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Mikami Y, Orita N, Yamasaki T, Kamijo Y, Kimura H, Adachi N. The Effect of Simultaneous Antigravity Treadmill Training and Electrical Muscle Stimulation After Total Hip Arthroplasty: Short Follow-Up Time. Ann Rehabil Med 2019; 43:474-482. [PMID: 31499601 PMCID: PMC6734026 DOI: 10.5535/arm.2019.43.4.474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 01/28/2019] [Indexed: 11/25/2022] Open
Abstract
Objective To assess the effectiveness of our devised hybrid physiotherapy regime using an anti-gravity treadmill and a low-frequency electrical stimulation device, as measured in patients with hip osteoarthritis after total hip arthroplasty (THA). Methods The outcomes of the postoperative rehabilitation in 44 patients who underwent THA for hip osteoarthritis were retrospectively examined. The conventional group (n=22) underwent the postoperative rehabilitation according to our protocol, while the hybrid group (n=22) underwent the same training, along with training on an anti-gravity treadmill and training using a low-frequency therapeutic device. The outcome measures were recorded and reviewed with the Numerical Rating Scale for pain, which rates pain on an 11-point scale from 0 to 10, surgical side knee joint extension force, 10-m walking test, Timed Up and Go test, and the 6-minute walking distance (6MD). The outcome measurement was taken 2 weeks after conducting pre-operation and antigravity treadmill training and electrical muscle stimulation, and compared the respective results. Results At the timeframe of 2 weeks from the surgery after conducting a devised hybrid physiotherapy, the values of knee extension muscle strength and 6MD were not worse in the hybrid group than conventional group. In the evaluation at 2 weeks after surgery, the knee extension muscle strength and 6MD values significantly decreased compared with the preoperative values only in the conventional group. Conclusion Lower limb muscular strength and endurance were maintained in the hybrid group, which suggested that hybrid physiotherapy could maintain physical functions early after THA operation.
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Affiliation(s)
- Yukio Mikami
- Department of Rehabilitation Medicine, Hiroshima University Hospital, Hiroshima, Japan
| | - Naoya Orita
- Division of Rehabilitation, Department of Clinical Practice and Support, Hiroshima University Hospital, Hiroshima, Japan
| | - Takuma Yamasaki
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Yoshiichiro Kamijo
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan
| | - Hiroaki Kimura
- Department of Rehabilitation Medicine, Hiroshima University Hospital, Hiroshima, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
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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: 11] [Impact Index Per Article: 2.2] [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: 125] [Impact Index Per Article: 25.0] [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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Thompson R, Novikov D, Cizmic Z, Feng JE, Fideler K, Sayeed Z, Meftah M, Anoushiravani AA, Schwarzkopf R. Arthrofibrosis After Total Knee Arthroplasty: Pathophysiology, Diagnosis, and Management. Orthop Clin North Am 2019; 50:269-279. [PMID: 31084828 DOI: 10.1016/j.ocl.2019.02.005] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Arthrofibrosis is the pathologic stiffening of a joint caused by an exaggerated inflammatory response. As a common complication following total knee arthroplasty (TKA), this benign-appearing connective tissue hyperplasia can cause significant disability among patients because the concomitant knee pain and restricted range of motion severely hinder postoperative rehabilitation, clinical outcomes, and basic activities of daily living. The most effective management for arthrofibrosis in the setting of TKA is prevention, including preoperative patient education programs, aggressive postoperative physical therapy regimens, and anti-inflammatory medications. Operative treatments include manipulation under anesthesia, arthroscopic debridement, and quadricepsplasty.
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Affiliation(s)
- Ryan Thompson
- Department of Orthopaedic Surgery, NYU Langone Orthopedics, NYU Langone Health, 301 East 17th Street, New York, NY 10003, USA; Department of Surgery, Chicago Medical School, North Chicago, IL, USA
| | - David Novikov
- Department of Orthopaedic Surgery, NYU Langone Orthopedics, NYU Langone Health, 301 East 17th Street, New York, NY 10003, USA
| | - Zlatan Cizmic
- Department of Orthopaedic Surgery, NYU Langone Orthopedics, NYU Langone Health, 301 East 17th Street, New York, NY 10003, USA
| | - James E Feng
- Department of Orthopaedic Surgery, NYU Langone Orthopedics, NYU Langone Health, 301 East 17th Street, New York, NY 10003, USA
| | - Kathryn Fideler
- Department of Orthopaedic Surgery, NYU Langone Orthopedics, NYU Langone Health, 301 East 17th Street, New York, NY 10003, USA; Department of Orthopaedic Surgery, Wexner Medical Center, Ohio State University, Columbus, OH, USA
| | - Zain Sayeed
- Department of Orthopaedic Surgery, NYU Langone Orthopedics, NYU Langone Health, 301 East 17th Street, New York, NY 10003, USA; Department of Surgery, Chicago Medical School, North Chicago, IL, USA
| | - Morteza Meftah
- Department of Orthopaedic Surgery, NYU Langone Orthopedics, NYU Langone Health, 301 East 17th Street, New York, NY 10003, USA
| | - Afshin A Anoushiravani
- Department of Orthopaedic Surgery, NYU Langone Orthopedics, NYU Langone Health, 301 East 17th Street, New York, NY 10003, USA; Department of Orthopaedic Surgery, Albany Medical Center, Albany, NY, USA
| | - Ran Schwarzkopf
- Division of Adult Reconstructive Surgery, Department of Orthopaedic Surgery, NYU Langone Orthopedics, NYU Langone Health, 301 East 17th Street, New York, NY 10003, USA.
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El-Gabalawy R, Sommer JL, Pietrzak R, Edmondson D, Sareen J, Avidan MS, Jacobsohn E. Post-traumatic stress in the postoperative period: current status and future directions. Can J Anaesth 2019; 66:1385-1395. [DOI: 10.1007/s12630-019-01418-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 04/19/2019] [Accepted: 04/22/2019] [Indexed: 11/24/2022] Open
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Topal B, Smelt HJ, Van Helden EV, Celik A, Verseveld M, Smeenk F, Pouwels S. Utility of preoperative exercise therapy in reducing postoperative morbidity after surgery; a clinical overview of current evidence. Expert Rev Cardiovasc Ther 2019; 17:395-412. [DOI: 10.1080/14779072.2019.1625771] [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] [Indexed: 12/15/2022]
Affiliation(s)
- Besir Topal
- Department of Cardiothoracic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | | | - Esmee V. Van Helden
- Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam/Schiedam, The Netherlands
| | - Alper Celik
- Department of Metabolic Surgery, Metabolic Surgery Clinic, Sisli, Istanbul, Turkey
| | - Maria Verseveld
- Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam/Schiedam, The Netherlands
| | - Frank Smeenk
- Department of Respiratory Medicine, Catharina Hospital, Eindhoven, The Netherlands
- SHE School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
| | - Sjaak Pouwels
- Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam/Schiedam, The Netherlands
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Shi X, Han J, Witchalls J, Waddington G, Adams R. Does treatment duration of manual therapy influence functional outcomes for individuals with chronic ankle instability: A systematic review with meta-analysis? Musculoskelet Sci Pract 2019; 40:87-95. [PMID: 30753998 DOI: 10.1016/j.msksp.2019.01.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 01/04/2019] [Accepted: 01/30/2019] [Indexed: 12/26/2022]
Abstract
QUESTION Can manual therapy improve functional outcomes for individuals with chronic ankle instability? DESIGN Systematic review with meta-analysis of randomized controlled trials. PARTICIPANTS Individuals with chronic ankle instability. INTERVENTION Manual therapy is defined as an intervention that involves joint mobilization, and mobilization with movement. OUTCOME MEASURE The primary outcome is patient reported function (PRF) questionnaires scores, the secondary outcomes are ankle dorsiflexion range of motion (DFROM) and balance control. RESULTS Four studies were included (n = 208, mean age = 24.4) in the meta-analysis, with moderate to high quality on the PEDro scale (range 6-8). For patient reported function (PRF) questionnaires, two studies reported significant improvement after six-session manual therapy measured by foot and ankle ability measures sport subscale (FAAMS) and Cumberland ankle instability tool (CAIT), respectively. For DFROM, one session manual therapy had no significant effect on the weight-bearing lunge test (WBLT) (3 studies, n = 147, SMD = 1.24 (95%CI -0.87 to 3.36), I2 = 96%) or non-weight-bearing inclinometer test (2 studies, n = 47, MD = 3.41° (95%CI -0.26 to 7.09),I2 = 43%), while six-sessions manual therapy showed, a significantly positive effect on WBLT(2 studies, n = 80, SMD = 2.39, (95% CI 0.55, to 4.23), I2 = 93%). For the SEBT, one-session manual therapy had no significant effect on overall star excursion balance test (SEBT) score (3 studies, n = 137,MD = 2.05,95%CI (-0.96,5.05), I2 = 75%), while qualitative analysis of 2 included studies showed significant improvement both on the SEBT score and single limb balance test (SLBT). CONCLUSIONS Six sessions rather than one session of manual therapy improves ankle functional performance for individuals with CAI. TRIAL REGISTRATION NUMBER PROSPERO CRD42017054715.
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Affiliation(s)
- Xiaojian Shi
- School of Kinesiology, Shanghai University of Sport, Shanghai, 200438, China.
| | - Jia Han
- School of Kinesiology, Shanghai University of Sport, Shanghai, 200438, China; Research Institute for Sport and Exercise, University of Canberra, ACT, 2601, Australia.
| | - Jeremy Witchalls
- Research Institute for Sport and Exercise, University of Canberra, ACT, 2601, Australia.
| | - Gordon Waddington
- Research Institute for Sport and Exercise, University of Canberra, ACT, 2601, Australia.
| | - Roger Adams
- Research Institute for Sport and Exercise, University of Canberra, ACT, 2601, Australia.
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Kwaees TA, Richards J, Rawlinson G, Charalambous CP, Chohan A. Can the use of proprioceptive knee braces have implications in the management of osteoarthritic knees: An exploratory study. Prosthet Orthot Int 2019; 43:140-147. [PMID: 30284952 DOI: 10.1177/0309364618796852] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND: Use of proprioceptive knee braces to control symptomology by altering neuromuscular control mechanisms has been shown in patellofemoral pain. Although their potential in patients with knee osteoarthritis is vast, little research has examined their efficacy. OBJECTIVES: This study examines the effect of a proprioceptive knee brace on lower limb kinematics and kinetics in healthy participants and in participants with OA. METHODS: Thirteen healthy participants were asked to perform a 10-cm step-down task with and without a proprioceptive brace. Data were collected using a 10-camera Qualisys system. Individuals with osteoarthritis completed the Knee injury and Osteoarthritis Outcome Score before and after 4 weeks of intervention. RESULTS: During step-down reductions in knee maximum internal rotation, transverse range of movement, transverse plane angular velocity and maximum internal rotation angular velocity was seen. Ankle plantar flexion and inversion angular velocity decreased while inversion and maximum supination angular velocity increased. Improvements in Knee injury and Osteoarthritis Outcome Score were noted across all parameters with brace use. CONCLUSION: Positive changes in kinematic variables in multiple planes can be achieved with proprioceptive bracing alongside improved patient outcome. These changes occur at the knee but analysis of other weight bearing joints should not be overlooked in future studies. This study supports the concept of neuromuscular reinforcement and re-education through proprioceptive bracing and its application in the management in knee osteoarthritis. CLINICAL RELEVANCE Proprioception can alter symptoms and biomechanics embraced and adjacent lower limb joints. The results of this study highlights the potential uses of non-mechanical bracing in the treatment of osteoarthritis and other potential to bridge the osteoarthritis treatment gap. Furthermore, large-scale research is needed to match disease subset to brace type.
