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Kempenaers K, VAN Beek N, Lauwers R, Tengrootenhuysen M. Total knee arthroplasty: do newer CR implants yield better results? A single center prospective study. Acta Orthop Belg 2023; 89:477-483. [PMID: 37935232 DOI: 10.52628/89.3.11325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
The aim of this study was to compare whether the newest TKA prosthesis (Persona) gives improved clinical outcomes due its more anatomical design in comparison to older prostheses (balanSys). This study included a total of 89 patients planned for TKA from June 2018 to September 2019. Outcomes such as Knee Injury and Osteoarthritis Outcome Score (KOOS), range of motion (ROM), numeric pain rating scale (NRS), analgesics and alignment were recorded next to patient characteristics and complications. Our results showed a significant improvement in NRS, ROM and functional scores postoperatively compared to preoperatively for both the Persona and the balanSys implants. Although the flexion ROM for the Persona group was higher at 6 and 12 months postoperative compared to the balanSys, this was mainly a regaining of the preoperative ROM. Throughout all timepoints, there were no statistically significant differences observed in NSAID and opioid usage between the balanSys and Persona groups. Both implants are safe and efficient to use in the treatment of knee osteoarthritis. Although Persona had an improved postoperative flexion, this did not have an impact on any of the patient-reported outcomes.
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Shon OJ, Kim GB, Cho SJ. Does Sarcopenia Accompanying End-Stage Knee Osteoarthritis Affect the Outcomes following Total Knee Arthroplasty? MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1078. [PMID: 37374280 DOI: 10.3390/medicina59061078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/26/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023]
Abstract
Background and Objectives: This study aimed to investigate the prevalence of sarcopenia in patients undergoing total knee arthroplasty (TKA) for advanced knee osteoarthritis (OA), and to assess whether sarcopenia accompanying OA affects patient-reported outcome measures (PROMs) after TKA. We evaluated which predisposing factors could influence the development of sarcopenia in patients with advanced knee OA. Material and Methods: A total of 445 patients whose body composition, muscle strength, and physical performance could be measured before primary TKA were enrolled. Sarcopenia was defined according to the Asian Working Group for Sarcopenia 2019 criteria. Patients were categorized into sarcopenia (S, n = 42) and non-sarcopenia groups (NS, n = 403). PROMs were investigated using the Knee Injury and Osteoarthritis Outcome Score and Western Ontario and McMaster Universities Osteoarthritis Index. Additionally, postoperative complications and predisposing factors for sarcopenia were evaluated. Results: The incidence of sarcopenia in the entire sample was 9.4%; the prevalence was higher in men (15.4%) than in women (8.7%), and significantly increased with advancing age (p < 0.001). At the six-month follow-up, PROMs in group S were significantly inferior to those in group NS, except for the pain score; however, at the 12-month follow-up, no significant difference was observed between the groups. Multivariate logistic regression indicated that age, body mass index (BMI), and a higher modified Charlson Comorbidity Index (mCCI) were predisposing factors for sarcopenia. Conclusions: A higher prevalence of sarcopenia was observed in men with progressive knee OA. Up to six months after primary TKA, PROMs in group S were inferior to those in group NS, except for the pain score; however, no significant difference was observed between the groups at 12 months. Age, BMI, and higher mCCI were predisposing factors for sarcopenia in patients with OA.
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Affiliation(s)
- Oog-Jin Shon
- Department of Orthopedic Surgery, Yeungnam University College of Medicine, 170 Hyonchung-ro, Namgu, Daegu 42415, Republic of Korea
- Department of Orthopedic Surgery, Yeungnam University Medical Center, 170 Hyonchung-ro, Namgu, Daegu 42415, Republic of Korea
| | - Gi Beom Kim
- Department of Orthopedic Surgery, Yeungnam University College of Medicine, 170 Hyonchung-ro, Namgu, Daegu 42415, Republic of Korea
- Department of Orthopedic Surgery, Yeungnam University Medical Center, 170 Hyonchung-ro, Namgu, Daegu 42415, Republic of Korea
| | - Seung Jae Cho
- Department of Orthopedic Surgery, Yeungnam University Medical Center, 170 Hyonchung-ro, Namgu, Daegu 42415, Republic of Korea
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Hanson HM, Friesen J, Beaupre L, Jasper L, Millington J, Jones CA. Supporting Rehabilitation of Rural Patients Receiving Total Knee Arthroplasty Through Physical Activity: Perceptions of Stakeholder Groups. ACR Open Rheumatol 2022; 4:863-871. [PMID: 35862257 PMCID: PMC9555196 DOI: 10.1002/acr2.11489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 06/05/2022] [Accepted: 06/16/2022] [Indexed: 11/06/2022] Open
Abstract
Objective To identify how patients with osteoarthritis waiting for and recovering from total knee arthroplasty (TKA) conceptualized and participated in physical activity behaviors in their rural setting and to gather perceptions of health care professionals and rehabilitation decision‐makers on the feasibility of a remotely led physical activity coaching intervention. Methods Using a qualitative descriptive study, we collected data from three stakeholder groups: patients waiting for or recovering from TKA (interviews), health professionals delivering a physical activity intervention to patients in the recovering cohort (focus group), and rehabilitation leaders involved in decision‐making at the local or provincial level (interviews). Results A total of 38 individuals provided their perspectives (25 patients, five health professionals, eight decision‐makers). Patients waiting for and recovering from surgery described the attributes of their rural environment that supported and restricted their ability to participate in physical activities. Patients recovering from TKA appreciated support for goal‐setting and problem‐solving during their rehabilitation. Health care professionals and decision‐makers commented on the benefits of the program's innovative use of relatively simple technology to support remotely delivered, personalized rehabilitation in rural settings. Conclusion This study adds to the limited voice of and about patients living with osteoarthritis who reside in rural settings and identifies facilitators and barriers to TKA rehabilitation in this population. Our findings highlight that it is important to consider the local context and the resources available to patients as they navigate living well with osteoarthritis.
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Affiliation(s)
- Heather M. Hanson
- Alberta Health Services, Edmonton, Alberta, Canada, and University of Calgary Calgary Alberta Canada
| | | | | | - Lisa Jasper
- University of Alberta Edmonton Alberta Canada
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Hodges A, Harmer AR, Dennis S, March L, Crawford R, Parker D. Prevalence and determinants of physical activity, sedentary behaviour and fatigue five years after total knee replacement. Clin Rehabil 2022; 36:1524-1538. [PMID: 35861777 DOI: 10.1177/02692155221113909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine the prevalence and predictors of physical activity, sedentary behaviour and fatigue five years after total knee replacement surgery. DESIGN A longitudinal cohort study. SETTING Community-dwelling adults who had previously undergone total knee replacement. METHODS Five-year follow-up questionnaire data were obtained from participants previously enrolled in a randomised controlled trial examining rehabilitation after total knee replacement. Main study outcomes at one year did not differ between randomisation groups, hence data were pooled for the present longitudinal analysis. Before and one and five years after surgery, participants completed questionnaires (Active Australia Survey, WOMAC, SF12 v2, demographics and fatigue). RESULTS 272/422 community-dwelling adults (45-74 years) completed the questionnaires at five years. Excessive sedentary behaviour was evident in 91% of the cohort, predicted by excessive sedentary behaviour and lack of energy at one year. Inadequate physical activity at five years was evident for 59% of the cohort, predicted by higher fatigue and comorbidity scores pre-surgery and inadequate physical activity at one year. Just under half (47%) of the cohort experienced clinically-important fatigue at five years, predicted by clinically-important fatigue before and one year after surgery, lack of sleep before surgery and physical activity one year after surgery. CONCLUSION Documenting physical activity, sedentary behaviour and fatigue before and one year after knee replacement is important to identify those at risk of longer-term inadequate physical activity, excessive sedentary behaviour and clinically-important fatigue. Interventions to maintain activity and reduce sedentary behaviour are needed to reap the potential health benefits of total knee replacement surgery.
