Primary Care of the (Near) Future: Exploring the Contribution of Digitalization and Remote Care Technologies through a Case Study

Predictive Factors of Inpatient Rehabilitation Stay and Post-Discharge Burden of Care After Joint Replacement for Hip and Knee Osteoarthritis: A Retrospective Study on 1678 Patients

The global demand for end-stage hip and knee osteoarthritis surgical treatment is rising, as is the need of optimal postoperative rehabilitation. Patient stratification is key to provide rehabilitation professionals and policy makers with real-life data in support of early discharge planning and continuous care provision. The aim of this retrospective, observational study was to investigate which factors can predict the burden of care at discharge (BCD) and the inpatient rehabilitation length of stay (LOS) based on a set of demographic, societal, clinical and organizational data collected from a high-volume orthopedic hospital. We included 45.306 variables from 1678 patients. All variables were initially tested individually using a linear regression model for inpatient rehabilitation LOS and a logistic regression model for BCD. Variables that resulted significant (p < 0.05) were subsequently considered in a single, comprehensive linear regression model, or a single, logistic regression model, respectively. Age, living with a family, occupational status, baseline Barthel Index and duration of surgery were predictors of inpatient rehabilitation LOS and BCD. Sex, primary or secondary osteoarthritis, American Society of Anesthesiologists score, body mass index, transfusion, biological risk, type of anesthesia, day of surgery, numeric pain rating scale and baseline cognitive function at baseline were not. Including specific patient comorbidities, surgical access technique and chronic use of pharmacological therapy can improve the predictive power of the model.

Developing Physiotherapy in Primary Health Care: A First Snapshot from the Italian Metropolitan City of Milan

INTRODUCTION

Since the COVID-19 pandemic, the Italian National Health Service (NHS) has been undergoing a structural reform shifting focus from hospital-centered care to smaller, intermediate, or primary health facilities closer to the community (e.g., community hospitals and community houses). This reorganization should include rehabilitation and physiotherapy, but the actual spread of these services is still unclear.

OBJECTIVE

This study explored the number and characteristics of community-based physiotherapy services in the Metropolitan City of Milan (Italy).

METHODS

Between April and May 2024, we distributed a structured, anonymous online survey about community physiotherapy services and users to all Directors of the Health and Social Care Professions Departments (DAPSS) in the Metropolitan City of Milan. We used descriptive statistics to analyze the number of community houses offering physiotherapy services, the specific intervention areas, and access modalities.

RESULTS

Six out of seven DAPSS Directors completed the survey (87%). Thirty-seven community houses were reported in the area, with fourteen of these offering physiotherapy services. In most of them, physiotherapy was a primary reason for access following a general practitioner's prescription. Five out of six responders reported that rehabilitation needs were mainly assessed by specialists in Physical and Rehabilitation Medicine, with physiotherapists involved in the assessment process in two cases. Physiotherapists primarily handled the intervention phase, dealing mainly with orthopedic and neurological conditions. DAPSS Directors noted that additional physiotherapy initiatives focusing on prevention will be implemented.

CONCLUSIONS

Physiotherapy services are becoming available in the Metropolitan City of Milan. However, more efforts are needed to facilitate access and ensure tailored assessment and effective interventions, particularly in preventive care. Future investigations should help to better define the number and the characteristics of the patients who can most benefit from this type of care, the number of sessions they need, and with what types of intervention; it would be also necessary to better define the communication network in the area that allows doctors, health professionals, and patients to be informed about this possibility.

The Impact of a Multicomponent Platform Intervention on the Daily Lives of Older Adults

Gerontechnology is an interdisciplinary field of research involving gerontology and technology in order to help older adults identify and slow down the effects of age-related physical and cognitive decline. It has enormous potential to allow individuals to remain in their own homes and improve their quality of life. This study aims to assess the impact of a multicomponent platform, consisting of an ambient sensor, wearable devices, and a cloud application, as an intervention in terms of usability and acceptance as primary outcomes and well-being, quality of life, and self-efficacy as secondary outcomes in a sample of 25 older adults aged over 65 after 21 days of non-supervised usage at home. This research involved the use of a mixed-methods approach, in which both qualitative and quantitative data were collected in three different measurements. Overall, the participants shared good engagement with the integrated platform. The system achieved positive results in terms of both usability and acceptance, especially the smartwatch. The state of complete well-being slightly improved over the period, whereas self-efficacy remained stable. This study demonstrates the ability of target users to use technology independently in their home environment: it strengthens the idea that this technology is ready for mainstream use and offers food for thought for developers who create products for the aging population.