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Harbourne AD, Sanchez-Santos MT, Arden NK, Filbay SR. Predictors of return to desired activity 12 months following unicompartmental and total knee arthroplasty. Acta Orthop 2019; 90:74-80. [PMID: 30451046 PMCID: PMC6366469 DOI: 10.1080/17453674.2018.1542214] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - 1 in 5 patients are dissatisfied following unicompartmental or total knee arthroplasty (UKA or TKA). This may be partly explained by failing to return to desired activity post-arthroplasty. To facilitate return to desired activity, a greater understanding of predictors of return to desired activity in UKA and TKA patients is needed. We compared rates of return to desired activity 12 months following UKA vs. TKA, and identified and compared predictors of return to desired activity 12 months following UKA vs. TKA. Patients and methods - Patients were prospectively recruited from 2 hospitals prior to undergoing UKA or primary TKA. Patients reported preoperatively the activity/activities that were limited due to their knee that they wished to return to after arthroplasty. At 12-months postoperatively, patients reported whether they had returned to these activities ('return to desired activity'). Preoperative predictors evaluated were age, sex, BMI, education, comorbidities, pain expectations, Oxford Knee Score (OKS), UCLA Activity Score, and EQ-5D. Generalized linear models assessed the relationship between potential predictors and return-to-desired-activity. Results - The response rate of all patients eligible for 12-month follow-up was 74%. TKA patients (n = 575) were older (mean (SD) 70 (9) vs. 67 (10)) with a greater BMI (31 (6) vs. 30 (5)) than patients undergoing UKA (n = 420). 75% of UKA and 59% of TKA patients returned to desired activity. TKA patients had a greater risk of non-return to desired activity than patients undergoing UKA (risk ratio (95% CI) 1.5 (1.2-1.8)). Predictors of non-return to desired activity following UKA were worse OKS (0.96 (0.93-0.99)), higher BMI (1.04 (1.01-1.08)), and worse expectations (1.9 (1.2-2.8)). Predictors of non-return to desired activity following TKA were worse EQ-5D (0.53 (0.33-0.85)) and worse OKS (0.98 (0.96-1.0)). Interpretation - UKA patients were more likely to return to desired activity than TKA patients. Predictors of return to desired activity differed following UKA and TKA. Optimizing selection of arthroplasty procedure based on patient characteristics and targeting predictors of poor outcome may facilitate return to desired activity with potential to enhance postoperative satisfaction.
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MESH Headings
- Activities of Daily Living/psychology
- Arthroplasty, Replacement, Knee/adverse effects
- Arthroplasty, Replacement, Knee/methods
- Arthroplasty, Replacement, Knee/psychology
- Arthroplasty, Replacement, Knee/rehabilitation
- Female
- Follow-Up Studies
- Humans
- Karnofsky Performance Status
- Knee Joint/physiopathology
- Knee Joint/surgery
- Male
- Middle Aged
- Osteoarthritis, Knee/surgery
- Pain, Postoperative/diagnosis
- Pain, Postoperative/psychology
- Patient Satisfaction
- Patient Selection
- Prognosis
- Quality of Life
- Recovery of Function
- Risk Assessment/methods
- Risk Factors
- United Kingdom
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Affiliation(s)
- Alexander D Harbourne
- Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Oxford, UK
| | - Maria T Sanchez-Santos
- Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Oxford, UK
| | - Nigel K Arden
- Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Oxford, UK
- MRC Lifecourse Epidemiology Unit, University of Southampton, UK
| | - Stephanie R Filbay
- Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Oxford, UK
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Abstract
PURPOSE OF REVIEW This review focuses on studies published during July 2001 to August 2017 of exercise as an intervention in knee and hip osteoarthritis, including its influence on an array of patient outcomes. RECENT FINDINGS Studies continue to illustrate the efficacy of exercise in treating and managing osteoarthritis, with current literature more focused on the knee compared with the hip joint. Both traditional (e.g. strength, aerobic, flexibility) and more nontraditional (e.g. yoga, Tai Chi, aquatic) training modes improve patient outcomes related to joint symptoms, mobility, quality of life, psychological health, musculoskeletal properties, body composition, sleep, and fatigue. Exercise that is adequately dosed (e.g. frequency, intensity) and progressive in nature demonstrated the greatest improvements in patient outcomes. Supervised, partially supervised, and nonsupervised interventions can be successful in the treatment of osteoarthritis, but patient preference regarding level of supervision and mode of exercise may be key predictors in exercise adherence and degree of outcome improvement. A topic of increasing interest in osteoarthritis is the supplementary role of behavior training in exercise interventions. SUMMARY Osteoarthritis is a complex, multifactorial disease that can be successfully managed and treated through exercise, with minimal risk for negative consequences. However, to have greatest impact, appropriate exercise prescription is needed. Efforts to achieve correct exercise doses and mitigate patient nonadherence are needed to lessen the lifelong burden of osteoarthritis.
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61
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Adie S, Harris I, Chuan A, Lewis P, Naylor JM. Selecting and optimising patients for total knee arthroplasty. Med J Aust 2019; 210:135-141. [DOI: 10.5694/mja2.12109] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Sam Adie
- St George and Sutherland Clinical SchoolUNSW Sydney NSW
- St George Hospital Sydney NSW
| | - Ian Harris
- South Western Sydney Clinical SchoolUNSW Sydney NSW
| | - Alwin Chuan
- South Western Sydney Clinical SchoolUNSW Sydney NSW
- Liverpool Hospital Sydney NSW
| | | | - Justine M Naylor
- South Western Sydney Clinical SchoolUNSW Sydney NSW
- South Western Sydney Local Health District Sydney NSW
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Negm AM, Kennedy CC, Ioannidis G, Gajic-Veljanoski O, Lee J, Thabane L, Adachi JD, Marr S, Lau A, Atkinson S, Petruccelli D, DeBeer J, Winemaker M, Avram V, Deheshi B, Williams D, Armstrong D, Lumb B, Panju A, Richardson J, Papaioannou A. Getting fit for hip and knee replacement: a protocol for the Fit-Joints pilot randomized controlled trial of a multi-modal intervention in frail patients with osteoarthritis. Pilot Feasibility Stud 2018; 4:127. [PMID: 30038794 PMCID: PMC6053795 DOI: 10.1186/s40814-018-0316-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 07/04/2018] [Indexed: 01/29/2023] Open
Abstract
Background Joint replacement provides significant improvements in pain, physical function, and quality of life in patients with osteoarthritis. With a growing body of evidence indicating that frailty can be treated, it is important to determine whether targeting frailty reduction in hip and knee replacement patients improves post-operative outcomes. Objectives The primary objective is to examine the feasibility of a parallel group RCT comparing a preoperative multi-modal frailty intervention to usual care in pre-frail/frail older adults undergoing elective unilateral hip or knee replacements. The secondary objectives areTo explore potential efficacy of the multi-modal frailty intervention in improving frailty and mobility between baseline and 6 weeks post-surgery using Fried frailty phenotype and short performance physical battery (SPPB) respectively. To explore potential efficacy of the multi-modal frailty intervention on post-operative healthcare services use.
Methods/Design In a parallel group pilot RCT, participants will be recruited from the Regional Joint Assessment Program in Hamilton, Canada. Participants who are (1) ≥ 60 years old; (2) pre-frail (score of 1 or 2) or frail (score of 3–5; Fried frailty phenotype); (3) having elective unilateral hip or knee replacement; and (4) having surgery wait times between 3 and 10 months will be recruited and randomized to either the intervention or usual care group. The multi-modal frailty intervention components will include (1) tailored exercise program (center-based and/or home-based) with education and cognitive behavioral change strategies; (2) protein supplementation; (3) vitamin D supplementation; and (4) medication review. The main comparative analysis will take place at 6 weeks post-operative. The outcome assessors, data entry personnel, and data analysts are blinded to treatment allocation. Assessments: feasibility will be assessed by recruitment rate, retention rate, and data collection completion. Frailty and healthcare use and other clinical outcomes will be assessed. The study outcomes will be collected at the baseline, 1 week pre-operative, and 6 weeks and 6 months post-operative. Discussion This is the first study to examine the feasibility of multi-modal frailty intervention in pre-frail/frail older adults undergoing hip or knee replacement. This study will inform the planning and designing of multi-modal frailty interventional studies in hip and knee replacement patients. Trial registration ClinicalTrials.govNCT02885337 Electronic supplementary material The online version of this article (10.1186/s40814-018-0316-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ahmed M Negm
- 1Geriatric Education and Research for the Aging Sciences (GERAS), St Peter's Hospital, 88 Maplewood Ave, Hamilton, ON L8M 1W9 Canada.,2School of Rehabilitation Sciences, IAHS 403, McMaster University, 1400 Main Street West, Hamilton, ON L8S 1C7A Canada
| | - Courtney C Kennedy
- 1Geriatric Education and Research for the Aging Sciences (GERAS), St Peter's Hospital, 88 Maplewood Ave, Hamilton, ON L8M 1W9 Canada
| | - George Ioannidis
- 1Geriatric Education and Research for the Aging Sciences (GERAS), St Peter's Hospital, 88 Maplewood Ave, Hamilton, ON L8M 1W9 Canada
| | - Olga Gajic-Veljanoski
- 1Geriatric Education and Research for the Aging Sciences (GERAS), St Peter's Hospital, 88 Maplewood Ave, Hamilton, ON L8M 1W9 Canada
| | - Justin Lee
- 1Geriatric Education and Research for the Aging Sciences (GERAS), St Peter's Hospital, 88 Maplewood Ave, Hamilton, ON L8M 1W9 Canada.,3Department of Medicine, McMaster University, 1280 Main St West, Hamilton, ON L8S 4L8 Canada
| | - Lehana Thabane
- 4Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St West, Hamilton, ON L8S 4L8 Canada.,5Department of Pediatrics, McMaster University, 1280 Main St West, Hamilton, ON L8S 4L8 Canada.,6Biostatistics Unit, St Joseph's Healthcare-Hamilton, 50 Charlton Avenue East, Hamilton, Ontario L8N 4A6 Canada
| | - Jonathan D Adachi
- 3Department of Medicine, McMaster University, 1280 Main St West, Hamilton, ON L8S 4L8 Canada
| | - Sharon Marr
- 1Geriatric Education and Research for the Aging Sciences (GERAS), St Peter's Hospital, 88 Maplewood Ave, Hamilton, ON L8M 1W9 Canada.,3Department of Medicine, McMaster University, 1280 Main St West, Hamilton, ON L8S 4L8 Canada
| | - Arthur Lau
- 3Department of Medicine, McMaster University, 1280 Main St West, Hamilton, ON L8S 4L8 Canada
| | - Stephanie Atkinson
- 5Department of Pediatrics, McMaster University, 1280 Main St West, Hamilton, ON L8S 4L8 Canada
| | - Danielle Petruccelli
- 7Department of Surgery, Division of Orthopaedics, McMaster University, 1280 Main St West, Hamilton, Ontario L8S 4L8 Canada
| | - Justin DeBeer
- 7Department of Surgery, Division of Orthopaedics, McMaster University, 1280 Main St West, Hamilton, Ontario L8S 4L8 Canada
| | - Mitchell Winemaker
- 7Department of Surgery, Division of Orthopaedics, McMaster University, 1280 Main St West, Hamilton, Ontario L8S 4L8 Canada
| | - Victoria Avram
- 7Department of Surgery, Division of Orthopaedics, McMaster University, 1280 Main St West, Hamilton, Ontario L8S 4L8 Canada
| | - Benjamin Deheshi
- 7Department of Surgery, Division of Orthopaedics, McMaster University, 1280 Main St West, Hamilton, Ontario L8S 4L8 Canada
| | - Dale Williams
- 7Department of Surgery, Division of Orthopaedics, McMaster University, 1280 Main St West, Hamilton, Ontario L8S 4L8 Canada
| | - David Armstrong
- 3Department of Medicine, McMaster University, 1280 Main St West, Hamilton, ON L8S 4L8 Canada
| | - Barry Lumb
- 3Department of Medicine, McMaster University, 1280 Main St West, Hamilton, ON L8S 4L8 Canada
| | - Akbar Panju
- 3Department of Medicine, McMaster University, 1280 Main St West, Hamilton, ON L8S 4L8 Canada
| | - Julie Richardson
- 2School of Rehabilitation Sciences, IAHS 403, McMaster University, 1400 Main Street West, Hamilton, ON L8S 1C7A Canada
| | - Alexandra Papaioannou
- 1Geriatric Education and Research for the Aging Sciences (GERAS), St Peter's Hospital, 88 Maplewood Ave, Hamilton, ON L8M 1W9 Canada.,3Department of Medicine, McMaster University, 1280 Main St West, Hamilton, ON L8S 4L8 Canada.,4Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St West, Hamilton, ON L8S 4L8 Canada
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Liu SC, Hou ZL, Tang QX, Qiao XF, Yang JH, Ji QH. Effect of knee joint function training on joint functional rehabilitation after knee replacement. Medicine (Baltimore) 2018; 97:e11270. [PMID: 29995759 PMCID: PMC6076101 DOI: 10.1097/md.0000000000011270] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
This retrospective study investigated the effect of knee joint function training (KJFT) on joint functional rehabilitation after knee replacement in Chinese patients with severe knee osteoarthritis (KOA).Eighty-six eligible patients with severe KOA were included. Of those, 43 patients in the intervention group received KJFT and educational program, while the other 43 patients received educational program only. Primary outcome was measured by the Western Ontario and McMaster Universities Arthritis Index (WOMAC). Secondary outcomes were measured by the visual analogue scale (VAS), and Knee Injury and Osteoarthritis Outcome Score (KOOS). All outcomes were assessed at baseline, 1 week before and 3 months after the surgery.Patients in the intervention group showed encouraging benefit neither at 1 week before nor 3 months after the surgery in all outcome measurements, including WOMAC, VAS, and KOOS, when compared with the patients in the control group.The results of this study did not show promising effect of KJFT for joint functional rehabilitation in Chinese patients with KOA after KJR.