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Affiliation(s)
- Alison Hodges
- Department of Physiotherapy, 6078Australian Catholic University, North Sydney, New South Wales, Australia
| | - Alison R Harmer
- Faculty of Medicine and Health, 153399University of Sydney, Camperdown, New South Wales, Australia
| | - Sarah Dennis
- University of Sydney, Camperdown, New South Wales, Australia.,South Western Sydney Local Health District, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Lyn March
- University of Sydney and North Shore Hospital, Sydney, New South Wales, Australia
| | - Ross Crawford
- Department of Orthopaedic Research, Queensland University of Technology, Brisbane, Queensland, Australia
| | - David Parker
- Sydney Orthopaedic Research Institute, Chatswood, New South Wales, Australia
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Leversedge C, Castro S, Appiani LMC, Kamal R, Shapiro L. Patient Follow-up After Orthopaedic Outreach Trips - Do We Know Whether Patients are Improving? World J Surg 2022; 46:2299-2309. [PMID: 35764890 PMCID: PMC9436850 DOI: 10.1007/s00268-022-06630-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2022] [Indexed: 12/21/2022]
Abstract
Background The burden of traumatic musculoskeletal injuries falls greatest on low- and middle-income countries (LMICs). To help address this burden, organizations host over 6,000 outreach trips annually, 20% of which are orthopaedic. Monitoring post-surgical outcomes is critical to ensuring care quality; however, the implementation of such monitoring is unknown. The purpose of this review is to identify published follow-up practices of short-term orthopaedic surgery outreach trips to LMICs.
Methods We completed a systematic review of Pubmed, Web of Science, EMBASE, and ProQuest following PRISMA guidelines. Follow-up method, rate, duration, and types of outcomes measured along with barriers to follow-up were collected and reported. Results The initial search yielded 1,452 articles, 18 of which were eligible. The mean follow-up time was 5.4 months (range: 15 days-7 years). The mean follow-up rate was 65.8% (range: 22%-100%), the weighted rate was 57.5%. Fifteen studies reported follow-up at or after 3 months while eight studies reported follow-up at or after 9 months. Fifteen studies reported follow-up in person, three reported follow-up via phone call or SMS. Outcome reporting varied among mortality, complications, and patient-reported outcomes. The majority (75%) outlined barriers to follow-up, most commonly noting transportation and costs of follow-up to the patient. Conclusions There is minimal and heterogeneous public reporting of patient outcomes and follow-up after outreach trips to LMICs, limiting quality assessment and improvement. Future work should address the design and implementation of tools and guidelines to improve follow-up as well as outcome measurement to ensure provision of high-quality care. Supplementary Information The online version contains supplementary material available at 10.1007/s00268-022-06630-w.
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Affiliation(s)
- Chelsea Leversedge
- Stanford School of Medicine Department of Orthopaedic Surgery, VOICES Health Policy Research Center, 450 Broadway St, Redwood City, CA 94306 USA
| | - Samuel Castro
- Stanford School of Medicine, 291 Campus Drive, Palo Alto, CA 94305 USA
| | - Luis Miguel Castro Appiani
- Department of Orthopaedic Surgery, Hospital Clinica Biblica Aveinda, 14 Calle 1 Y Central, San José, Costa Rica USA
| | - Robin Kamal
- Stanford School of Medicine Department of Orthopaedic Surgery, VOICES Health Policy Research Center, 450 Broadway St, Redwood City, CA 94306 USA
| | - Lauren Shapiro
- School of Medicine Department of Orthopaedics, University of California San Francisco, 1500 Owens Street, San Francisco, CA 94158 USA
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Patient perspectives of pain and function after knee replacement: a systematic review and meta-synthesis of qualitative studies. Pain Rep 2022; 7:e1006. [PMID: 35558092 PMCID: PMC9088230 DOI: 10.1097/pr9.0000000000001006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/30/2022] [Accepted: 03/05/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Joint replacement surgery typically results in good clinical outcome, although some people experience suboptimal pain relief and functional improvement. Predicting surgical outcome is difficult. Objectives There is merit in better understanding patients' perspectives of pain and function to identify avoidable problems perceived to contribute to their outcome, to inform prognostic expectations, and to identify potential cointerventions to sit alongside surgery that might mitigate pain/functional problems. Here, we aimed to synthesise the available literature exploring perspectives of people with knee osteoarthritis about their pain and function following joint replacement. Methods Six electronic databases and 2 websites were searched. Two independent reviewers completed study inclusion, quality assessment, and data extraction. Data were iteratively synthesised using first-, second-, and third-order analyses. Results Twenty-eight studies were included. Four themes were identified; perceptions of pain and function were inseparable. Theme 1 addressed experiences of recovery after surgery, which often differed from expectations. Theme 2 described the challenges of the pain experience and its functional impact, including the difficulty navigating medication use in context of personal beliefs and perceived stigma. Theme 3 articulated the toll of ongoing problems spanning pain-function-mood, necessitating the need to "endure." Theme 4 encompassed the importance of clinical/social interactions on mood and pain, with reports of concerns dismissed and practical support missing. Conclusions Together, these findings show that numerous individual considerations beyond the technical aspects of surgery influence experiences of pain and function. A tailored approach addressing these considerations from the patient perspective could provide a basis for improved success of knee replacement surgery.
