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Murao M, Nankaku M, Kawano T, Goto K, Kuroda Y, Kawai T, Ikeguchi R, Matsuda S. Reproducibility, criterion-related validity, and minimal clinically important difference of the stair negotiation test after total Hip arthroplasty. Physiother Theory Pract 2023; 39:2438-2445. [PMID: 35581533 DOI: 10.1080/09593985.2022.2078255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 03/10/2022] [Accepted: 05/11/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To determine the reproducibility, criterion-related validity, and minimal clinically important difference (MCID) of the stair negotiation test (SNT) after total hip arthroplasty (THA). METHODS Sixty patients who underwent THA were included in this study. They performed the SNT and rated their difficulty in stair negotiation (question 7 of the Oxford Hip Score [OHSQ7]) before and 6 months after surgery. The SNT determined the time taken by a patient to ascend, turn around, and descend the stairs (15 cm × 4 steps) and was measured twice each time. As a measure of reproducibility, the intraclass correlation coefficient (ICC1,1) was calculated using the preoperative SNT. As an index of criterion-related validity, Spearman's rank correlation coefficient was used to evaluate the relationship between the better score of two trials in the preoperative SNT and the OHSQ7. The MCID of the SNT was calculated using the distribution-based method and the anchor-based method. The change in the OHSQ7 between before and after surgery was used as an anchor in the latter method. RESULTS The ICC1,1 of the SNT was 0.97. The SNT was significantly correlated with the OHSQ7 (r = 0.40, p < .05). Moreover, the anchor-based MCID of the SNT was 1.98 seconds. CONCLUSION The SNT is an objective assessable test of stair negotiation ability in post-THA patients that has good reproducibility and moderate criterion-related validity. Changes in the SNT beyond the MCID (1.98 seconds) represent clinically important changes in stair negotiation ability.
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Affiliation(s)
- Masanobu Murao
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
| | - Manabu Nankaku
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
| | - Takumi Kawano
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
| | - Koji Goto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yutaka Kuroda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toshiyuki Kawai
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ryosuke Ikeguchi
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shuichi Matsuda
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Ou-Young J, Boggett S, El Ansary D, Clarke-Errey S, Royse CF, Bowyer AJ. Identifying risk factors for poor multidimensional recovery after major surgery: A systematic review. Acta Anaesthesiol Scand 2023; 67:1294-1305. [PMID: 37403236 DOI: 10.1111/aas.14302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/18/2023] [Accepted: 06/10/2023] [Indexed: 07/06/2023]
Abstract
Traditional risk factors used for predicting poor postoperative recovery have focused on postoperative complications, adverse symptoms (nausea, pain), length of hospital stay, and patient quality of life. Despite these being traditional performance indicators of patient postoperative "status," they may not fully define the multidimensional nature of patient recovery. The definition of postoperative recovery is thus evolving to include patient-reported outcomes that are important to the patient. Previous reviews have focused on risk factors for the above traditional outcomes after major surgery. Yet, there remains a need for further study of risk factors predicting multidimensional patient-focused recovery, and investigation beyond the immediate postoperative period after patients are discharged from the hospital. This review aimed to appraise the current literature identifying risk factors for multidimensional patient recovery. METHODS A systematic review without meta-analysis was performed to qualitatively summarize preoperative risk factors for multidimensional recovery 4-6 weeks after major surgery (PROSPERO, CRD42022321626). We reviewed three electronic databases between January 2012 and April 2022. The primary outcome was risk factors for multidimensional recovery at 4-6 weeks. A GRADE quality appraisal and a risk of bias assessment were completed. RESULTS In total, 5150 studies were identified, after which 1506 duplicates were removed. After the primary and secondary screening, nine articles were included in the final review. Interrater agreements between the two assessors for the primary and secondary screening process were 86% (k = 0.47) and 94% (k = 0.70), respectively. Factors associated with poor recovery were found to include ASA grade, recovery tool baseline score, physical function, number of co-morbidities, previous surgery, and psychological well-being. Mixed results were reported for age, BMI, and preoperative pain. Due to the observational nature, heterogeneity, multiple definitions of recovery, and moderate risk of bias of the primary studies, the quality of evidence was rated from very low to low. CONCLUSION Our review found that there were few studies assessing preoperative risk factors as predictors for poor postoperative multidimensional recovery. This confirms the need for higher quality studies assessing risk for poor recovery, ideally with a consistent and multi-dimensional definition of recovery.