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MESH Headings
- Aged
- Arthroplasty, Replacement, Knee/adverse effects
- Arthroplasty, Replacement, Knee/methods
- Arthroplasty, Replacement, Knee/rehabilitation
- Exercise Therapy/methods
- Female
- Humans
- Knee Joint/physiopathology
- Male
- Osteoarthritis, Knee/surgery
- Outcome Assessment, Health Care
- Pain Measurement/methods
- Pain, Postoperative/diagnosis
- Pain, Postoperative/therapy
- Patient Education as Topic
- Quality of Life
- Range of Motion, Articular
- Recovery of Function
- Treatment Outcome
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Affiliation(s)
- Shi-chen Liu
- First Ward of Orthopedics Department, First Affiliated Hospital of Jiamusi University, Jiamusi
| | - Zhi-ling Hou
- Department of Emergency Surgery, First Affiliated Hospital of Jiamusi University, Jiamusi
| | - Qing-xi Tang
- Department of Emergency Surgery, First Affiliated Hospital of Jiamusi University, Jiamusi
| | - Xiao-feng Qiao
- First Ward of Orthopedics Department, First Affiliated Hospital of Jiamusi University, Jiamusi
| | - Jian-hua Yang
- Department of Orthopedics, Longgang District People's Hospital of Shenzhen, Shenzhen, Guangdong, China
| | - Qing-hui Ji
- First Ward of Orthopedics Department, First Affiliated Hospital of Jiamusi University, Jiamusi
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Physical Activity and Exercise Therapy Benefit More Than Just Symptoms and Impairments in People With Hip and Knee Osteoarthritis. J Orthop Sports Phys Ther 2018; 48:439-447. [PMID: 29669488 DOI: 10.2519/jospt.2018.7877] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Synopsis Osteoarthritis (OA) of the hip and knee is among the leading causes of global disability, highlighting the need for early, targeted, and effective treatment. The benefits of exercise therapy in people with hip and knee OA are substantial and supported by high-quality evidence, underlining that it should be part of first-line treatment in clinical practice. Furthermore, unlike other treatments for OA, such as analgesia and surgery, exercise therapy is not associated with risk of serious harm. Helping people with OA become more physically active, along with structured exercise therapy targeting symptoms and impairments, is crucial, considering that the majority of people with hip and knee OA do not meet physical activity recommendations. Osteoarthritis is associated with a range of chronic comorbidities, including type 2 diabetes, cardiovascular disease, and dementia, all of which are associated with chronic low-grade inflammation. Physical activity and exercise therapy not only improve symptoms and impairments of OA, but are also effective in preventing at least 35 chronic conditions and treating at least 26 chronic conditions, with one of the potential working mechanisms being exercise-induced anti-inflammatory effects. Patient education may be crucial to ensure long-term adherence and sustained positive effects on symptoms, impairments, physical activity levels, and comorbidities. J Orthop Sports Phys Ther 2018;48(6):439-447. Epub 18 Apr 2018. doi:10.2519/jospt.2018.7877.
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65
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What is the current evidence of the impact on quality of life whilst waiting for management/treatment of orthopaedic/musculoskeletal complaints? A systematic scoping review. Qual Life Res 2018; 27:2227-2242. [PMID: 29611148 DOI: 10.1007/s11136-018-1846-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2018] [Indexed: 12/29/2022]
Abstract
PURPOSE To describe quality of life (QoL) outcome measures that are reported in the literature in patients waiting for outpatient orthopaedic/musculoskeletal specialist care and how waiting impacts on QoL in these terms. METHODS A subset of studies reporting on QoL outcome measures were extracted from literature identified in a recent scoping search of Medline, Embase, Pubmed, NHS Economic Evaluation Database (Prospero registration CRD42016047332). The systematic scoping search examined impacts on patients waiting for orthopaedic specialist care. Two independent reviewers ranked study design using the National Health and Medical Research Council aetiology evidence hierarchy, and appraised study quality using Critical Appraisal Skills Programme tools. QoL measures were mapped against waiting period timepoints. RESULTS The scoping search yielded 142 articles, of which 18 reported on impact on QoL. These studies reported only on patients waiting for hip and/or knee replacement surgery. The most recent study reported on data collected in 2006/7. The Western Ontario and McMaster Universities Arthritis Index and the SF-36 were the most commonly reported QoL measures. QoL was measured at variable timepoints in the waiting period (from a few weeks to greater than 12 months). The impact of waiting on QoL was inconsistent. CONCLUSION The evidence base was over 10 years old, reported only on patients with hip and knee problems, and on limited QoL outcome measures, and with inconsistent findings. A better understanding of the impact on QoL for patients waiting for specialist care could be gained by using standard timepoints in the waiting period, patients with other orthopaedic conditions, comprehensive QoL measures, as well as expectations, choices and perspectives of patients waiting for specialist care.
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66
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Chabaud A, Eschalier B, Zullian M, Plan-Paquet A, Aubreton S, Saragaglia D, Descamps S, Coudeyre E. Mixed qualitative and quantitative approach for validating an information booklet before total hip arthroplasty. Ann Phys Rehabil Med 2018; 61:140-143. [PMID: 29499381 DOI: 10.1016/j.rehab.2018.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 02/08/2018] [Accepted: 02/09/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Providing patients with validated information before total hip arthroplasty may help lessen discrepancies between patients' expectations and the surgical result. This study sought to validate an information booklet for candidates for hip arthroplasty by using a mixed qualitative and quantitative approach based on a panel of patients and a sample of healthcare professionals. METHODS We developed a booklet in accordance with the standard methods and then conducted focus groups to collect the opinions of a sample of multidisciplinary experts involved in the care of patients with hip osteoarthritis. The number of focus groups and experts was determined according to the data saturation principle. A panel of patients awaiting hip arthroplasty or those in the immediate post-operative period assessed the booklet with self-reporting questionnaires (knowledge, beliefs, and expectations) and semi-structured interviews. RESULTS All experts and both patient groups validated the booklet in terms of content and presentation. Semi-structured interviews were uninformative, especially for post-operative patients. Reading the booklet significantly (P<0.001) improved the knowledge scores in both groups, with no intergroup differences, but did not affect beliefs in either patient group. Only pre-operative patients significantly changed their expectations. CONCLUSION Our mixed qualitative and quantitative approach allowed us to validate a booklet for patients awaiting hip arthroplasty, taking into account the opinions of both patients and healthcare professionals.
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Affiliation(s)
- Aurore Chabaud
- Service de médecine physique et de réadaptation, INRA, université Clermont-Auvergne, CHU de Clermont-Ferrand, 63000 Clermont Ferrand, France
| | - Bénédicte Eschalier
- Département de médecine générale, université Clermont-Auvergne, Clermont-Ferrand, 63000, France
| | - Myriam Zullian
- Service de médecine physique et de réadaptation, hôpital rhumatologique, 38410 Uriage, France
| | - Anne Plan-Paquet
- Service de médecine physique et de réadaptation, INRA, université Clermont-Auvergne, CHU de Clermont-Ferrand, 63000 Clermont Ferrand, France
| | - Sylvie Aubreton
- Service de médecine physique et de réadaptation, INRA, université Clermont-Auvergne, CHU de Clermont-Ferrand, 63000 Clermont Ferrand, France
| | - Dominique Saragaglia
- Service de chirurgie orthopédique et de traumatologie du sport, CHU Grenoble-Echirolles, 38000 Grenoble, France
| | - Stéphane Descamps
- Service de chirurgie orthopédique et traumatologie, CNRS, SIGMA-Clermont, ICCF, université Clermont-Auvergne, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Emmanuel Coudeyre
- Service de médecine physique et de réadaptation, INRA, université Clermont-Auvergne, CHU de Clermont-Ferrand, 63000 Clermont Ferrand, France.
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Westby MD, Marshall DA, Jones CA. Development of quality indicators for hip and knee arthroplasty rehabilitation. Osteoarthritis Cartilage 2018; 26:370-382. [PMID: 29292095 DOI: 10.1016/j.joca.2017.10.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 10/24/2017] [Accepted: 10/25/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To develop quality indicators (QIs) reflecting the minimum acceptable standard of rehabilitation care before and after elective total hip arthroplasty (THA) and total knee arthroplasty (TKA) for osteoarthritis (OA). METHODS Informed by high quality evidence and using a modified RAND-UCLA Delphi approach, an 18-member Canadian panel of clinicians, researchers and patients considered 81 proposed QIs (40 for THA, 42 for TKA) addressing rehabilitation before and after elective THA and TKA. Panelists rated QIs for their importance and validity on a 9-point Likert scale through two rounds of online rating interspersed with a moderated and anonymous online discussion forum. Those QIs with median ratings of ≥7 for importance and validity with no disagreement based on the inter-percentile range adjusted for symmetry were included in the final sets. RESULTS Fifteen panelists from seven provinces and varied practice settings completed the Delphi process. Of the 81 plus one additional QIs (total of 82), 67 (82%) were rated as both important and valid (31 for THA, 36 for TKA). For THA, 14 pre-op, six acute and eight post-acute QIs were accepted. For TKA, 16 pre-op, 10 acute and eight post-acute indicators were accepted. Two of three 'across-continuum' QIs were rated appropriate for both procedures. CONCLUSION This work represents the first QIs with which to measure, report and benchmark quality of care in patients receiving rehabilitation before and after THA/TKA surgery. The QIs will be further tested for reliability and feasibility before being widely disseminated in clinical settings and used to assess care gaps.