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Hwang D, Han HS, Lee MC, Ro DH. Low muscle mass is an independent risk factor for postoperative blood transfusion in total knee arthroplasty: a retrospective, propensity score-matched cohort study. BMC Geriatr 2022; 22:218. [PMID: 35296255 PMCID: PMC8928693 DOI: 10.1186/s12877-022-02903-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/03/2022] [Indexed: 01/04/2023] Open
Abstract
Background Sarcopenia, an age-related loss of skeletal muscle mass and function, is correlated with adverse outcomes after some surgeries. This study examined the characteristics of sarcopenic patients undergoing primary total knee arthroplasty (TKA), and identified low muscle mass as an independent risk factor for postoperative TKA complications. Methods A retrospective cohort study examined 452 patients who underwent TKA. The skeletal muscle index (SMI) was obtained via bioelectrical impedance analysis (BIA), along with demographics, the Charlson Comorbidity Index, and medication, laboratory and operative data for 2018–2021. Patients were categorized into normal (n = 417) and sarcopenic (n = 35) groups using the SMI cut-off suggested by the Asian Working Group for Sarcopenia 2019 (males, < 7.0 kg/m2; females, < 5.7 kg/m2). Three postoperative complications were analysed: blood transfusion, delirium, and acute kidney injury (AKI). Baseline characteristics were propensity score-matched to address potential bias and confounding factors. Results The proportion of sarcopenic patients in primary TKA was 7.7% (35/452). The sarcopenic group had a lower preoperative haemoglobin (12.18 ± 1.20 vs. 13.04 ± 1.73 g/dL, p = 0.004) and total protein (6.73 ± 0.42 vs. 7.06 ± 0.44 mg/dL, p = 0.001). Propensity scoring matching and logistic regression showed that more patients in the sarcopenic group received postoperative blood transfusions (OR = 6.60, 95% CI: 1.57–45.5, p = 0.021); there was no significant difference in AKI or delirium. Univariate receiver operating characteristic curve analysis of the propensity-matched group, to determine the predictive value of SMI for postoperative transfusion, gave an AUC of 0.797 (0.633–0.96) and SMI cut-off of 5.6 kg/m2. Conclusions Low muscle mass determined by BIA was an independent risk factor for postoperative transfusion in TKA. Multifrequency BIA can serve as a screening tool for sarcopenia that may influence the orthopaedic decision-making process or treatment planning in patients with sarcopenia undergoing primary TKA. Level of evidence III, retrospective cohort study. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-02903-0.
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Affiliation(s)
- Doohyun Hwang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, Republic of Korea.,Department of Orthopedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - Hyuk-Soo Han
- Department of Orthopedic Surgery, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, Republic of Korea.,Department of Orthopedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - Myung Chul Lee
- Department of Orthopedic Surgery, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, Republic of Korea.,Department of Orthopedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - Du Hyun Ro
- Department of Orthopedic Surgery, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, Republic of Korea. .,Department of Orthopedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea. .,CONNECTEVE Co., Ltd., 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea.
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8
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Yeh HW, Chan CH, Yang SF, Chen YC, Yeh YT, Yeh YT, Huang JY, Yeh CB, Chiu CH. Total knee replacement in osteoarthritis patients on reducing the risk of major adverse cardiac events: a 18-year retrospective cohort study. Osteoarthritis Cartilage 2022; 30:416-425. [PMID: 34800630 DOI: 10.1016/j.joca.2021.09.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 08/29/2021] [Accepted: 09/06/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Osteoarthritis (OA) is a common degenerative joint disease, and total knee replacement (TKR) is a successful surgical intervention for knee OA treatment. However, the risks of mortality and major cardiovascular events (MACEs) in patients receiving TKR remain unclear. This study investigated the risks of mortality and MACEs in knee OA patients who received TKR. METHODS For this population-based cohort study, the Longitudinal Health Insurance Database 2000 was used. Two million individuals with knee OA defined by ICD-9-CM codes who received physical therapy between 1999 and 2017 were selected. For propensity score matching (PSM), we considered the year of knee OA diagnosis, demographics, comorbidities, co-medications, and knee OA-related hyaluronic acid or physical therapy at baseline. After PSM, regression analyses were performed to assess the association of mortality or MACEs with TKR and non-TKR individuals. RESULTS We identified patients (n = 189,708) with a new diagnosis of knee OA between 2000 and 2017. In total, 10,314 propensity-score-paired TKR and non-TKR individuals were selected. The PSM cohort algorithm revealed that the risk of mortality or MACEs was lower in the TKR group (adjusted hazard ratio: 0.791; 95% confidence interval: 0.755-0.830) than in the non-TKR group. CONCLUSIONS Patients with knee OA who received TKR had decreased risks of mortality and MACEs than those who did not receive TKR. Moreover, the TKR group received a reduced dosage of nonsteroidal anti-inflammatory drugs at the 1-year follow-up.
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Affiliation(s)
- H-W Yeh
- School of Medicine, Chang Gung University, Taoyuan City, Taiwan; Medical Education Department, Chang Gung Memorial Hospital, Linkou, Taoyuan City, Taiwan
| | - C-H Chan
- Department of Microbiology and Immunology, Chung Shan Medical University, Taichung, Taiwan
| | - S-F Yang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Y-C Chen
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Surgery, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Y-T Yeh
- School of Dentistry, Chung Shan Medical University, Taichung, Taiwan; Department of Dentistry, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Y-T Yeh
- School of Dentistry, Chung Shan Medical University, Taichung, Taiwan; Department of Dentistry, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - J-Y Huang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - C-B Yeh
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Emergency Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.
| | - C-H Chiu
- School of Medicine, Chang Gung University, Taoyuan City, Taiwan; Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.
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Hawke LJ, Taylor NF, Dowsey MM, Choong PFM, Shields N. In the dark about physical activity - exploring patient perceptions of physical activity after elective total knee joint replacement: a qualitative study. Arthritis Care Res (Hoboken) 2021; 74:965-974. [PMID: 34057314 DOI: 10.1002/acr.24718] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 05/06/2021] [Accepted: 05/25/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The study aimed to explore patient perceptions of and motivations for physical activity after total knee joint replacement. METHODS Participants were purposively sampled after completing a public outpatient rehabilitation exercise group. Semi-structured interviews were completed with 22 participants (mean age 70 years, 45% women) 6 to 12 months after total knee joint replacement. Interviews were audiotaped and transcribed verbatim. Themes were identified by an inductive and iterative process of data analysis. RESULTS The main theme to emerge was participants were in the dark about physical activity. Participants were typically not familiar with physical activity guidelines and had difficulty distinguishing between low and moderate-intensity physical activity. Three subthemes were identified: (1) people prioritise participation in meaningful life situations after total knee joint replacement; (2) rehabilitation was perceived to not explicitly address moderate-intensity physical activity levels; and (3) other health and social reasons replaced knee osteoarthritis as barriers to physical activity. CONCLUSION Limited understanding of physical activity recommendations, prioritisation of participation in meaningful life situations, rehabilitation that was impairment focused and other health and social reasons appeared to contribute to low levels of moderate-intensity physical activity for adults after knee joint replacement. Addressing being in the dark about physical activity may be an important first step to increase the effectiveness of behavioural interventions designed to promote physical activity after total knee joint replacement.
