 11. The Lower Extremity Functional Scale (LEFS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Injury and Osteoarthritis Outcome Score (KOOS), and International Knee Documentation Committee (IKDC) were compared to participant identified functional limitations. RESULTS 9 themes were identified in 7 interviews: Incomplete Recovery as Acceptable, Motivation for Adequate Long Term Function, Guidance Needed to Facilitate Recovery, Sports: To Play or Not to Play, Pain, Therapy Participation and Interventions, Impact on Life, Decreased Knowledge and Condition Management, and A Wide Range of Functional Limitations. The LEFS captured 23/26 identified functional activities, the KOOS 22/26, the IKDC 16/26, and the WOMAC 13/26. CONCLUSIONS Incomplete recovery as an acceptable outcome was the most unique theme found in this study. LEFS captured the most relevant functional activities reported by this group. Physical Therapists should consider these findings in PROM selection to better inform meaningful outcome measurement.
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Brusco NK, Frawley HC. Program evaluation within the research translation framework. J Physiother 2019; 65:63-64. [PMID: 30910565 DOI: 10.1016/j.jphys.2019.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 11/29/2018] [Accepted: 02/07/2019] [Indexed: 10/27/2022] Open
Affiliation(s)
- Natasha K Brusco
- Alpha Crucis Group, Melbourne, Australia; Centre for Allied Health Research and Education, Cabrini Health, Melbourne, Australia; School of Primary and Allied Health Care, Monash University, Melbourne, Australia.
| | - Helena C Frawley
- Centre for Allied Health Research and Education, Cabrini Health, Melbourne, Australia; School of Primary and Allied Health Care, Monash University, Melbourne, Australia
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Givens DL, Eskildsen S, Taylor KE, Faldowski RA, Del Gaizo DJ. Timed Up and Go test is predictive of Patient-Reported Outcomes Measurement Information System physical function in patients awaiting total knee arthroplasty. Arthroplast Today 2018; 4:505-509. [PMID: 30560183 PMCID: PMC6287225 DOI: 10.1016/j.artd.2018.07.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 07/25/2018] [Accepted: 07/27/2018] [Indexed: 12/02/2022] Open
Abstract
Background The Patient Reported Outcomes Measurement Information System (PROMIS) Computerized Adaptive Test (CAT) physical function rapidly assesses self-reported function capability. The Timed Up and Go (TUG) test is often used in clinical practice, but administration may be impeded by space and patient limitations. PROMIS CAT can potentially address these limitations, but we lack evidence if TUG and health indicators are predictors of PROMIS CAT. This study assessed whether TUG, body mass index (BMI), numeric pain rating scale (NPRS), and smoking status were predictors of PROMIS CAT in total knee arthroplasty (TKA) candidates. Methods Sixty-five TKA candidates completed the PROMIS CAT physical function test using an iPad application. TUG, NPRS, BMI, and smoking status were obtained at the clinic visit or from medical records. Univariate and multiple regression analyses identified the strongest predictors of PROMIS CAT. Results TUG was the best predictor of PROMIS CAT physical function based on simple regression (r = −0.43, 95% CI = −0.62 to −0.20) or multiple regression (βˆ = −0.45, 95% CI = −0.73 to −0.17) analyses. BMI and NPRS did not incrementally help predict the PROMIS score beyond TUG. Smoking status did not contribute to the prediction of the PROMIS CAT score. Conclusions The findings suggest that the PROMIS CAT physical function is not a surrogate for the TUG performance-based measure in candidates for TKA. However, TUG was the best predictor of PROMIS physical function compared with BMI, NPRS, and smoking status. Clinicians should consider both patient-reported and performance-based measures when evaluating function for TKA outcomes.
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Affiliation(s)
- Deborah L. Givens
- Division of Physical Therapy, Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Corresponding author. Division of Physical Therapy, UNC Chapel Hill, 3032 Bondurant Hall, CB 7135, Chapel Hill, NC 27599, USA. Tel.: +1 919 843 8660.