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Affiliation(s)
- M D Westby
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, 2635 Laurel Street, Vancouver, British Columbia, V5Z 1M9, Canada.
| | - D A Marshall
- Department of Community Health Sciences, Arthur JE Child Chair in Rheumatology Research, University of Calgary, Calgary, Alberta, Canada
| | - C A Jones
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
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Feng JE, Novikov D, Anoushiravani AA, Schwarzkopf R. Total knee arthroplasty: improving outcomes with a multidisciplinary approach. J Multidiscip Healthc 2018; 11:63-73. [PMID: 29416347 PMCID: PMC5790068 DOI: 10.2147/jmdh.s140550] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Total knee arthroplasty (TKA) is the most commonly performed inpatient surgical procedure within the USA and is estimated to reach 3.48 million procedures annually by 2030. As value-based care initiatives continue to focus on hospital readmission rates and patient satisfaction, it has become essential for health care providers to develop and implement a multidisciplinary approach to enhance TKA outcomes while minimizing unnecessary expenditures. Through this necessity, clinical care pathways have been developed to standardize, organize, and improve the quality and efficiency of patient care while simultaneously encouraging the collaboration among various medical care providers. Here, we review several systems based programs and specialty care practices that can be adopted into the standard orthopedic practice.
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Affiliation(s)
- James E Feng
- Division of Adult Reconstructive Surgery, NYU Langone Orthopedics, NYU Langone Health, New York, NY, USA
| | - David Novikov
- Division of Adult Reconstructive Surgery, NYU Langone Orthopedics, NYU Langone Health, New York, NY, USA
| | - Afshin A Anoushiravani
- Division of Adult Reconstructive Surgery, NYU Langone Orthopedics, NYU Langone Health, New York, NY, USA
| | - Ran Schwarzkopf
- Division of Adult Reconstructive Surgery, NYU Langone Orthopedics, NYU Langone Health, New York, NY, USA
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Influence of anxiety and pain catastrophizing on the course of pain within the first year after uncomplicated total knee replacement: a prospective study. Arch Orthop Trauma Surg 2017; 137:1735-1742. [PMID: 28965133 DOI: 10.1007/s00402-017-2797-5] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Indexed: 02/09/2023]
Abstract
PURPOSE Prolonged postoperative pain is a frequent problem after uncomplicated total knee replacement (TKR). The purpose of this study was to evaluate the effect of anxiety and pain catastrophizing on postoperative pain after TKR. METHODS A total of 150 patients were enrolled in this prospective study. Preoperatively, anxiety was assessed using the State-Trait Anxiety Inventory (STAI) and pain catastrophizing was assessed using the Pain Catastrophizing Scale (PCS). The primary outcome measure was postoperative pain on a numerical rating scale (NRS). The secondary outcome parameters were the different Knee Osteoarthritis Outcome Score (KOOS) subscales and patient satisfaction. Intergroup differences were tested with an independent t test. The odds ratio was calculated to determine the probability of an unsatisfactory outcome. RESULTS Preoperatively and at 6 and 12 months postoperatively, patients with anxiety and particularly patients with pain catastrophizing usually had a higher NRS score, lower knee function before and after surgery, and higher dissatisfaction. These intergroup differences were significant preoperatively and at 6 months postoperatively. CONCLUSIONS Psychopathologic factors, particularly pain catastrophizing, have an impact on postoperative pain after TKR. Preoperative screening and concurrent treatment of the diagnosed psychological disorder may improve patient-perceived outcomes.
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Umehara T, Tanaka R. Effective exercise intervention period for improving body function or activity in patients with knee osteoarthritis undergoing total knee arthroplasty: a systematic review and meta-analysis. Braz J Phys Ther 2017; 22:265-275. [PMID: 29174345 DOI: 10.1016/j.bjpt.2017.10.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 10/20/2017] [Accepted: 10/26/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Various systematic reviews and/or meta-analyses examining the effects of pre- or postoperative exercise on body function or activity in patients undergoing total knee arthroplasty (TKA) have been published. However, the interventional period needed to at least improve outcomes is unknown. OBJECTIVE The aim of this systematic review and meta-analysis was to investigate the exercise intervention period needed to effectively improve body function or activity before and after TKA in patients with knee osteoarthritis (OA). METHODS Studies published until July 2017 were included in the review. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was applied to each meta-analysis to determine the quality of the evidence. RESULTS Twenty-seven randomized controlled trials were identified. A meta-analysis indicated that exercises performed for 8 weeks after discharge in addition to standard postoperative intervention effectively improved body function as assessed using pain level; physical function, and stiffness on the Western Ontario and McMaster Universities Arthritis Index; extension strength; active knee flexion range of motion; timed up and go test; and gait speed. CONCLUSION Overall, we found low- to moderate-quality evidence that an 8-week exercise period was needed after discharge to improve body function and activity in patients with knee OA undergoing TKA.
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Affiliation(s)
- Takuya Umehara
- Department of Rehabilitation, Saiseikai Kure Hospital, Kure, Japan.
| | - Ryo Tanaka
- Department of Rehabilitation, Hiroshima International University, Higashihiroshima, Japan
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Effect of Land-Based Generic Physical Activity Interventions on Pain, Physical Function, and Physical Performance in Hip and Knee Osteoarthritis: A Systematic Review and Meta-Analysis. Am J Phys Med Rehabil 2017; 96:773-792. [PMID: 28323761 DOI: 10.1097/phm.0000000000000736] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the effects of land-based generic physical activity interventions on pain, physical function, and physical performance in individuals with hip/knee osteoarthritis, when compared with a control group that received no intervention, minimal intervention, or usual care. METHODS A systematic search for randomized controlled trials on 11 electronic databases (from their inception up until April 30, 2016) identified 27 relevant articles. According to the compendium of physical activities, interventions were categorized into: recreational activities (tai chi/Baduajin-6 articles), walking (9 articles), and conditioning exercise (12 articles). RESULTS Meta-analysis for recreational activity (n = 3) demonstrated significant mean difference (MD) of -9.56 (95% confidence interval [CI], -13.95 to -5.17) for physical function (Western Ontario and McMaster Universities Arthritis Index) at 3 mos from randomization. Pooled estimate for walking intervention was not significant for pain intensity and physical performance but was significant for physical function (n = 2) with a MD of -10.38 (95% CI, -12.27 to -8.48) at 6 mos. Meta-analysis for conditioning exercise was significant for physical function (n = 3) with a MD of -3.74 (95% CI, -5.70 to -1.78) and physical performance (6-minute walk test) with a MD of 42.72 m (95% CI, 27.78, 57.66) at 6 mos. The timed stair-climbing test (n = 2) demonstrated a significant effect at 18 mos with a MD of -0.49 secs (95% CI, -0.75 to -0.23). CONCLUSION Very limited evidence to support recreational activity and walking intervention was found for knee osteoarthritis, in the short-term on pain and physical function, respectively.
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72
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Joice MG, Bhowmick S, Amanatullah DF. Perioperative Physiotherapy in Total Knee Arthroplasty. Orthopedics 2017; 40:e765-e773. [PMID: 28530765 DOI: 10.3928/01477447-20170518-03] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 10/31/2016] [Indexed: 02/03/2023]
Abstract
Total knee arthroplasty has a high success rate. In the interest of enhancing patient outcomes, numerous perioperative interventions have been studied, including preoperative education, preoperative rehabilitation, postoperative inpatient rehabilitation, continuous passive motion, postoperative outpatient rehabilitation, unsupervised in-home exercises, telerehabilitation, and various combinations of these. This comprehensive review analyzes the existing body of evidence on these perioperative interventions and examines some burgeoning opportunities in rehabilitation after total knee arthroplasty in the interest of improving patient outcomes and ensuring sustainable health care utilization for the future of total knee arthroplasty. [Orthopedics. 2017; 40(5):e765-e773.].
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Eschalier B, Descamps S, Pereira B, Vaillant-Roussel H, Girard G, Boisgard S, Coudeyre E. Randomized blinded trial of standardized written patient information before total knee arthroplasty. PLoS One 2017; 12:e0178358. [PMID: 28678854 PMCID: PMC5497941 DOI: 10.1371/journal.pone.0178358] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 05/10/2017] [Indexed: 12/13/2022] Open
Abstract
Background The effect of patient education before total knee arthroplasty (TKA) is controversial. No consensus exists about the optimal content of educational interventions. In a previous study, we developed and validated an educational booklet on the peri-TKA management of knee osteoarthritis. Purposes Our primary purpose was to evaluate the impact of the educational booklet on knowledge among patients awaiting TKA. Patients and methods This randomized controlled single-blind trial evaluated standard information by the surgeon with or without delivery of the educational booklet 4–6 weeks before primary noncomplex TKA in patients aged 55–75 years with incapacitating knee osteoarthritis. Patients were enrolled at a French surgical center between June 2011 and January 2012. A patient knowledge score was determined at baseline, on the day before TKA, and 3–6 weeks after TKA, using a self-administered questionnaire developed for our previous study. The assessor was blinded to group assignment. Results Of 44 eligible patients, 42 were randomized, 22 to the intervention and 20 to the control group, all of whom were included in the analysis. The groups were comparable at baseline. The intervention was associated with significantly better patient knowledge scores. Conclusions An educational booklet improves knowledge among patients awaiting TKA. A study assessing the impact of the booklet combined with a exercise program would be helpful. Level of evidence Level I, randomized controlled double-blind trial; see S1 CONSORT Checklist. Trial registration clinicaltrials.gov #NCT01747759
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Affiliation(s)
- Benedicte Eschalier
- Département de Médecine Générale, Faculté de Médecine, Université Clermont Auvergne Clermont-Ferrand, France
| | - Stephane Descamps
- Service de Chirurgie Orthopédique et Traumatologie, CHU Clermont-Ferrand, C-BIOSENSS, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Bruno Pereira
- Direction de la Recherche Clinique et de l’Innovation, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Hélène Vaillant-Roussel
- Département de Médecine Générale, Faculté de Médecine, Université Clermont Auvergne Clermont-Ferrand, France
| | - Guillaume Girard
- Service de Chirurgie Orthopédique et Traumatologie, CHU Clermont-Ferrand, C-BIOSENSS, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Stephane Boisgard
- Service de Chirurgie Orthopédique et Traumatologie, CHU Clermont-Ferrand, C-BIOSENSS, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Emmanuel Coudeyre
- Service de Médecine Physique et de Réadaptation, CHU Clermont-Ferrand, France, INRA, Université Clermont Auvergne, Clermont-Ferrand, France
- * E-mail:
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Pasanen T, Tolvanen S, Heinonen A, Kujala UM. Exercise therapy for functional capacity in chronic diseases: an overview of meta-analyses of randomised controlled trials. Br J Sports Med 2017; 51:1459-1465. [PMID: 28500079 DOI: 10.1136/bjsports-2016-097132] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To summarise all meta-analyses of randomised controlled trials that have evaluated the effects of exercise therapy on functional capacity in patients with chronic diseases. DESIGN Umbrella review of meta-analyses of randomised controlled trials. DATA SOURCES We systematically searched the CENTRAL, CINAHL, DARE, Medline, OTSeeker, PEDro, SPORTDiscus, ProQuest Nursing & Allied Health Database, Web of Science, Scopus, OpenGrey and BMC Proceedings from database inception to 1 September 2016. ELIGIBILITY CRITERIA FOR SELECTING STUDIES We included meta-analyses that compared the effects of exercise therapy with no treatment or usual care in adults with non-communicable chronic diseases and included outcomes related to functional capacity. We excluded meta-analyses with less than 100 patients. RESULTS Eighty-five meta-analyses with 22 different chronic diseases were included. The exercise interventions resulted in statistically significant (p<0.05) improvements for 126 of 146 (86%) functional capacity outcomes, compared with the control group. The standardised mean differences were small in 64 (44%), moderate in 54 (37%) and large in 28 (19%) of the 146 functional capacity outcomes. The results were similar for aerobic exercise, resistance training, and aerobic and resistance training combined. There were no significant differences in serious adverse effects between the intervention and control groups in any of the meta-analyses. CONCLUSION Exercise therapy appears to be a safe way to improve functional capacity and reduce disability in individuals with chronic disease.