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Affiliation(s)
- Lyndon J Hawke
- La Trobe University, Bundoora, and Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia
| | - Nicholas F Taylor
- La Trobe University, Bundoora, and Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia
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10
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Ho KKW, Lau LCM, Chau WW, Poon Q, Chung KY, Wong RMY. End-stage knee osteoarthritis with and without sarcopenia and the effect of knee arthroplasty - a prospective cohort study. BMC Geriatr 2021; 21:2. [PMID: 33397330 PMCID: PMC7784022 DOI: 10.1186/s12877-020-01929-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 11/24/2020] [Indexed: 12/21/2022] Open
Abstract
Background Sarcopenia often accompanies osteoarthritis (OA), which is managed by total knee arthroplasty (TKA) in the late stage. Recent studies have suggested a higher risk of post-operative complications after TKA in sarcopenic OA subjects, but whether TKA can benefit them similar to non-sarcopenic subjects remains unexplored. This study aimed to examine the dynamic, mutual impact of sarcopenia and TKA in a one-year post-operative period. Methods This prospective cohort study was conducted between 2015 to 2018 at our hospital. Patients with end-stage OA of the knee waiting for TKA were recruited into the study. Primary outcome measures were change in muscle strength, mass and function. Secondary outcome measures were quality of life (QOL) measurements for pain, psychological and physical health. Results Fifty-eight patients were recruited, of which 79.3% were female and 32.8% already had sarcopenia at baseline. The average age of sarcopenic subjects and non-sarcopenic subjects was comparable (67.89 ± 7.07 vs. 67.92 ± 6.85; p = 0.99), but sarcopenic subjects had a lower body mass index (BMI) (25.64 ± 2.64 vs. 28.57 ± 4.04; p = 0.01). There was a statistically significant improvement in walking speed (10.24 ± 5.35 vs. 7.69 ± 2.68, p < 0.01) and muscle strength in both sarcopenic and non-sarcopenic patients after TKA. This was accompanied by an improvement trend in muscle mass in all subjects. There was no change in handgrip power before and after TKA and subsequent follow-up (19.31 ± 5.92 vs. 18.98 ± 6.37 vs. 19.36 ± 7.66; p = 0.97). QOL measured before, after and at follow-up with WOMAC (total: 42.27 ± 15.98 vs. 20.65 ± 15.24 vs. 16.65 ± 18.13) and SF12v2 (PCS: 33.06 ± 8.55 vs. 38.96 ± 8.01 vs. 40.67 ± 7.93) revealed progressive significant improvement (both comparisons p ≤ 0.01). Further analysis with the IPAQ also found increased engagement of high-intensity activities. Conclusions This study showed that sarcopenia among patients with end-stage OA of the knee is not uncommon, but both sarcopenic and non-sarcopenic OA patients achieved significant clinical and functional improvement after TKA. Further studies with a larger sample size and different ethnicities could help ascertain a beneficial role of TKA in sarcopenic OA subjects. Trial registration Registry: ClinicalTrials.gov, Registration number: NCT03579329. Date of registration: 6 July 2018. Retrospectively registered.
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Affiliation(s)
- Kevin Ki-Wai Ho
- Department of Orthopaedics and Traumatology, Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
| | - Lawrence Chun-Man Lau
- Department of Orthopaedics and Traumatology, Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.,Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - Wai-Wang Chau
- Department of Orthopaedics and Traumatology, Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Queena Poon
- Department of Orthopaedics and Traumatology, Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Kwong-Yin Chung
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - Ronald Man-Yeung Wong
- Department of Orthopaedics and Traumatology, Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
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11
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Development of Patient Education Materials for Total Joint Replacement During an International Surgical Brigade. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2020; 4:01979360-202010000-00007. [PMID: 33986204 PMCID: PMC7571875 DOI: 10.5435/jaaosglobal-d-20-00074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/22/2020] [Indexed: 11/18/2022]
Abstract
Temporary brigade trips to deliver international surgical care are increasingly common. For the purposes of this work, we use the term brigade to describe self-contained short-term medical or surgical mission trips where healthcare professionals are brought in from foreign regions to provide care to an underserved population. Many brigade programs have begun to collect and publish data on outcomes and complications, but few have examined their own patient education practices.
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12
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Solano MA, Ramcharran KK, Jones LC, Sterling RS, Samaroo DR, Khanuja HS. Preoperative Patient Education Class During an Orthopedic Mission Trip: Effects on Knowledge, Anxiety, and Informed Consent. J Arthroplasty 2020; 35:2410-2417. [PMID: 32451279 DOI: 10.1016/j.arth.2020.04.084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 04/03/2020] [Accepted: 04/24/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Patient knowledge about arthritis and risks, benefits, and outcomes of joint arthroplasty in developing countries is unknown. We evaluated the effectiveness of a preoperative class on improving knowledge and decreasing anxiety during a surgical mission trip offering total joint arthroplasty. METHODS A team of US health care providers taught a preoperative class to 41 patients selected for total joint arthroplasty during a surgical mission trip to Guyana. Participants completed a 32-point survey about arthritis; indications, risks, and benefits of joint arthroplasty; and postoperative, in-patient rehabilitation expectations. The State-Trait Anxiety Inventory was used to measure participant anxiety. Participants completed identical surveys before and after class. Matched-pairs Student t tests were used to compare means between preclass and postclass surveys. Significance was accepted at P < .05. RESULTS Seventy-eight percent of patients (31 of 41) scored less than 12 of 32 possible points (40%) on the preclass knowledge questionnaire. Mean ± standard deviation knowledge scores improved from 14.0 ± 4.5 before the class to 16.5 ± 6.5 after the class (P = .008). Anxiety scores (n = 33) improved from 35 ± 13 before the class to 33 ± 12 after the class (P = .047). CONCLUSION On this surgical mission trip, underserved patients' knowledge about total joint arthroplasty increased only modestly after taking a preoperative class. Greater understanding of how to educate patients and reduce their anxiety on medical missions is needed.
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Affiliation(s)
- Mitchell A Solano
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD; Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR
| | | | - Lynne C Jones
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
| | - Robert S Sterling
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
| | - David R Samaroo
- Department of Orthopaedic Surgery, Georgetown Public Hospital, Georgetown, Guyana
| | - Harpal S Khanuja
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
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Patterns of Weight Change and Their Effects on Clinical Outcomes Following Total Knee Arthroplasty in an Asian Population. J Arthroplasty 2020; 35:375-379. [PMID: 31563395 DOI: 10.1016/j.arth.2019.09.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 08/23/2019] [Accepted: 09/02/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND This prospective cohort study was designed to evaluate weight change patterns and their effects on clinical outcomes following total knee arthroplasty (TKA) in the Asian population. We hypothesized that Asian patients will have a different pattern of weight change following TKA compared to Western patients and that weight loss following TKA will be associated with better clinical outcomes. METHODS A cohort of consecutive patients who underwent TKA from 2004 to 2015 was included. All patients received a conventional posterior-stabilized TKA implant and underwent a standard perioperative care pathway. Assessments were done preoperatively, at 6 months, and 2 years after surgery. The range of motion, Knee Society Score, Oxford Knee Score, and the Short-Form 36 questionnaire were used to assess outcomes. Height and weight of patients were recorded for body mass index (BMI) calculation. Patterns of weight loss following TKA in this cohort were charted. Clinical outcomes were then analyzed against the change in BMI. RESULTS A total of 602 patients (602 knees) were reviewed. Mean age was 66.39 ± 7.27 years. Mean BMI was 27.75 ± 4.51 kg/m2. Overall, 63.12% of all our patients gained weight following TKA. Moreover, weight loss did not influence patients' odds for better clinical outcomes. Furthermore, patients who were in the preoperative BMI category of obese class I were more likely to gain weight as compared to those in the normal category (odds ratio 0.35, 95% confidence interval 0.2-0.61, P < .001). Moreover, older people were more likely to gain more weight compared to younger people. We also showed that the mean 2-year Knee Society Knee Score was significantly higher in the patients who gained weight while the patients who lost weight had the highest mean 2-year Oxford Knee Score and the lowest mean 2-year Knee Society Function Score. CONCLUSION Asians tend to gain weight following TKA. However, this weight change following TKA does not affect clinical outcomes, which remain good across all BMI groups. LEVEL OF EVIDENCE Therapeutic Level III.