| | - Scott Eskildsen
- Department of Orthopaedics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Richard A. Faldowski
- Office of Research, Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Daniel J. Del Gaizo
- Department of Orthopaedics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Poitras S, Au K, Wood K, Dervin G, Beaulé PE. Predicting hospital length of stay and short-term function after hip or knee arthroplasty: are both performance and comorbidity measures useful? INTERNATIONAL ORTHOPAEDICS 2018; 42:2295-2300. [PMID: 29453585 DOI: 10.1007/s00264-018-3833-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 02/04/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE Variations in hospital length of stay (LOS) and function are present after hip or knee arthroplasty. Comorbidity and performance measures have been associated with post-operative outcomes. It is however not known if both independently contribute to outcome prediction. The objective of this study was to evaluate the combined predictive ability of comorbidity scores (American Society of Anesthesiologists classification system (ASA), Charlson comorbidity index (CCI), 2008 version of the CCI (CCI08)) and a performance measure (Timed-Up-and-Go (TUG)) on LOS and short-term function in patients undergoing knee or hip arthroplasty. METHODS One hundred eight patients undergoing hip or knee arthroplasty were assessed preoperatively with the ASA, CCI, CCI08, and TUG. LOS was determined through administrative data. The Older Americans Resources and Services ADL questionnaire (OARS) was used to assess function two and six weeks after surgery. Logistic regression was used to assess the relationship between pre-operative assessments and LOS and OARS scores. RESULTS Both the ASA and TUG significantly contributed to LOS prediction. Odds ratio (OR) was 3.57 (95% confidence interval (CI) 1.26-10.07) for the ASA, and 2.18 (95% CI 1.67-4.15) for a one-standard deviation (SD) increase of 4.45 s of the TUG. Only the TUG was predictive of two weeks function and trending towards significance for six weeks function. One SD TUG increase yielded an OR of 2.14 (95% CI 1.53-3.79) for two week function. CONCLUSIONS The TUG and ASA can be used pre-operatively in combination to predict LOS, and TUG can also be used to predict short-term post-operative function.
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Affiliation(s)
- Stéphane Poitras
- School of Rehabilitation Sciences, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada.
| | - Kendrick Au
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, ON, Canada
| | - Kristi Wood
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, ON, Canada
| | - Geoffrey Dervin
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, ON, Canada
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, ON, Canada
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Imada A, Nelms N, Halsey D, Blankstein M. Physical therapists collect different outcome measures after total joint arthroplasty as compared to most orthopaedic surgeons: a New England study. Arthroplast Today 2017; 4:113-117. [PMID: 29560405 PMCID: PMC5859202 DOI: 10.1016/j.artd.2017.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 08/10/2017] [Accepted: 08/13/2017] [Indexed: 11/18/2022] Open
Abstract
Background Following total knee and hip arthroplasty, patient progress can be assessed with patient-reported outcome measures (PROMs) and performance-based outcome measures (PBOMs). The American Joint Replacement Registry 2016 guide recommends collecting several measures, including Patient Reported Outcome Measure Information System Global, Knee Injury and Osteoarthritis Outcome Score Jr, and Hip Injury and Osteoarthritis Outcome Score Jr. This study aimed to assess the current and anticipated use of PROMs and PBOMs by New England physical therapists. Methods An online survey was conducted in July and August of 2015 asking physical therapists in New England to rate their current and anticipated future use of PROMs and PBOMs in terms of clinical decision making associated with the treatment and care of patients after total hip and knee replacement. Results There were 122 responses. The most often used and recommended PROMS were the Numeric Pain Rating Scale (99.2% and 97.5%, respectively) and Lower Extremity Function Scale (76.2% and 77.0%). There was significant variability in the use of different PBOMs, but the most often used and recommended were the Timed Up and Go (93.4% and 85.2%) and the Single Leg Balance Test (90.2% and 87.7%). Conclusions This study suggests that orthopaedic surgeons and physical therapists use different PROMs and PBOMs for postoperative assessment of total joint patients and highlights the need for more collaboration and consistency between these disciplines.