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Affiliation(s)
- Tero Pasanen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Samppa Tolvanen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Ari Heinonen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Urho M Kujala
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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Fernandes L, Roos EM, Overgaard S, Villadsen A, Søgaard R. Supervised neuromuscular exercise prior to hip and knee replacement: 12-month clinical effect and cost-utility analysis alongside a randomised controlled trial. BMC Musculoskelet Disord 2017; 18:5. [PMID: 28061841 PMCID: PMC5217578 DOI: 10.1186/s12891-016-1369-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 12/19/2016] [Indexed: 12/20/2022] Open
Abstract
Background There are indications of beneficial short-term effect of pre-operative exercise in reducing pain and improving activity of daily living after total hip replacement (THR) and total knee replacement (TKR) surgery. Though, information from studies conducting longer follow-ups and economic evaluations of exercise prior to THR and TKR is needed. The aim of the study was to analyse 12-month clinical effect and cost-utility of supervised neuromuscular exercise prior to THR and TKR surgery. Methods The study was conducted alongside a randomised controlled trial including 165 patients scheduled for standard THR or TKR at a hospital located in a rural area of Denmark. The patients were randomised to replacement surgery with or without an 8-week preoperative supervised neuromuscular exercise program (Clinical Trials registration no.: NCT01003756). Clinical effect was measured with Hip disability and Osteoarthritis Outcome Score (HOOS) and Knee injury and Osteoarthritis Outcome Score (KOOS). Quality adjusted life years (QALYs) were based on EQ-5D-3L and Danish preference weights. Resource use was extracted from national registries and valued using standard tariffs (2012-EUR). Incremental net benefit was analysed to estimate the probability for the intervention being cost effective for a range of threshold values. A health care sector perspective was applied. Results HOOS/KOOS quality of life [8.25 (95% CI, 0.42 to 16.10)] and QALYs [0.04 (95% CI, 0.01 to 0.07)] were statistically significantly improved. Effect-sizes ranged between 0.09-0.59 for HOOS/KOOS subscales. Despite including an intervention cost of €326 per patient, there was no difference in total cost between groups [€132 (95% CI −3942 to 3679)]. At a threshold of €40,000, preoperative exercise was found to be cost effective at 84% probability. Conclusion Preoperative supervised neuromuscular exercise for 8 weeks was found to be cost-effective in patients scheduled for THR and TKR surgery at conventional thresholds for willingness to pay. One-year clinical effects were small to moderate and favoured the intervention group, but only statistically significant for quality of life measures. Trial registration ClinicalTrials.gov (NCT01003756) October 28, 2009.
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Affiliation(s)
- Linda Fernandes
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark. .,Department of Rehabilitation, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark.
| | - Ewa M Roos
- Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Søren Overgaard
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Allan Villadsen
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
| | - Rikke Søgaard
- Department of Public Health, Aarhus University, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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76
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Jones CA, Martin RS, Westby MD, Beaupre LA. Total joint arthroplasty: practice variation of physiotherapy across the continuum of care in Alberta. BMC Health Serv Res 2016; 16:627. [PMID: 27809849 PMCID: PMC5095989 DOI: 10.1186/s12913-016-1873-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 10/21/2016] [Indexed: 12/27/2022] Open
Abstract
Background Comprehensive and timely rehabilitation for total joint arthroplasty (TJA) is needed to maximize recovery from this elective surgical procedure for hip and knee arthritis. Administrative data do not capture the variation of treatment for rehabilitation across the continuum of care for TJA, so we conducted a survey for physiotherapists to report practice for TJA across the continuum of care. The primary objective was to describe the reported practice of physiotherapy for TJA across the continuum of care within the context of a provincial TJA clinical pathway and highlight possible gaps in care. Method A cross-sectional on-line survey was accessible to licensed physiotherapists in Alberta, Canada for 11 weeks. Physiotherapists who treated at least five patients with TJA annually were asked to complete the survey. The survey consisted of 58 questions grouped into pre-operative, acute care and post-acute rehabilitation. Variation of practice was described in terms of number, duration and type of visits along with goals of care and program delivery methods. Results Of the 80 respondents, 26 (33 %) stated they worked in small centres or rural settings in Alberta with the remaining respondents working in two large urban sites. The primary treatment goal differed for each phase across the continuum of care in that pre-operative phase was directed at improving muscle strength, functional activities were commonly reported for acute care, and post-acute phase was directed at improving joint range-of-motion. Proportionally, more physiotherapists from rural areas treated patients in out-patient hospital departments (59 %), whereas a higher proportion in urban physiotherapists saw patients in private clinics (48 %). Across the continuum of care, treatment was primarily delivered on an individual basis rather than in a group format. Conclusions Variation of practice reported with pre-and post-operative care in the community will stimulate dialogue within the profession as to what is the minimal standard of care to provide patients undergoing TJA. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1873-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- C Allyson Jones
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, T6G 2G4, Canada.
| | - Ruben San Martin
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, T6G 2G4, Canada
| | - Marie D Westby
- School of Public Health, University of Alberta, Edmonton, Alberta, T6G 1C9, Canada
| | - Lauren A Beaupre
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, T6G 2G4, Canada
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Alghadir A, Iqbal ZA, Anwer S. Comparison of the effect of pre- and post-operative physical therapy versus post-operative physical therapy alone on pain and recovery of function after total knee arthroplasty. J Phys Ther Sci 2016; 28:2754-2758. [PMID: 27821929 PMCID: PMC5088120 DOI: 10.1589/jpts.28.2754] [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: 04/18/2016] [Accepted: 06/09/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The aim of the present study was to compare the effect of pre-operative and
post-operative physical therapy versus post-operative physical therapy alone on pain and
recovery of function after total knee arthroplasty. [Subjects and Methods] Fifty patients
(18 males and 32 females) ranging in age from 48 to 80 years (mean 63.28, SD 9.44)
participated in a 6-week two-arm randomized rater-blinded trial. One group received pre-
and post-operative physical therapy whereas the other group received only post-operative
physical therapy. Pain and function were measured with a visual analogue scale and a lower
extremity functional scale at baseline (pre-operative) as well as week 3 and week 6
post-operative. [Results] The differences in pain intensity and functional score at week 3
and week 6 post-operative remained statistically insignificant between the two groups.
[Conclusion] The reduction of pain and recovery of function was similar in subjects who
received pre- and post-operative physical therapy and those who received only
post-operative physical therapy after total knee arthroplasty. Additional pre-operative
physical therapy did not bring about any further improvement in pain intensity or recovery
of function after total knee arthroplasty.
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Affiliation(s)
- Ahmad Alghadir
- Rehabilitation Research Chair, Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Saudi Arabia
| | - Zaheen Ahmed Iqbal
- Rehabilitation Research Chair, Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Saudi Arabia
| | - Shahnawaz Anwer
- Rehabilitation Research Chair, Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Saudi Arabia; Dr. D. Y. Patil College of Physiotherapy, Dr. D. Y. Patil Vidyapeeth, Pune, India
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Chesham RA, Shanmugam S. Does preoperative physiotherapy improve postoperative, patient-based outcomes in older adults who have undergone total knee arthroplasty? A systematic review. Physiother Theory Pract 2016; 33:9-30. [PMID: 27736286 DOI: 10.1080/09593985.2016.1230660] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Knee osteoarthritis (OA) is a leading cause of disability in older adults (≥60) in the UK. If nonsurgical management fails and if OA severity becomes too great, knee arthroplasty is a preferred treatment choice. Preoperative physiotherapy is often offered as part of rehabilitation to improve postoperative patient-based outcomes. OBJECTIVES Systematically review whether preoperative physiotherapy improves postoperative, patient-based outcomes in older adults who have undergone total knee arthroplasty (TKA) and compare study interventions to best-practice guidelines. METHOD A literature search of Randomized Controlled Trials (RCTs), published April 2004-April 2014, was performed across six databases. Individual studies were evaluated for quality using the PEDro Scale. RESULTS Ten RCTs met the full inclusion/exclusion criteria. RCTs compared control groups versus: preoperative exercise (n = 5); combined exercise and education (n = 2); combined exercise and acupuncture (n = 1); neuromuscular electrical stimulation (NMES; n = 1); and acupuncture versus exercise (n = 1). RCTs recorded many patient-based outcomes including knee strength, ambulation, and pain. Minimal evidence is presented that preoperative physiotherapy is more effective than no physiotherapy or usual care. PEDro Scale and critical appraisal highlighted substantial methodological quality issues within the RCTs. CONCLUSION There is insufficient quality evidence to support the efficacy of preoperative physiotherapy in older adults who undergo total knee arthroplasty.
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Affiliation(s)
- Ross Alexander Chesham
- a Department of Psychology, Social Work and Allied Health Sciences , School of Health and Life Sciences, Glasgow Caledonian University , Glasgow , UK
| | - Sivaramkumar Shanmugam
- a Department of Psychology, Social Work and Allied Health Sciences , School of Health and Life Sciences, Glasgow Caledonian University , Glasgow , UK
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79
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Meneses SRF, Goode AP, Nelson AE, Lin J, Jordan JM, Allen KD, Bennell KL, Lohmander LS, Fernandes L, Hochberg MC, Underwood M, Conaghan PG, Liu S, McAlindon TE, Golightly YM, Hunter DJ. Clinical algorithms to aid osteoarthritis guideline dissemination. Osteoarthritis Cartilage 2016; 24:1487-99. [PMID: 27095418 DOI: 10.1016/j.joca.2016.04.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 03/14/2016] [Accepted: 04/04/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Numerous scientific organisations have developed evidence-based recommendations aiming to optimise the management of osteoarthritis (OA). Uptake, however, has been suboptimal. The purpose of this exercise was to harmonize the recent recommendations and develop a user-friendly treatment algorithm to facilitate translation of evidence into practice. METHODS We updated a previous systematic review on clinical practice guidelines (CPGs) for OA management. The guidelines were assessed using the Appraisal of Guidelines for Research and Evaluation for quality and the standards for developing trustworthy CPGs as established by the National Academy of Medicine (NAM). Four case scenarios and algorithms were developed by consensus of a multidisciplinary panel. RESULTS Sixteen guidelines were included in the systematic review. Most recommendations were directed toward physicians and allied health professionals, and most had multi-disciplinary input. Analysis for trustworthiness suggests that many guidelines still present a lack of transparency. A treatment algorithm was developed for each case scenario advised by recommendations from guidelines and based on panel consensus. CONCLUSION Strategies to facilitate the implementation of guidelines in clinical practice are necessary. The algorithms proposed are examples of how to apply recommendations in the clinical context, helping the clinician to visualise the patient flow and timing of different treatment modalities.