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Lape EC, Hudak P, Davis AM, Katz JN. Body-Self Unity With a New Hip or Knee: Understanding Total Joint Replacement Within an Embodiment Framework. ACR Open Rheumatol 2019; 1:90-96. [PMID: 31777785 PMCID: PMC6857960 DOI: 10.1002/acr2.1014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Medical research increasingly makes use of embodiment concepts to understand how illness disrupts unity of body and self. However, few have applied embodiment concepts in total joint replacement (TJR), an effective treatment for end‐stage arthritis. In considering why a troubling proportion of TJR recipients have continued pain and functional limitation, we ask: what role might be played by the embodied experience of living with an implant? Relevant theoretical models and prior research on embodiment in musculoskeletal health and transplantation are reviewed. Our findings suggest a research agenda with implications for addressing suboptimal outcomes in TJR.
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Affiliation(s)
- Emma C Lape
- Brigham and Women's Hospital Boston Massachusetts
| | - Pamela Hudak
- Alternative Dispute Resolution Practice, Inc. Toronto Canada
| | - Aileen M Davis
- Krembil Research Institute University Health Network and University of Toronto Toronto Canada
| | - Jeffrey N Katz
- Harvard Medical School and Brigham and Women's Hospital Boston Massachusetts
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15
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Sobon Sensor C. Health-Related Beliefs, Practices, and Experiences of Migrant Dominicans in the Northeastern United States. J Transcult Nurs 2018; 30:492-500. [DOI: 10.1177/1043659618801967] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: The purpose of this study was to describe cultural health beliefs, practices, and experiences with professional health care in the United States by migrants from the Dominican Republic because their practices are largely unknown to professional providers. Method: A qualitative descriptive design was used, guided by Leininger’s culture care theory and four-phase analysis method with a convenience sample of 15 self-identified migrant Dominican adults in three interpreter-assisted focus groups, in a familiar apartment. Results: The following four themes emerged: Stress affects health and well-being, family support and faith in God are essential, use of folk care and professional care to treat illness and maintain health, and access to care, cost, communication and expressions of caring practices affect perceptions about the quality of professional care. Discussion: Results informed development of specific strategies to provide culturally responsive care and risk-reduction interventions that promote health and improve quality of care in the Dominican community.
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16
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Roche S, Brockington M, Fathima S, Nandi M, Silverberg B, Rice HE, Hall-Clifford R. Freedom of choice, expressions of gratitude: Patient experiences of short-term surgical missions in Guatemala. Soc Sci Med 2018; 208:117-125. [PMID: 29803969 DOI: 10.1016/j.socscimed.2018.05.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 05/04/2018] [Accepted: 05/07/2018] [Indexed: 12/28/2022]
Abstract
Lack of surgical care has been highlighted as a critical global health problem, and short-term medical missions (STMMs) have become a de facto measure to address this shortfall. Participation in STMMs is an increasingly popular activity for foreign medical professionals to undertake in low- and middle-income countries (LMICs) where their clinical skills may be in short supply. While there is emerging literature on the STMM phenomenon, patient experiences of surgical missions are underrepresented. This research addresses this gap through thirty-seven in-depth interviews with patients or caregivers who received care from a short-term surgical mission within the three years prior to the four-week data collection period in July and August 2013. Interviews were conducted in Antigua, Guatemala and nearby communities, and participants came from 9 different departments of the country. These first-hand accounts of health-seeking through a surgical mission provide important insights into the benefits and challenges of STMMs that patients encounter, including waiting time, ancillary costs, and access to care. Patient agency in care-seeking is considered within the pluralistic, privatized health care context in Guatemala in which foreign participants deliver STMM care.
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Affiliation(s)
- Stephanie Roche
- NAPA-OT Field School, Guatemala; University of Washington, Department of Global Health, United States
| | | | | | | | - Benjamin Silverberg
- NAPA-OT Field School, Guatemala; Duke University, Global Health Institute, United States
| | - Henry E Rice
- Duke University, Global Health Institute, United States
| | - Rachel Hall-Clifford
- NAPA-OT Field School, Guatemala; Agnes Scott College Departments of Sociology and Anthropology and Public Health, United States.
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17
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Bido J, Ghazinouri R, Collins JE, Diez Portela D, Alcantara L, Thornhill TS, Katz JN. A Conceptual Model for the Evaluation of Surgical Missions. J Bone Joint Surg Am 2018; 100:e35. [PMID: 29557871 PMCID: PMC5916479 DOI: 10.2106/jbjs.17.00689] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Medical missions to low and middle-income countries are increasingly frequent, with an estimated 6,000 trips sponsored by U.S. organizations accounting for approximately 200,000 surgical cases and $250 million in costs annually. However, these missions have received little critical evaluation. This paper describes the research program Operation Walk (Op-Walk) Boston, and proposes an evaluation model for similar surgical missions. METHODS We propose an evaluation model, borrowing from the work of Donabedian and enriched by evidence from our research program. The model calls for evaluation of the salient contextual factors (culture and beliefs), system management (structure, process, and outcomes), and sustainability of the program's interventions. We used these domains to present findings from the quantitative and qualitative research work of Op-Walk Boston. RESULTS Op-Walk's qualitative research findings demonstrated that cultural factors are important determinants of patients' perceptions of arthritis etiology, physical activity patterns, and treatment preferences. Quantitative assessments documented that Dominican patients had worse lower-extremity functional status (mean Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC] function score of 33.6) and pain preoperatively than patients undergoing total hip or knee replacement in the U.S. (WOMAC function score of 43.3 to 54), yet they achieved excellent outcomes (50-point improvement), comparable to those of their U.S. counterparts. Assessments of the quality and sustainability of the Op-Walk program showed that the quality of care provided by Op-Walk Boston meets Blue Cross Blue Shield Centers of Excellence (Blue Distinction) criteria, and that sustainable changes were transferred to the host hospital. CONCLUSIONS Our proposed model offers a method for formal assessment of medical missions that addresses the call for evidence of their merit. We suggest that surgical missions adopt quantitative and qualitative strategies to document their impact, identify areas of improvement, and justify program continuation, growth, and support.
