Physical Therapy Use and Associated Factors in Adults with and without Osteoarthritis-An Analysis of the Population-Based German Health Update Study

The impact of gender on outcomes following anatomic and reverse total shoulder arthroplasty

BACKGROUND

Total shoulder arthroplasty is a highly effective intervention for treating pain and dysfunction of the shoulder. Previous studies have suggested worse postoperative outcomes in women compared to men. This study aims to examine the impact of gender on pain and functional outcomes after anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA).

METHODS

A retrospective chart review from January 2007 to September 2022 was conducted on all-cause total shoulder replacement by 4 fellowship-trained orthopedic surgeons at a single level 1 trauma center. Demographic variables including age, gender, and race were queried. Outcomes of interest included active forward flexion, active external rotation, visual analog scale pain score, American Shoulder and Elbow Surgeons score, as well as readmission and revision rates.

RESULTS

Nine hundred and fifty-six total shoulder arthroplasty cases were reviewed, which included 426 aTSA (mean age 63.5 years, 50.5% female, 82.8% Caucasian) and 530 rTSAs (mean age 69.9 years, 58.5% female, 72.0% Caucasian) with an overall mean follow-up of 5.8 years. When comparing males to females in the aTSA cohort, no significant differences in range of motion emerged. Males did report significantly less pain at 6 months (0.75, P = .044). However, at most recent follow-up, pain and functional outcomes in the aTSA cohort were similar between males and females. No differences were noted for genders with respect to surgery duration (7.7 minutes, P = .153) nor for rates in postoperative readmission (0.017, P = .725) and revision (0.004, P = .824) by 1 year follow-up. When comparing males to females in the rTSA cohort, there were also no significantly different outcomes in range of motion. Additionally, while females reported more preoperative pain (1.14, P = .0064), pain and functional outcomes in the rTSA cohort were similar between males and females postoperatively.

CONCLUSION

This study shows minimal gender differences in shoulder arthroplasty outcomes, with both genders achieving similar long-term results in pain relief and function. Overall, outcomes are comparable, suggesting only minor gender-specific factors.

Identification of risk factors associated with early discontinuation of physical therapy following shoulder surgery

BACKGROUND

Postoperative physical therapy (POPT) is a critical aspect of patient recovery following orthopedic shoulder surgery. Despite the importance of POPT, some patients do not complete their course of physical therapy, which can affect postoperative recovery and outcomes. This study aimed to identify risk factors that influence patient adherence and attendance of POPT.

METHODS

Patients >90 days postop from elective shoulder surgery were retrospectively recruited for this study from an urban, academic tertiary medical center. Patient charts were reviewed for demographic factors with eligible patients being contacted via telephone call to answer a questionnaire concerning their use of POPT. Inadequate levels of POPT were defined as stopping formal physical therapy earlier than the physical therapist recommended. Final analysis cohorts were compared using Fisher's Exact Test and Wilcoxon Rank Sum Test.

RESULTS

A total of 104 patients were included in the final analysis with 84 completing POPT and 20 reporting having stopped therapy early. Patient medical history including elevated body mass index (mean significance difference 3.8, [0.018-7.6 95% CI]) (P = .026), being a smoker (P = .027), having diabetes (P < .001), and having Medicaid as their primary insurance (P = .008) were significantly associated with stopping physical therapy earlier than recommended by the physical therapist . Demographic factors such as requiring additional assistance to get to medical appointments (P = .012) and living farther away from a physical therapy center (P = .007) were also substantially associated with a greater risk of stopping physical therapy earlier than recommended by the physical therapist .

CONCLUSION

Elevated body mass index, tobacco use, diabetes, Medicaid enrollment status, requiring additional assistance to get to PT appointments, and living farther away from their physical therapy center are risk factors associated with patients stopping PT after elective shoulder surgery earlier than recommended by a physical therapist. Knowledge of these patient-specific risk factors should be considered by orthopedic surgeons and physical therapists when tailoring a POPT protocol.

Smartphone-assisted training with education for patients with hip and/or knee osteoarthritis (SmArt-E): study protocol for a multicentre pragmatic randomized controlled trial

Introduction

Hip and knee osteoarthritis are associated with functional limitations, pain and restrictions in quality of life and the ability to work. Furthermore, with growing prevalence, osteoarthritis is increasingly causing (in)direct costs. Guidelines recommend exercise therapy and education as primary treatment strategies. Available options for treatment based on physical activity promotion and lifestyle change are often insufficiently provided and used. In addition, the quality of current exercise programmes often does not meet the changing care needs of older people with comorbidities and exercise adherence is a challenge beyond personal physiotherapy. The main objective of this study is to investigate the short- and long-term (cost-)effectiveness of the SmArt-E programme in people with hip and/or knee osteoarthritis in terms of pain and physical functioning compared to usual care.

Methods

This study is designed as a multicentre randomized controlled trial with a target sample size of 330 patients. The intervention is based on the e-Exercise intervention from the Netherlands, consists of a training and education programme and is conducted as a blended care intervention over 12 months. We use an app to support independent training and the development of self-management skills. The primary and secondary hypotheses are that participants in the SmArt-E intervention will have less pain (numerical rating scale) and better physical functioning (Hip Disability and Osteoarthritis Outcome Score, Knee Injury and Osteoarthritis Outcome Score) compared to participants in the usual care group after 12 and 3 months. Other secondary outcomes are based on domains of the Osteoarthritis Research Society International (OARSI). The study will be accompanied by a process evaluation.

Discussion

After a positive evaluation, SmArt-E can be offered in usual care, flexibly addressing different care situations. The desired sustainability and the support of the participants’ behavioural change are initiated via the app through audio-visual contact with their physiotherapists. Furthermore, the app supports the repetition and consolidation of learned training and educational content. For people with osteoarthritis, the new form of care with proven effectiveness can lead to a reduction in underuse and misuse of care as well as contribute to a reduction in (in)direct costs.

Trial registration

German Clinical Trials Register, DRKS00028477. Registered on August 10, 2022.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-023-06255-7.

Association between weather and utilisation of physical therapy in patients with osteoarthritis: a case-crossover study

Background

During varied weather conditions, patients with osteoarthritis experience different severity of symptoms and signs. However, weather may also cause barriers or incentives for patients to seek medical services. These factors may result in changes in medical utilisation; however, no studies have investigated whether the probability of physical therapy utilisation among patients with osteoarthritis is associated with changes in meteorological factors.

Method

By using a secondary data of NHID in Taiwan, we conducted a population-based, retrospective study with case-crossover design for patients initially diagnosed with osteoarthritis between 2000 and 2013. The meteorological factors of months with the lowest treatment rate were used as patients’ own control periods and compared with the parameters of months with high treatment frequency. The risk of exposure to different meteorological factors, including mean temperature, daily highest temperature, daily minimum temperature, diurnal temperature range, relative humidity, and barometric pressure, was estimated and represented by odds ratios (ORs) and 95% confidence intervals (CIs).

Results

A total of 8,130 patients were recruited. Regardless of univariate or multivariable analysis, increased daily highest temperature enhanced the frequency of physical therapy (OR: 1.04; 95% CI: 1.02–1.05; p < 0.01; OR: 1.07; 95% CI: 1.04–1.10; p < 0.01). When the weather was hotter (> 23 °C), higher diurnal temperature range and humidity resulted in an increase in the utilisation of physical therapy. However, when the weather was colder (< 23 °C), reverse effects were observed.

Conclusions

An increase in temperature increases the probability of physical therapy resource use. Therefore, temperature, along with other meteorological factors, may play a key role in the utilization of physical therapy among patients with osteoarthritis.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-022-05233-9.