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Affiliation(s)
- S R F Meneses
- Department of Physiotherapy, Occupational Therapy and Speech Therapy, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil; Royal North Shore Hospital, Rheumatology Department, and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, NSW, Australia.
| | - A P Goode
- Department of Orthopedic Surgery, Duke University, Durham, NC, USA
| | - A E Nelson
- Department of Medicine and Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA
| | - J Lin
- Institute of Bone and Joint, Peking University People's Hospital, Peking, China
| | - J M Jordan
- Department of Medicine and Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA; Gillings School of Global Public Health, Department of Epidemiology, USA; Department of Orthopaedics, University of North Carolina at Chapel Hill, USA
| | - K D Allen
- Department of Medicine and Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA; Health Services Research and Development Service, U.S. Department of Veterans Affairs Medical Center, Durham, NC, USA
| | - K L Bennell
- Centre for Health, Exercise and Sports Medicine (CHESM), Department of Physiotherapy, The University of Melbourne, Victoria, Australia
| | - L S Lohmander
- Orthopaedics, Department of Clinical Sciences, Lund University, Sweden
| | - L Fernandes
- Department of Rehabilitation, Odense University Hospital, Odense C, Denmark
| | - M C Hochberg
- Department Epidemiology and Public Health, University of Maryland School of Medicine, and Medical Care Clinical Center, Veterans Affairs Maryland Health Care System, Baltimore, Maryland, USA
| | - M Underwood
- Warwick Clinical Trials Unit, Warwick Medical School, UK
| | - P G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds & NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
| | - S Liu
- Royal North Shore Hospital, Rheumatology Department, and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, NSW, Australia
| | - T E McAlindon
- Department of Rheumatology, Tufts Medical Center, Boston, MA, USA
| | - Y M Golightly
- Department of Medicine and Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA; Injury Prevention Research Center, University of North Carolina at Chapel Hill, USA
| | - D J Hunter
- Royal North Shore Hospital, Rheumatology Department, and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, NSW, Australia
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80
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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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Skoffer B, Maribo T, Mechlenburg I, Hansen PM, Søballe K, Dalgas U. Efficacy of Preoperative Progressive Resistance Training on Postoperative Outcomes in Patients Undergoing Total Knee Arthroplasty. Arthritis Care Res (Hoboken) 2016; 68:1239-51. [PMID: 26713665 DOI: 10.1002/acr.22825] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 11/26/2015] [Accepted: 12/15/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To investigate the efficacy of 4 weeks of preoperative and 4 weeks of postoperative progressive resistance training (PRT), compared to 4 weeks of postoperative PRT only on functional performance, muscle strength, and patient-reported outcomes in patients undergoing total knee arthroplasty (TKA). METHODS In total, 59 patients were randomized to 4 weeks of preoperative PRT (intervention group) or to a group who lived as usual (control group). Both groups performed 4 weeks of PRT after TKA. At 6 weeks and 1 week before TKA, and at 1, 6, and 12 weeks after TKA, performance-based measures (30-second chair stand test [30sCST], timed-up-and-go [TUG], and walking tests), knee extensor and flexor muscle strength (dynamometry), patient-reported functional performance, health-related quality of life, and pain scores were evaluated. RESULTS When comparing the changes from baseline to the primary test point 6 weeks after TKA, a significant group difference in favor of the intervention group was found for the 30sCST (2.5 repetitions [95% confidence interval (95% CI) 0.9, 4.1] versus -1.1 repetitions [95% CI -2.8, 0.7]; P < 0.004), the TUG (-0.7 seconds [95% CI -1.6, 0.1] versus 0.8 seconds [95% CI -0.1, 1.7]; P = 0.015), normalized knee extensor muscle strength (-0.2 Nm/kg [95% CI -0.3, -0.1] versus -0.4 Nm/kg [95% CI -0.5, -0.3]; P = 0.002), and normalized knee flexor muscle strength (0.1 Nm/kg [95% CI 0.0, 0.2] versus 0.0 Nm/kg [95% CI -0.1, 0.1]; P = 0.016). No differences were found between groups on patient-reported outcomes. CONCLUSION Supervised preoperative PRT is an efficacious and safe intervention for improving postoperative functional performance and muscle strength, but improvements in patient-reported outcomes were not detected.
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Affiliation(s)
- Birgit Skoffer
- Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Thomas Maribo
- Aarhus University and Public Health and Quality Improvement, Central Denmark Region, Aarhus, Denmark
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82
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Wylde V, Artz N, Marques E, Lenguerrand E, Dixon S, Beswick AD, Burston A, Murray J, Parwez T, Blom AW, Gooberman-Hill R. Effectiveness and cost-effectiveness of outpatient physiotherapy after knee replacement for osteoarthritis: study protocol for a randomised controlled trial. Trials 2016; 17:289. [PMID: 27296366 PMCID: PMC4906683 DOI: 10.1186/s13063-016-1418-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 05/27/2016] [Indexed: 12/27/2022] Open
Abstract
Background Primary total knee replacement is a common operation that is performed to provide pain relief and restore functional ability. Inpatient physiotherapy is routinely provided after surgery to enhance recovery prior to hospital discharge. However, international variation exists in the provision of outpatient physiotherapy after hospital discharge. While evidence indicates that outpatient physiotherapy can improve short-term function, the longer term benefits are unknown. The aim of this randomised controlled trial is to evaluate the long-term clinical effectiveness and cost-effectiveness of a 6-week group-based outpatient physiotherapy intervention following knee replacement. Methods/design Two hundred and fifty-six patients waiting for knee replacement because of osteoarthritis will be recruited from two orthopaedic centres. Participants randomised to the usual-care group (n = 128) will be given a booklet about exercise and referred for physiotherapy if deemed appropriate by the clinical care team. The intervention group (n = 128) will receive the same usual care and additionally be invited to attend a group-based outpatient physiotherapy class starting 6 weeks after surgery. The 1-hour class will be run on a weekly basis over 6 weeks and will involve task-orientated and individualised exercises. The primary outcome will be the Lower Extremity Functional Scale at 12 months post-operative. Secondary outcomes include: quality of life, knee pain and function, depression, anxiety and satisfaction. Data collection will be by questionnaire prior to surgery and 3, 6 and 12 months after surgery and will include a resource-use questionnaire to enable a trial-based economic evaluation. Trial participation and satisfaction with the classes will be evaluated through structured telephone interviews. The primary statistical and economic analyses will be conducted on an intention-to-treat basis with and without imputation of missing data. The primary economic result will estimate the incremental cost per quality-adjusted life year gained from this intervention from a National Health Services (NHS) and personal social services perspective. Discussion This research aims to benefit patients and the NHS by providing evidence on the long-term effectiveness and cost-effectiveness of outpatient physiotherapy after knee replacement. If the intervention is found to be effective and cost-effective, implementation into clinical practice could lead to improvement in patients’ outcomes and improved health care resource efficiency. Trial registration ISRCTN32087234, registered on 11 February 2015.
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Affiliation(s)
- Vikki Wylde
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Learning and Research Building (Level 1), Southmead Hospital, Bristol, BS10 5NB, UK.
| | - Neil Artz
- School of Health Professions, University of Plymouth, Peninsula Allied Health Centre, Derriford Road, Plymouth, Devon, PL6 8BH, UK
| | - Elsa Marques
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Learning and Research Building (Level 1), Southmead Hospital, Bristol, BS10 5NB, UK.,National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care West (CLAHRC West), University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol, BS2 8HW, UK
| | - Erik Lenguerrand
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Learning and Research Building (Level 1), Southmead Hospital, Bristol, BS10 5NB, UK
| | - Samantha Dixon
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Learning and Research Building (Level 1), Southmead Hospital, Bristol, BS10 5NB, UK
| | - Andrew D Beswick
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Learning and Research Building (Level 1), Southmead Hospital, Bristol, BS10 5NB, UK
| | - Amanda Burston
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Learning and Research Building (Level 1), Southmead Hospital, Bristol, BS10 5NB, UK
| | - James Murray
- North Bristol NHS Trust, Brunel Building, Southmead Hospital, Bristol, BS10 5NB, UK
| | - Tarique Parwez
- Emersons Green Independent Treatment Centre, The Brooms, Emersons Green, Bristol, BS16 7FH, UK
| | - Ashley W Blom
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Learning and Research Building (Level 1), Southmead Hospital, Bristol, BS10 5NB, UK
| | - Rachael Gooberman-Hill
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Learning and Research Building (Level 1), Southmead Hospital, Bristol, BS10 5NB, UK
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83
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84
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Saw MM, Kruger-Jakins T, Edries N, Parker R. Significant improvements in pain after a six-week physiotherapist-led exercise and education intervention, in patients with osteoarthritis awaiting arthroplasty, in South Africa: a randomised controlled trial. BMC Musculoskelet Disord 2016; 17:236. [PMID: 27233479 PMCID: PMC4884378 DOI: 10.1186/s12891-016-1088-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 05/19/2016] [Indexed: 02/08/2023] Open
Abstract
Background A major challenge facing those with late stage osteoarthritis is delayed surgery due to waiting lists. In South Africa patients wait years for a hip/knee arthroplasty. Affected patients require effective management to address their pain, especially while awaiting surgery. Existing literature is mostly available from high income countries exploring effects of interventions during short waiting periods. Research is warranted in low income countries where long waiting periods are common. This study explored the effects of a six-week physiotherapist-led exercise and education intervention on pain in this population. Methods A randomised controlled trial was performed at two public hospitals in South Africa. Ethical approval and informed consent was obtained. 74 participants from arthroplasty waiting lists were randomly allocated to an intervention (n = 35) or control group (n = 39). The intervention included six physiotherapist-led group-based sessions (two hours/week of education, exercise and relaxation). The control group received usual care. Data collection was conducted by blinded physiotherapists at baseline, week six, 12 and month six. The primary outcome was pain, measured by the Brief Pain Inventory. Additionally, participants completed an open-ended questionnaire at month six, to gain insight regarding the intervention. Analysis was by intention to treat using two-way analysis of variance and post-hoc Tukey comparisons. Answers to subjective questions were analysed according to common themes that emerged. Results The intervention group had significant improvements compared with the control group with moderate to large effect sizes (ES) on pain severity [week 6: p < 0.01, ES = 0.94, 95 % CI (0.45,1.41), month 6: p = 0.02. ES = 0.74, 95 % CI (0.26,1.2)] and moderate to large effects on pain interference [week 6: p < 0.01, ES = 1.2, 95 % CI (0.70,1.69), week 12: p = 0.04, ES = 0.68, 95 % CI (0.20,1.14), month 6: p < 0.01, ES = 0.98, 95 % CI (0.49,1.45)]. 53 % of participants reported that the intervention improved their pain. Conclusions The intervention resulted in sustained significant improvements in pain severity and interference in patients with hip/knee osteoarthritis, awaiting arthroplasty compared with a control group. Additionally, participants’ individual feedback supported observed significant improvements in pain. Such an intervention appears to be effective in managing pain in this population and should be incorporated into practice for appropriate patients. Further research is being conducted to explore long term and postoperative outcomes. Clinical trial registration Pan African Clinical Trial Registry, PACTR201409000885765, PACTR201507001186115. Electronic supplementary material The online version of this article (doi:10.1186/s12891-016-1088-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M M Saw
- Physiotherapy department, Tygerberg Hospital, Cape Town, South Africa
| | - T Kruger-Jakins
- ICAS South Africa, Musculoskeletal Health, Johannesburg, South Africa
| | - N Edries
- Department of Health & Rehab Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - R Parker
- Department of Health & Rehab Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
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85
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Miyagawa H, Ikemoto T, Honjo H, Akao M, Tsujimoto T, Ushida T. One-year results of voluntary-based supervised exercise or treatment at orthopedic clinic for radiographic severe knee osteoarthritis. J Phys Ther Sci 2016; 28:906-10. [PMID: 27134382 PMCID: PMC4842463 DOI: 10.1589/jpts.28.906] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 12/12/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] In this study, we investigated the efficacy of supervised physical exercise or
conventional treatment on symptomatic knee osteoarthritis with severe morphological
degeneration. [Subjects] Sixty-six patients with severe radiographic knee osteoarthritis
were enrolled. [Methods] Participants were separated into two groups: in one group
patients conducted physical exercise under supervision; while in the other group they were
treated by conventional clinical methods for one year. Participants filled out two types
of questionnaires; the Japanese Knee Osteoarthritis Measure and the Pain Disability
Assessment Scale at baseline and one year following enrollment in the study. Two-way
repeated measures analysis of variance was used to examine the effects over time and by
group for a total of 43 participants; consisting of an exercise group (n=20) and a
clinical group (n=23) excluding 23 dropouts. [Results] Analysis did not show a significant
time-course effect or interaction between time-course and the groups in both
questionnaires. On the other hand, there were significant group effects in both
questionnaires with an advantage in the exercise group. [Conclusion] These results
indicate that patients with knee osteoarthritis under supervised exercise conditions are
more likely to maintain a better clinical outcome at one-year follow-up, despite the
severe morphological degeneration in their knees.