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Affiliation(s)
- Jennifer Bido
- Orthopaedic and Arthritis Center for Outcomes Research (J.B., R.G., J.E.C., T.S.T., and J.N.K.), Center for Healthcare Delivery Sciences, Department of Medicine (R.G.); Department of Orthopaedic Surgery (J.E.C., T.S.T., and J.N.K.); and Division of Rheumatology, Immunology, and Allergy (J.N.K.), Brigham and Women’s Hospital, Boston, Massachusetts,Harvard Medical School, Boston, Massachusetts
| | - Roya Ghazinouri
- Orthopaedic and Arthritis Center for Outcomes Research (J.B., R.G., J.E.C., T.S.T., and J.N.K.), Center for Healthcare Delivery Sciences, Department of Medicine (R.G.); Department of Orthopaedic Surgery (J.E.C., T.S.T., and J.N.K.); and Division of Rheumatology, Immunology, and Allergy (J.N.K.), Brigham and Women’s Hospital, Boston, Massachusetts
| | - Jamie E. Collins
- Orthopaedic and Arthritis Center for Outcomes Research (J.B., R.G., J.E.C., T.S.T., and J.N.K.), Center for Healthcare Delivery Sciences, Department of Medicine (R.G.); Department of Orthopaedic Surgery (J.E.C., T.S.T., and J.N.K.); and Division of Rheumatology, Immunology, and Allergy (J.N.K.), Brigham and Women’s Hospital, Boston, Massachusetts,Harvard Medical School, Boston, Massachusetts
| | - Desirée Diez Portela
- Departments of Project Management (D.D.P.) and Orthopaedic Surgery (L.A.), Hospital General de la Plaza de la Salud, Santo Domingo, Dominican Republic
| | - Luis Alcantara
- Departments of Project Management (D.D.P.) and Orthopaedic Surgery (L.A.), Hospital General de la Plaza de la Salud, Santo Domingo, Dominican Republic
| | - Thomas S. Thornhill
- Orthopaedic and Arthritis Center for Outcomes Research (J.B., R.G., J.E.C., T.S.T., and J.N.K.), Center for Healthcare Delivery Sciences, Department of Medicine (R.G.); Department of Orthopaedic Surgery (J.E.C., T.S.T., and J.N.K.); and Division of Rheumatology, Immunology, and Allergy (J.N.K.), Brigham and Women’s Hospital, Boston, Massachusetts,Harvard Medical School, Boston, Massachusetts
| | - Jeffrey N. Katz
- Orthopaedic and Arthritis Center for Outcomes Research (J.B., R.G., J.E.C., T.S.T., and J.N.K.), Center for Healthcare Delivery Sciences, Department of Medicine (R.G.); Department of Orthopaedic Surgery (J.E.C., T.S.T., and J.N.K.); and Division of Rheumatology, Immunology, and Allergy (J.N.K.), Brigham and Women’s Hospital, Boston, Massachusetts,Harvard Medical School, Boston, Massachusetts,Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts,E-mail address for J.N. Katz:
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18
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Pellegrini CA, Ledford G, Chang RW, Cameron KA. Understanding barriers and facilitators to healthy eating and physical activity from patients either before and after knee arthroplasty. Disabil Rehabil 2017; 40:2004-2010. [PMID: 28475433 DOI: 10.1080/09638288.2017.1323026] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE We sought to identify patient-reported barriers and facilitators to healthy eating and physical activity among patients before or after knee arthroplasty. MATERIALS AND METHODS Twenty patients with knee osteoarthritis aged 40-79 years who had knee arthroplasty surgery scheduled or completed within 3 months were interviewed. Interview topics included perceived barriers and facilitators to healthy eating and activity before or after surgery. Interviews were coded and analyzed using constant comparative analysis. RESULTS Interviews were completed with 11 pre-operative (67.1 ± 7.6 years, 45.5% female, BMI 31.2 ± 6.3) and nine post-operative patients (61.7 ± 11.7 years, 44.4% female, BMI 30.2 ± 4.7 kg/m2). The most commonly identified personal barriers to healthy eating identified were desire for high-fat/high-calorie foods, managing overconsumption and mood. Factors related to planning, portion control and motivation to improve health were identified as healthy eating facilitators. Identified personal barriers for activity included pain, physical limitations and lack of motivation, whereas facilitators included having motivation to improve knee symptoms/outcomes, personal commitment to activity and monitoring activity levels. CONCLUSION Identifying specific eating and activity barriers and facilitators, such as mood and motivation to improve outcomes, provides critical insight from the patient perspective, which will aid in developing weight management programs during rehabilitation for knee arthroplasty patients. Implications for rehabilitation This study provides insight into the identified barriers and facilitators to healthy eating and physical activity in knee arthroplasty patients, both before and after surgery. Intrapersonal barriers that may hinder engagement in physical activity and rehabilitation include pain, physical limitations and lack of motivation; factors that may help to improve activity and the rehabilitation process include being motivated to improve knee outcomes, having a personal commitment to activity and tracking activity levels. Barriers that may interfere with healthy eating behaviors and knee arthroplasty rehabilitation include the desire for high-fat/high-calorie foods, overeating and mood; whereas planning and portion control may help to facilitate healthy eating. Understanding barriers and facilitators to healthy eating and physical activity can help guide rehabilitation professionals with their discussions on weight management with patients who had or are contemplating knee arthroplasty.
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Affiliation(s)
- Christine A Pellegrini
- a Department of Preventive Medicine , Northwestern University , Chicago , IL , USA.,b Department of Exercise Science , University of South Carolina , Columbia , SC , USA
| | - Gwendolyn Ledford
- a Department of Preventive Medicine , Northwestern University , Chicago , IL , USA
| | - Rowland W Chang
- a Department of Preventive Medicine , Northwestern University , Chicago , IL , USA
| | - Kenzie A Cameron
- a Department of Preventive Medicine , Northwestern University , Chicago , IL , USA.,c Division of General Internal Medicine and Geriatrics, Department of Medicine , Northwestern University , Chicago , IL , USA
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19
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Factors associated with gait speed recovery after total knee arthroplasty: A longitudinal study. Semin Arthritis Rheum 2017; 46:544-551. [DOI: 10.1016/j.semarthrit.2016.10.012] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 10/27/2016] [Accepted: 10/27/2016] [Indexed: 11/22/2022]
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20
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Roche S, Hall-Clifford R. Making surgical missions a joint operation: NGO experiences of visiting surgical teams and the formal health care system in Guatemala. Glob Public Health 2016; 10:1201-14. [PMID: 25734638 DOI: 10.1080/17441692.2015.1011189] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Each year, thousands of Guatemalans receive non-emergent surgical care from short-term medical missions (STMMs) hosted by local non-governmental organizations (NGOs) and staffed by foreign visiting medical teams (VMTs). The purpose of this study was to explore the perspectives of individuals based in NGOs involved in the coordination of surgical missions to better understand how these missions articulate with the larger Guatemalan health care system. During the summers of 2011 and 2013, in-depth interviews were conducted with 25 representatives from 11 different Guatemalan NGOs with experience with surgical missions. Transcripts were analysed for major themes using an inductive qualitative data analysis process. NGOs made use of the formal health care system but were limited by several factors, including cost, issues of trust and current ministry of health policy. Participants viewed the government health care system as a potential resource and expressed a desire for more collaboration. The current practices of STMMs are not conducive to health system strengthening. The role of STMMs must be defined and widely understood by all stakeholders in order to improve patient safety and effectively utilise health resources. Priority should be placed on aligning the work of VMTs with that of the larger health care system.