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Affiliation(s)
- Allicia Imada
- Department of Orthopedics and Rehabilitation, University of Vermont College of Medicine, Burlington, VT, USA
| | - Nathaniel Nelms
- Department of Orthopedics and Rehabilitation, University of Vermont Medical Center, South Burlington, VT, USA
| | - David Halsey
- Department of Orthopedics and Rehabilitation, University of Vermont Medical Center, South Burlington, VT, USA
| | - Michael Blankstein
- Department of Orthopedics and Rehabilitation, University of Vermont Medical Center, South Burlington, VT, USA
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Poitras S, Wood KS, Savard J, Dervin GF, Beaulé PE. Assessing functional recovery shortly after knee or hip arthroplasty: a comparison of the clinimetric properties of four tools. BMC Musculoskelet Disord 2016; 17:478. [PMID: 27852257 PMCID: PMC5112748 DOI: 10.1186/s12891-016-1338-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 11/10/2016] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Following hip or knee arthroplasty, it is clinically warranted to get patients functional as quickly as possible. However, valid tools to assess function shortly after knee or hip arthroplasty are lacking. The objective was to compare the clinimetric properties of four instruments to assess function shortly after arthroplasty. METHODS One hundred eight patients undergoing hip or knee arthroplasty were assessed preoperatively, 1 and 2 days postoperatively, and 2 and 6 weeks postoperatively with the Timed Up and Go (TUG), Iowa Level of Assistance Scale (ILAS), Postoperative Quality of Recovery Scale (PQRS), and Readiness for Hospital Discharge Scale (RHDS). Descriptive data, floor and ceiling effects, responsiveness, interpretation and construct validity were determined. RESULTS Only the ILAS and RHDS support subscale demonstrated floor or ceiling effects. A large deterioration from preoperative to postoperative, followed by large improvements after surgery were seen in the TUG and ILAS scores. The RHDS personal status subscale and the PQRS pain and function dimensions demonstrated large improvements after surgery. Changes in the RHDS global scale and personal status subscale, PQRS pain dimension and TUG were significantly related to patient perceived improvement. Minimal important changes were obtained for the RHDS global (1.1/10) and personal status subscale (2.3/10), and the TUG (43.4 s at 6 weeks). For construct validity, the PQRS function dimension and RHDS were moderately related to the TUG or ILAS. The correlation between TUG and ILAS was high from preoperative to postoperative day 2, but substantially decreased at 2 and 6 weeks. CONCLUSIONS The TUG and RHDS personal status subscale demonstrated the best clinimetric properties to assess function in the first 6 weeks after hip or knee arthroplasty.
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Affiliation(s)
- Stéphane Poitras
- School of Rehabilitation Sciences, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada.
| | - Kristi S Wood
- Department of Orthopaedic Surgery, The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
| | - Jacinthe Savard
- School of Rehabilitation Sciences, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada
| | - Geoffrey F Dervin
- Department of Orthopaedic Surgery, The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
| | - Paul E Beaulé
- Department of Orthopaedic Surgery, The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
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Poitras S, Wood KS, Savard J, Dervin GF, Beaule PE. Predicting early clinical function after hip or knee arthroplasty. Bone Joint Res 2015; 4:145-51. [PMID: 26336897 PMCID: PMC4561370 DOI: 10.1302/2046-3758.49.2000417] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Objectives Patient function after arthroplasty should ideally quickly improve.
It is not known which peri-operative function assessments predict
length of stay (LOS) and short-term functional recovery. The objective
of this study was to identify peri-operative functions assessments
predictive of hospital LOS and short-term function after hospital discharge
in hip or knee arthroplasty patients. Methods In total, 108 patients were assessed peri-operatively with the
timed-up-and-go (TUG), Iowa level of assistance scale, post-operative
quality of recovery scale, readiness for hospital discharge scale,
and the Western Ontario and McMaster Osteoarthritis Index (WOMAC).
The older Americans resources and services activities of daily living
(ADL) questionnaire (OARS) was used to assess function two weeks
after discharge. Results Following multiple regressions, the pre- and post-operative day
two TUG was significantly associated with LOS and OARS score, while
the pre-operative WOMAC function subscale was associated with the
OARS score. Pre-operatively, a cut-off TUG time of 11.7 seconds
for LOS and 10.3 seconds for short-term recovery yielded the highest
sensitivity and specificity, while a cut-off WOMAC function score
of 48.5/100 yielded the highest sensitivity and specificity. Post-operatively,
a cut-off day two TUG time of 31.5 seconds for LOS and 30.9 seconds
for short-term function yielded the highest sensitivity and specificity. Conclusions The pre- and post-operative day two TUG can indicate hospital
LOS and short-term functional capacities, while the pre-operative
WOMAC function subscale can indicate short-term functional capacities. Cite this article: Bone Joint Res 2015;4:145–151.
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Affiliation(s)
- S Poitras
- University of Ottawa, Ottawa, Ontario, Canada
| | - K S Wood
- The Ottawa Hospital, Ottawa, Ontario, Canada
| | - J Savard
- University of Ottawa, Ottawa, Ontario, Canada
| | - G F Dervin
- The Ottawa Hospital, Ottawa, Ontario, Canada
| | - P E Beaule
- The Ottawa Hospital, Ottawa, Ontario, Canada
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