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Affiliation(s)
- Hirofumi Miyagawa
- Institute of Physical Fitness, Sports Medicine and Rehabilitation, Aichi Medical University, Japan
| | - Tatsunori Ikemoto
- Institute of Physical Fitness, Sports Medicine and Rehabilitation, Aichi Medical University, Japan
| | - Hiroshi Honjo
- Department of Orthopedic Surgery, Aichi Medical University, Japan
| | - Machiko Akao
- Department of Orthopedic Surgery, Aichi Medical University, Japan
| | | | - Takahiro Ushida
- Institute of Physical Fitness, Sports Medicine and Rehabilitation, Aichi Medical University, Japan
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Cavill S, McKenzie K, Munro A, McKeever J, Whelan L, Biggs L, Skinner EH, Haines TP. The effect of prehabilitation on the range of motion and functional outcomes in patients following the total knee or hip arthroplasty: A pilot randomized trial. Physiother Theory Pract 2016; 32:262-70. [DOI: 10.3109/09593985.2016.1138174] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Stuart Cavill
- Department of Physiotherapy, Monash Medical Centre, Monash Health, Clayton, Victoria, Australia
| | - Kylie McKenzie
- Department of Physiotherapy, Monash Medical Centre, Monash Health, Clayton, Victoria, Australia
| | - Adrienne Munro
- Department of Occupational Therapy, Alfred Hospital, Prahran, Victoria, Australia
| | - Janice McKeever
- Department of Occupational Therapy, Dandenong Hospital, Monash Health, Dandenong, Victoria, Australia
| | - Lucy Whelan
- Department of Physiotherapy, Community Rehabilitation, Monash Health, Cranbourne, Victoria, Australia
| | - Luke Biggs
- Department of Physiotherapy, Community Rehabilitation, Monash Health, Cranbourne, Victoria, Australia
| | - Elizabeth H. Skinner
- Allied Health Research Unit, Monash Medical Centre, Monash Health, Clayton, Victoria, Australia
- Department of Physiotherapy, Sunshine Hospital, Western Health, Sunshine, Victoria, Australia
| | - Terry P. Haines
- Allied Health Research Unit, Monash Medical Centre, Monash Health, Clayton, Victoria, Australia
- Department of Physiotherapy, Faculty of Medicine Nursing and Health Science, Monash University, Frankston, Victoria, Australia
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The provision of preoperative and postoperative physical therapy in elderly people with hip and knee osteoarthritis undergoing primary joint replacement surgery. CURRENT ORTHOPAEDIC PRACTICE 2016. [DOI: 10.1097/bco.0000000000000347] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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88
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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: 113] [Impact Index Per Article: 14.1] [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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89
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Wright S, Wiechula R, McLiesh P. The effectiveness of prehabilitation for adults having elective surgery: a systematic review protocol. ACTA ACUST UNITED AC 2016; 14:78-92. [DOI: 10.11124/jbisrir-2016-2460] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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90
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De Santis R, Gloria A, Russo T, Ronca A, D’Amora U, Negri G, Ronca D, Ambrosio L. Viscoelastic Properties of Rapid Prototyped Magnetic Nanocomposite Scaffolds for Osteochondral Tissue Regeneration. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.procir.2015.07.037] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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91
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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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92
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Westby MD, Klemm A, Li LC, Jones CA. Emerging Role of Quality Indicators in Physical Therapist Practice and Health Service Delivery. Phys Ther 2016; 96:90-100. [PMID: 26089040 PMCID: PMC4706598 DOI: 10.2522/ptj.20150106] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 06/08/2015] [Indexed: 12/27/2022]
Abstract
Quality-based care is a hallmark of physical therapy. Treatment effectiveness must be evident to patients, managers, employers, and funders. Quality indicators (QIs) are tools that specify the minimum acceptable standard of practice. They are used to measure health care processes, organizational structures, and outcomes that relate to aspects of high-quality care of patients. Physical therapists can use QIs to guide clinical decision making, implement guideline recommendations, and evaluate and report treatment effectiveness to key stakeholders, including third-party payers and patients. Rehabilitation managers and senior decision makers can use QIs to assess care gaps and achievement of benchmarks as well as to guide quality improvement initiatives and strategic planning. This article introduces the value and use of QIs to guide clinical practice and health service delivery specific to physical therapy. A framework to develop, select, report, and implement QIs is outlined, with total joint arthroplasty rehabilitation as an example. Current initiatives of Canadian and American physical therapy associations to develop tools to help clinicians report and access point-of-care data on patient progress, treatment effectiveness, and practice strengths for the purpose of demonstrating the value of physical therapy to patients, decision makers, and payers are discussed. Suggestions on how physical therapists can participate in QI initiatives and integrate a quality-of-care approach in clinical practice are made.
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Affiliation(s)
- Marie D Westby
- M.D. Westby, PT, PhD, School of Public Health, University of Alberta, c/o Arthritis Research Canada, 5591 No. 3 Rd, Richmond, British Columbia, Canada V6X 2C7.
| | - Alexandria Klemm
- A. Klemm, BKin, Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Linda C Li
- L.C. Li, PT, PhD, Department of Physical Therapy, University of British Columbia
| | - C Allyson Jones
- C.A. Jones, PT, PhD, Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
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93
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Thienpont E, Lavand'homme P, Kehlet H. The constraints on day-case total knee arthroplasty: the fastest fast track. Bone Joint J 2015; 97-B:40-4. [PMID: 26430085 DOI: 10.1302/0301-620x.97b10.36610] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Total knee arthroplasty (TKA) is a major orthopaedic intervention. The length of a patient's stay has been progressively reduced with the introduction of enhanced recovery protocols: day-case surgery has become the ultimate challenge. This narrative review shows the potential limitations of day-case TKA. These constraints may be social, linked to patient's comorbidities, or due to surgery-related adverse events (e.g. pain, post-operative nausea and vomiting, etc.). Using patient stratification, tailored surgical techniques and multimodal opioid-sparing analgesia, day-case TKA might be achievable in a limited group of patients. The younger, male patient without comorbidities and with an excellent social network around him might be a candidate. Demographic changes, effective recovery programmes and less invasive surgical techniques such as unicondylar knee arthroplasty, may increase the size of the group of potential day-case patients. The cost reduction achieved by day-case TKA needs to be balanced against any increase in morbidity and mortality and the cost of advanced follow-up at a distance with new technology. These factors need to be evaluated before adopting this ultimate 'fast-track' approach.
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Affiliation(s)
- E Thienpont
- Catholic University of Louvain Cliniques Universitaires St-Luc, Av Hippocrate 10, B-1200 Brussels, Belgium
| | - P Lavand'homme
- Catholic University of Louvain Cliniques Universitaires St-Luc, Av Hippocrate 10, B-1200 Brussels, Belgium
| | - H Kehlet
- Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
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94
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Anwer S, Alghadir A, Abu Shaphe M, Anwar D. Effects of Exercise on Spinal Deformities and Quality of Life in Patients with Adolescent Idiopathic Scoliosis. BIOMED RESEARCH INTERNATIONAL 2015; 2015:123848. [PMID: 26583083 PMCID: PMC4637024 DOI: 10.1155/2015/123848] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 06/15/2015] [Accepted: 06/18/2015] [Indexed: 01/08/2023]
Abstract
OBJECTIVES This systematic review was conducted to examine the effects of exercise on spinal deformities and quality of life in patients with adolescent idiopathic scoliosis (AIS). DATA SOURCES Electronic databases, including PubMed, CINAHL, Embase, Scopus, Cochrane Register of Controlled Trials, PEDro, and Web of Science, were searched for research articles published from the earliest available dates up to May 31, 2015, using the key words "exercise," "postural correction," "posture," "postural curve," "Cobb's angle," "quality of life," and "spinal deformities," combined with the Medical Subject Heading "scoliosis." STUDY SELECTION This systematic review was restricted to randomized and nonrandomized controlled trials on AIS published in English language. The quality of selected studies was assessed by the PEDro scale, the Cochrane Collaboration's tool, and the Grading of Recommendations Assessment, Development, and Evaluation System (GRADE). DATA EXTRACTION Descriptive data were collected from each study. The outcome measures of interest were Cobb angle, trunk rotation, thoracic kyphosis, lumbar kyphosis, vertebral rotation, and quality of life. DATA SYNTHESIS A total of 30 studies were assessed for eligibility. Six of the 9 selected studies reached high methodological quality on the PEDro scale. Meta-analysis revealed moderate-quality evidence that exercise interventions reduce the Cobb angle, angle of trunk rotation, thoracic kyphosis, and lumbar lordosis and low-quality evidence that exercise interventions reduce average lateral deviation. Meta-analysis revealed moderate-quality evidence that exercise interventions improve the quality of life. CONCLUSIONS A supervised exercise program was superior to controls in reducing spinal deformities and improving the quality of life in patients with AIS.
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Affiliation(s)
- Shahnawaz Anwer
- Rehabilitation Research Chair, Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
- Dr. D. Y. Patil College of Physiotherapy, Dr. D. Y. Patil Vidyapeeth, Pune, India
| | - Ahmad Alghadir
- Rehabilitation Research Chair, Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
| | - Md. Abu Shaphe
- Department of Physiotherapy, College of Applied Medical Sciences, Jazan University, Saudi Arabia
| | - Dilshad Anwar
- Department of Orthopedics, JNMC, AMU, Aligarh, India
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95
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Kwok IHY, Paton B, Haddad FS. Does Pre-Operative Physiotherapy Improve Outcomes in Primary Total Knee Arthroplasty? - A Systematic Review. J Arthroplasty 2015; 30:1657-63. [PMID: 25913232 DOI: 10.1016/j.arth.2015.04.013] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 04/03/2015] [Indexed: 02/01/2023] Open
Abstract
We undertook a systematic review of 11 randomised controlled trials comparing patient outcomes in total knee arthroplasty in those who had undergone pre-operative physiotherapy-based interventions against control groups. Results show that there is little evidence that pre-operative physiotherapy brings about significant improvements in patient outcome scores, lower limb strength, pain, range of movement and hospital length of stay following total knee arthroplasty. The overall quality of the studies was moderate to poor, mostly due to the small sample sizes.