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Affiliation(s)
- Stephanie Roche
- a Department of Global Health , Boston University , Boston , MA , USA
| | - Rachel Hall-Clifford
- b Department of Anthropology , Agnes Scott College , Decatur , GA , USA.,c Department of Public Health , Agnes Scott College , Decatur , GA , USA
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21
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Meiring RM, Frimpong E, Mokete L, Pietrzak J, Van Der Jagt D, Tikly M, McVeigh JA. Rationale, design and protocol of a longitudinal study assessing the effect of total knee arthroplasty on habitual physical activity and sedentary behavior in adults with osteoarthritis. BMC Musculoskelet Disord 2016; 17:281. [PMID: 27411316 PMCID: PMC4944438 DOI: 10.1186/s12891-016-1141-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 06/29/2016] [Indexed: 01/11/2023] Open
Abstract
Background Physical activity levels are decreased and sedentary behaviour levels are increased in patients with knee osteoarthritis (OA). However, previous studies have shown that following total knee arthroplasty (TKA), objectively measured physical activity levels do not change compared to before the surgery. Very few studies have objectively assessed sedentary behaviour following TKA. This study aims to assess patterns of objective habitual physical activity and sedentary behaviour in patients with knee OA and to determine whether these change following TKA. Methods Patients diagnosed with knee osteoarthritis and scheduled for unilateral primary total knee arthroplasty will be recruited from the Orthopaedic Division at the Charlotte Maxeke Johannesburg Academic Hospital. Eligible participants will have assessments completed one week before the scheduled arthroplasty, six weeks, and six months post-operatively. The primary outcomes are habitual physical activity and sedentary behaviour which will be measured using accelerometry (Actigraph GTX3+ and activPal monitors) at the specific time points. The secondary outcomes will be improvements in osteoarthritis-specific quality of life measures using the following questionnaires: Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee injury and Osteoarthritis Outcome Score (KOOS), Oxford Knee Score (OKS), Knee Society Clinical Rating System (KSS), UCLA activity index; subjective pain scores, and self reported sleep quality. Discussion The present study will contribute to the field of musculoskeletal health by providing a rich detailed description of the patterns of accumulation of physical activity and sedentary behaviour in patients with knee OA. These data will contribute to existing knowledge using an objective measurement for the assessment of functional ability after total knee arthroplasty. Although studies have used accelerometry to measure physical activity in knee OA patients, the data provided thus far have not delved into the detailed patterns of how and when physical activity is accumulated before and after TKA. Accurate assessment of physical activity is important for physical activity interventions that target special populations. Trial registration NCT02675062 (4 February 2016).
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Affiliation(s)
- Rebecca M Meiring
- Exercise Physiology Laboratory, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, 7 York Rd, Parktown, Johannesburg, South Africa.
| | - Emmanuel Frimpong
- Exercise Physiology Laboratory, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, 7 York Rd, Parktown, Johannesburg, South Africa
| | - Lipalo Mokete
- Division of Orthopaedics, Faculty of Health Sciences, University of the Witwatersrand, 7 York Rd, Parktown, Johannesburg, South Africa
| | - Jurek Pietrzak
- Division of Orthopaedics, Faculty of Health Sciences, University of the Witwatersrand, 7 York Rd, Parktown, Johannesburg, South Africa
| | - Dick Van Der Jagt
- Division of Orthopaedics, Faculty of Health Sciences, University of the Witwatersrand, 7 York Rd, Parktown, Johannesburg, South Africa
| | - Mohammed Tikly
- Division of Rheumatology, Department of Medicine, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, 7 York Rd, Parktown, Johannesburg, South Africa
| | - Joanne A McVeigh
- Exercise Physiology Laboratory, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, 7 York Rd, Parktown, Johannesburg, South Africa.,School of Physiotherapy and Exercise Science, Curtin University, Kent St, Bentley, Western Australia
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Devine CA, Yu A, Kasdin RG, Bogart LM, Davis AM, Alcántara Abreu L, Ghazinouri R, Thornhill TS, Katz JN. Postoperative Pain Management Among Dominican and American Health-Care Providers: A Qualitative Analysis. J Bone Joint Surg Am 2016; 98:e50. [PMID: 27307368 DOI: 10.2106/jbjs.15.01004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND U.S. practitioners have prescribed opioid analgesics increasingly in recent years, contributing to what has been declared an opioid epidemic by the U.S. Centers for Disease Control and Prevention (CDC). Opioids are used frequently in the preoperative and postoperative periods for patients undergoing total joint replacement in developed countries, but cross-cultural comparisons of this practice are limited. An international medical mission such as Operation Walk Boston, which provides total joint replacement to financially vulnerable patients in the Dominican Republic, offers a unique opportunity to compare postoperative pain management approaches in a developed nation and a developing nation. METHODS We interviewed American and Dominican surgeons and nurses (n = 22) during Operation Walk Boston 2015. We used a moderator's guide with open-ended questions to inquire about postoperative pain management and factors influencing prescribing practices. Interviews were recorded and transcripts were analyzed using content analysis. RESULTS Providers highlighted differences in the patient-provider relationship, pain medication prescribing variability, and access to medications. Dominican surgeons emphasized adherence to standardized pain protocols and employed a paternalistic model of care, and American surgeons reported prescribing variability and described shared decision-making with patients. Dominican providers described limited availability of potent opioid preparations in the Dominican Republic, in contrast to American providers, who discussed opioid accessibility in the United States. CONCLUSIONS Our findings suggest that cross-cultural comparisons provide insight into how opioid prescribing practices, approaches to the patient-provider relationship, and medication access inform distinct pain management strategies in American and Dominican surgical settings. Integrating lessons from cross-cultural pain management studies may yield more effective pain management strategies for surgical procedures performed in the United States and abroad.