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Affiliation(s)
| | - Bruce Paton
- University College London Hospital, London, UK
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96
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Does a preoperative cognitive-behavioral intervention affect disability, pain behavior, pain, and return to work the first year after lumbar spinal fusion surgery? Spine (Phila Pa 1976) 2015; 40:593-600. [PMID: 25705964 DOI: 10.1097/brs.0000000000000843] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A randomized clinical trial including 90 patients. OBJECTIVE To examine the effect of a preoperative cognitive-behavioral intervention (CBT) for patients undergoing lumbar spinal fusion (LSF) surgery. SUMMARY OF BACKGROUND DATA Few published studies have looked at the potential of rehabilitation to improve outcomes after LSF. Rehabilitation programs using CBT are recommended. Furthermore, initiating interventions preoperatively seems beneficial, but only limited data exist in the field of spine surgery. METHODS Patients with degenerative disc disease or spondylolisthesis undergoing LSF were randomized to usual care (control group) or preoperative CBT and usual care (CBT group). Primary outcome was change in Oswestry Disability Index from baseline to 1-year follow-up. Secondary outcomes were catastrophizing, fear avoidance belief, work status, and back and leg pain. RESULTS At 1-year follow-up, there was no statistically significant difference between the CBT group and the control group in Oswestry Disability Index score (P = 0.082). However, the CBT group had achieved a significant reduction of -15 points (-26; -4) already at 3 months (between group difference P = 0.003), and this reduction was maintained throughout the year. There were no differences between groups at 1-year follow-up with regard to any of the secondary outcomes. CONCLUSION Participating in a preoperative CBT intervention in addition to usual care did not produce better outcomes at 1-year follow-up for patients undergoing LSF. Although the reduction in disability was achieved much faster in the CBT group, resulting in a significant difference between groups already 3 months after surgery, it did not translate into a faster return to work. Our findings support the need for further research into the use of targeted rehabilitation interventions among patients with elevated levels of catastrophizing and fear avoidance beliefs. LEVEL OF EVIDENCE 2.
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97
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Huber EO, Roos EM, Meichtry A, de Bie RA, Bischoff-Ferrari HA. Effect of preoperative neuromuscular training (NEMEX-TJR) on functional outcome after total knee replacement: an assessor-blinded randomized controlled trial. BMC Musculoskelet Disord 2015; 16:101. [PMID: 25925404 PMCID: PMC4414282 DOI: 10.1186/s12891-015-0556-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 04/16/2015] [Indexed: 12/27/2022] Open
Abstract
Background Improving functional status preoperatively through exercise may improve postoperative outcome. Previous knowledge on preoperative exercise in knee osteoarthritis is insufficient. The aim of the study was to compare the difference in change between groups in lower extremity function from baseline to 3 months after Total Knee Replacement (TKR) following a neuromuscular exercise programme (NEMEX-TJR) plus a knee school educational package (KS) or KS alone. Methods 45 patients (55–83 years, 53% male, waiting for TKR) were randomized to receive a minimum of 8 sessions of NEMEXTJR plus 3 sessions of KS or 3 sessions of KS alone. Function was assessed with the Chair Stand Test (CST, primary endpoint) and the Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales focusing on daily living function (ADL) and pain (secondary endpoints). Assessments were performed immediately before and after the intervention, and at 6 weeks, 3 months and 12 months after surgery by a physiotherapist, blinded to group allocation. Results After intervention before surgery we observed a small improvement for primary and secondary endpoints in both groups, which did not differ significantly between groups: comparing the exercise to the control group the treatment effect for the CST was −1.5 seconds (95% CI: −5.3, 2.2), for KOOS ADL and KOOS pain the treatment effect was 1.3 points (−10.1, 12.8) and −2.3 (−12.4, 7.9) respectively. At 3 months after surgery we observed a small improvement in the primary endpoint in the control group and a significant improvement in the secondary endpoints in both exercise and control groups, which did not differ significantly between groups: comparing the exercise group to the control group the treatment effect in the CST was 2.0 seconds (−1.8, 5.8), for KOOS ADL and KOOS pain the treatment effect was −4.9 points (−16.3, 6.5) and −3.3 points (−13.5, 6.8) respectively. Conclusions A median (IQR) of 10 (8, 14) exercise sessions before surgery showed an additional small but non-significant improvement in all functional assessments compared to patient education alone. These benefits were not sustained after TKR. Our trial doesn’t give a conclusive answer to whether additional preoperative exercise on postoperative functional outcomes is beneficial. Electronic supplementary material The online version of this article (doi:10.1186/s12891-015-0556-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Erika O Huber
- Centre of Aging and Mobility, University Hospital Zurich and Waid City Hospital Zurich, Rämistrasse 100, Zurich, Switzerland. .,School of Health Professions, Institute of Physiotherapy, Zurich University of Applied Sciences, Technikumstrasse 71, 8401, Winterthur, Switzerland. .,Department of Epidemiology, Musculoskeletal Research Division CAHPRI, Maastricht University, PO Box 616, Maastricht, The Netherlands.
| | - Ewa M Roos
- University of Southern Denmark, Institute of Sports Science and Clinical Biomechanics, Campusvej 55, 5230, Odense M, Denmark.
| | - André Meichtry
- School of Health Professions, Institute of Physiotherapy, Zurich University of Applied Sciences, Technikumstrasse 71, 8401, Winterthur, Switzerland.
| | - Rob A de Bie
- Department of Epidemiology, Musculoskeletal Research Division CAHPRI, Maastricht University, PO Box 616, Maastricht, The Netherlands.
| | - Heike A Bischoff-Ferrari
- Centre of Aging and Mobility, University Hospital Zurich and Waid City Hospital Zurich, Rämistrasse 100, Zurich, Switzerland. .,Department of Geriatrics and Aging Research, University Hospital Zurich, Rämistrasse 100, Zurich, Switzerland.
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98
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Tanaka R, Ozawa J, Kito N, Moriyama H. Effects of exercise therapy on walking ability in individuals with knee osteoarthritis: a systematic review and meta-analysis of randomised controlled trials. Clin Rehabil 2015; 30:36-52. [DOI: 10.1177/0269215515570098] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 12/28/2014] [Indexed: 11/15/2022]
Abstract
Objective: To examine the effect of exercise therapy on the walking ability of individuals with knee osteoarthritis. Data sources: Randomised clinical trials (RCTs) were identified by searching through PubMed, Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database, and Cumulative Index to Nursing and Allied Health Literature. All literature published to October 2014 were included in the search. Review methods: Data were collected from RCTs that compared the effects of exercise therapy on walking ability with the effects of no intervention or psychoeducational intervention in participants with knee osteoarthritis. The outcome data on the total distance walked (6-minute walk test); the amount of time spent walking (the time to walk arbitrary distances); and gait velocity were obtained and analysed. Standardized mean differences (SMDs) and 95% confidence intervals (CIs) were calculated. Results: Twenty-eight RCTs were identified. Meta-analysis provided very-low-quality evidence that exercise therapy increased the total distance walked in the 6-minute walk test, in comparison with the effects of the control interventions (SMD = 0.44, 95% CI 0.27 to 0.60). Meta-analysis also provided low- or moderate-quality evidence that the amount of time spent walking and gait velocity were improved more by exercise therapy than by the control interventions (the amount of time spent walking: SMD = −0.50, 95% CI −0.70 to −0.30; gait velocity: SMD = 1.78, 95% CI 0.98 to 2.58). Conclusion: In individuals with knee osteoarthritis, exercise therapy can improve the amount of time spent walking, gait velocity, and maybe the total distance walked.
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Affiliation(s)
- Ryo Tanaka
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Japan
| | - Junya Ozawa
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Japan
| | - Nobuhiro Kito
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Japan
| | - Hideki Moriyama
- Department of Rehabilitation Science, Graduate School of Health Sciences, Kobe University, Japan
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99
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Ambrose KR, Golightly YM. Physical exercise as non-pharmacological treatment of chronic pain: Why and when. Best Pract Res Clin Rheumatol 2015; 29:120-30. [PMID: 26267006 PMCID: PMC4534717 DOI: 10.1016/j.berh.2015.04.022] [Citation(s) in RCA: 278] [Impact Index Per Article: 30.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Chronic pain broadly encompasses both objectively defined conditions and idiopathic conditions that lack physical findings. Despite variance in origin or pathogenesis, these conditions are similarly characterized by chronic pain, poor physical function, mobility limitations, depression, anxiety, and sleep disturbance, and they are treated alone or in combination by pharmacologic and non-pharmacologic approaches, such as physical activity (aerobic conditioning, muscle strengthening, flexibility training, and movement therapies). Physical activity improves general health, disease risk, and progression of chronic illnesses such as cardiovascular disease, type 2 diabetes, and obesity. When applied to chronic pain conditions within appropriate parameters (frequency, duration, and intensity), physical activity significantly improves pain and related symptoms. For chronic pain, strict guidelines for physical activity are lacking, but frequent movement is preferable to sedentary behavior. This gives considerable freedom in prescribing physical activity treatments, which are most successful when tailored individually, progressed slowly, and account for physical limitations, psychosocial needs, and available resources.
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Affiliation(s)
- Kirsten R Ambrose
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Yvonne M Golightly
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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100
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da Silva MB, Almeida MDA, Panato BP, Siqueira APDO, da Silva MP, Reisderfer L. Clinical applicability of nursing outcomes in the evolution of orthopedic patients with Impaired Physical Mobility. Rev Lat Am Enfermagem 2015; 23:51-8. [PMID: 25806631 PMCID: PMC4376031 DOI: 10.1590/0104-1169.3526.2524] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2013] [Accepted: 11/07/2014] [Indexed: 11/22/2022] Open
Abstract
AIM to evaluate the clinical applicability of outcomes, according to the Nursing Outcomes Classification (NOC) in the evolution of orthopedic patients with Impaired Physical Mobility METHOD longitudinal study conducted in 2012 in a university hospital, with 21 patients undergoing Total Hip Arthroplasty, evaluated daily by pairs of trained data collectors. Data were collected using an instrument containing five Nursing Outcomes, 16 clinical indicators and a five point Likert scale, and statistically analyzed. RESULTS The outcomes Body Positioning: self-initiated, Mobility, Knowledge: prescribed activity, and Fall Prevention Behavior presented significant increases in mean scores when comparing the first and final evaluations (p<0.001) and (p=0.035). CONCLUSION the use of the NOC outcomes makes it possible to demonstrate the clinical progression of orthopedic patients with Impaired Physical Mobility, as well as its applicability in this context.
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Affiliation(s)
- Marcos Barragan da Silva
- Doctoral student, Escola de Enfermagem, Universidade Federal do Rio
Grande do Sul, Porto Alegre, RS, Brazil
| | - Miriam de Abreu Almeida
- PhD, Associate Professor, Escola de Enfermagem, Universidade Federal do
Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Bruna Paulsen Panato
- Undergraduate student in Nursing, Escola de Enfermagem, Universidade
Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | - Mariana Palma da Silva
- Undergraduate student in Nursing, Escola de Enfermagem, Universidade
Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Letícia Reisderfer
- Undergraduate student in Nursing, Escola de Enfermagem, Universidade
Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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