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Affiliation(s)
- Christopher A Devine
- Orthopedic and Arthritis Center for Outcomes Research (C.A.D, A.Y., R.G.K., R.G., T.S.T., and J.N.K.), Department of Orthopedic Surgery (T.S.T. and J.N.K.), and Division of Rheumatology, Immunology, and Allergy (J.N.K.), Brigham and Women's Hospital, Boston, Massachusetts Harvard Medical School, Boston, Massachusetts
| | - Amy Yu
- Orthopedic and Arthritis Center for Outcomes Research (C.A.D, A.Y., R.G.K., R.G., T.S.T., and J.N.K.), Department of Orthopedic Surgery (T.S.T. and J.N.K.), and Division of Rheumatology, Immunology, and Allergy (J.N.K.), Brigham and Women's Hospital, Boston, Massachusetts Harvard Medical School, Boston, Massachusetts
| | - Rachel G Kasdin
- Orthopedic and Arthritis Center for Outcomes Research (C.A.D, A.Y., R.G.K., R.G., T.S.T., and J.N.K.), Department of Orthopedic Surgery (T.S.T. and J.N.K.), and Division of Rheumatology, Immunology, and Allergy (J.N.K.), Brigham and Women's Hospital, Boston, Massachusetts
| | - Laura M Bogart
- Harvard Medical School, Boston, Massachusetts Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts
| | - Aileen M Davis
- Toronto Western Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Luis Alcántara Abreu
- Department of Orthopedic Surgery, Hospital General de la Plaza de la Salud, Santo Domingo, Dominican Republic
| | - Roya Ghazinouri
- Orthopedic and Arthritis Center for Outcomes Research (C.A.D, A.Y., R.G.K., R.G., T.S.T., and J.N.K.), Department of Orthopedic Surgery (T.S.T. and J.N.K.), and Division of Rheumatology, Immunology, and Allergy (J.N.K.), Brigham and Women's Hospital, Boston, Massachusetts
| | - Thomas S Thornhill
- Orthopedic and Arthritis Center for Outcomes Research (C.A.D, A.Y., R.G.K., R.G., T.S.T., and J.N.K.), Department of Orthopedic Surgery (T.S.T. and J.N.K.), and Division of Rheumatology, Immunology, and Allergy (J.N.K.), Brigham and Women's Hospital, Boston, Massachusetts Harvard Medical School, Boston, Massachusetts
| | - Jeffrey N Katz
- Orthopedic and Arthritis Center for Outcomes Research (C.A.D, A.Y., R.G.K., R.G., T.S.T., and J.N.K.), Department of Orthopedic Surgery (T.S.T. and J.N.K.), and Division of Rheumatology, Immunology, and Allergy (J.N.K.), Brigham and Women's Hospital, Boston, Massachusetts Harvard Medical School, Boston, Massachusetts Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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23
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Taniguchi M, Sawano S, Kugo M, Maegawa S, Kawasaki T, Ichihashi N. Physical Activity Promotes Gait Improvement in Patients With Total Knee Arthroplasty. J Arthroplasty 2016; 31:984-8. [PMID: 26707650 DOI: 10.1016/j.arth.2015.11.012] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Revised: 11/04/2015] [Accepted: 11/09/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The study aimed to examine whether the improvement in gait function after total knee arthroplasty (TKA) correlated with the amount of physical activity and whether both gait self-efficacy and gait function are predictors of the amount of physical activity up to 6 months after surgery. METHODS Eighty-one patients were tested preoperatively and at the first and sixth postoperative months after TKA. Physical performance (timed up and go [TUG], sit to stand, muscle strength) and the modified gait efficacy scale scores were evaluated. The average amount of physical activity during the 6 postoperative months was measured with a pedometer with triaxial accelerometer. Stepwise multiple regression analyses were performed using TUG changes and postoperative physical activity. The discriminative properties of physical activity for improvement in gait function were subsequently investigated by applying a receiver operating characteristic curve analysis. RESULTS The multiple regression analyses indicated that the amount of physical activity and the improvement in sit-to-stand time were important in predicting improvement in TUG scores after TKA, and postoperative physical activity up to 6 months was predicted by the modified gait efficacy scale and TUG scores at the first postoperative month. The receiver operating characteristic curve analysis suggests that with a cutoff point of 3053 steps/d, the amount of physical activity may be a good predictive factor for gait function after TKA. CONCLUSION The clinical implications are that increases in physical activity can promote improvement in gait function after TKA and present with a solid numerical target for the recommended amount of physical activity.
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Affiliation(s)
- Masashi Taniguchi
- Division of Physical Therapy, Rehabilitation Units, Shiga University of Medical Science Hospital, Otsu City, Shiga, Japan; Development and Rehabilitation of Motor Function, Department of Physical Therapy, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto, Japan
| | - Shinichiro Sawano
- Division of Physical Therapy, Rehabilitation Units, Shiga University of Medical Science Hospital, Otsu City, Shiga, Japan
| | - Masato Kugo
- Division of Physical Therapy, Rehabilitation Units, Shiga University of Medical Science Hospital, Otsu City, Shiga, Japan
| | - Shoji Maegawa
- Division of Physical Therapy, Rehabilitation Units, Shiga University of Medical Science Hospital, Otsu City, Shiga, Japan
| | - Taku Kawasaki
- Department of Rehabilitation, Shiga University of Medical Science Hospital, Otsu City, Shiga, Japan
| | - Noriaki Ichihashi
- Development and Rehabilitation of Motor Function, Department of Physical Therapy, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto, Japan
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Smith TO, Latham S, Maskrey V, Blyth A. Patients' perceptions of physical activity before and after joint replacement: a systematic review with meta-ethnographic analysis. Postgrad Med J 2015; 91:483-91. [PMID: 26306502 DOI: 10.1136/postgradmedj-2015-133507] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 07/20/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND It has been perceived that people following total hip arthroplasty (THA) or total knee arthroplasty (TKA) have the capability, with reduced pain, to increase their levels of physical activity. OBJECTIVES To determine the attitudes and perceptions of people awaiting or having undergone THA or TKA to physical activity post-arthroplasty and to identify potential facilitators or barriers to engage in active living and physical activity pursuits. METHODS Systematic review of published and unpublished databases was undertaken from their inception to November 2014. Studies exploring the attitudes and perceptions of people awaiting or having undergone THA or TKA to physical activity post-arthroplasty were included. Data were analysed through a meta-ethnography approach. RESULTS From 528 citations, 13 papers were eligible, sampling 282 people post-THA or TKA. The literature was judged moderate to high quality. Following THA and TKA, people either wished to return to their pre-pathology level of physical activity or simply be able to engage in less physically demanding activities that are meaningful to them and their lifestyles. Barriers to engaging in higher levels of physical activity were largely related to limited information, which culminated in fear surrounding 'doing the right thing' both for individual's recovery and the longevity of the joint replacement. CONCLUSIONS While many people post-THA or TKA wish to return to pre-pathological physical activity status, there is limited interest in actually undertaking greater levels of physical activity post-arthroplasty either for pleasure or health gains. Improvement in education and awareness of this may be key drivers to improve habitualisation of physical activity post-arthroplasty. TRIAL REGISTRATION NUMBER CRD42014014995.
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Affiliation(s)
- Toby O Smith
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Sarah Latham
- Physiotherapy Department, St George's Hospital, London, UK
| | | | - Annie Blyth
- School of Pharmacy, University of East Anglia, Norwich, UK
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Evaluation Indexes of Military Hospitals From the Experts' Perspective: A Qualitative Study. Disaster Med Public Health Prep 2015; 9:409-14. [PMID: 25991414 DOI: 10.1017/dmp.2015.55] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Given the importance of evaluation in an organization and considering the objectives and missions of military hospitals, we aimed to extract some indexes (in addition to common evaluation indexes) for use in evaluating military hospitals. This was an applied-type qualitative study. The participants were 15 health experts who were first chosen by a purposeful sampling, which was then continued by theoretical sampling. The data obtained were analyzed by using MAXQDA11 software and the content analysis method. After 290 obtained codes were analyzed, 17 indexes in 6 domains were extracted, including capacity development for crisis periods, equipment and facilities, training and research, passive defense, treatment, and services, from which 8 indexes were related to capacity development for crisis periods and equipment and facilities (4 indexes each), 3 indexes were related to services, and 6 indexes were related to training and research, passive defense, and treatment (2 indexes each). The results of the present research, as a supplement to current evaluation methods such as accreditation, can be used for the comprehensive evaluation of military hospitals.
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