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Affiliation(s)
- Jared Ou-Young
- Department of Surgery, University of Melbourne, Parkville, Victoria, Australia
- Department of Anesthesia and Pain Management, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Stuart Boggett
- Department of Surgery, University of Melbourne, Parkville, Victoria, Australia
- Department of Anesthesia and Pain Management, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Doa El Ansary
- Department of Surgery, University of Melbourne, Parkville, Victoria, Australia
- School of Health and Biomedical Science, RMIT University, Bundoora, Victoria, Australia
| | - Sandy Clarke-Errey
- Statistical Consulting Centre, University of Melbourne, Parkville, Victoria, Australia
| | - Colin F Royse
- Department of Surgery, University of Melbourne, Parkville, Victoria, Australia
- Department of Anesthesia and Pain Management, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- Outcomes Research Consortium, Cleveland Clinic, Cleveland, Ohio, USA
| | - Andrea J Bowyer
- Department of Surgery, University of Melbourne, Parkville, Victoria, Australia
- Department of Anesthesia and Pain Management, The Royal Melbourne Hospital, Parkville, Victoria, Australia
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Mooiweer Y, Seeber GH, Brütt AL, Eleveld R, Ulitzka R, Lazovic D, Ansmann L, Stevens M. Influence of health system and patient characteristics on expectations and outcome in total hip arthroplasty patients in the Dutch-German border region: protocol for a mixed-methods prospective observational comparative study (hip across). BMJ Open 2023; 13:e067499. [PMID: 37105704 PMCID: PMC10151850 DOI: 10.1136/bmjopen-2022-067499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
INTRODUCTION Total hip arthroplasty (THA) is the treatment of choice for end-stage osteoarthritis of the hip. Management of THA differs between countries, and it is hypothesised that this can influence patients' expectations and self-efficacy. Using Chen's intervening mechanism evaluation approach, this study aims to explore how structure of care influences expectations and self-efficacy of patients undergoing THA, and how expectations and self-efficacy in turn influence outcome in terms of perceived physical function and satisfaction. METHODS AND ANALYSIS A mixed-methods study will be conducted in two German and two Dutch hospitals near the Dutch-German border. In the quantitative part, patients will complete questionnaires at three timepoints: preoperatively and at 3 and 6 months postoperatively. Data analysis will include multiple regression analysis and structural equation modelling. In the qualitative part, interviews will be held with patients (preoperatively and 3 months postoperatively) and healthcare providers. Analysis will be performed using structured qualitative content analysis. ETHICS AND DISSEMINATION The study is approved by the Institutional Review Boards of both Carl von Ossietzky University Oldenburg (2021-167) and University Medical Center Groningen (METc 2021/562 and METc 2021/601). The results will be disseminated in the international scientific community via publications and conference presentations. TRIAL REGISTRATION NUMBER The study is registered in the German Clinical Trials Registry (DRKS: DRKS00026744).
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Affiliation(s)
- Yvet Mooiweer
- Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
- Department of Orthopedics, University Medical Center Groningen, Groningen, The Netherlands
| | - Gesine H Seeber
- Department of Orthopedics, University Medical Center Groningen, Groningen, The Netherlands
- University Hospital of Orthopedics and Trauma Surgery Pius-Hospital, Medical Campus University Oldenburg, Oldenburg, Germany
| | - Anna Levke Brütt
- Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Rienk Eleveld
- Department of Orthopedics, Ommelander Ziekenhuis Groningen, Scheemda, The Netherlands
| | - Raimund Ulitzka
- Department of Orthopedics and Trauma Surgery, Klinikum Leer gGmbH, Leer, Germany
| | - Djordje Lazovic
- University Hospital of Orthopedics and Trauma Surgery Pius-Hospital, Medical Campus University Oldenburg, Oldenburg, Germany
| | - Lena Ansmann
- Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Martin Stevens
- Department of Orthopedics, University Medical Center Groningen, Groningen, The Netherlands
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Schwartz CE, Rapkin BD, Sniderman J, Finkelstein JA. Appraisal and patient-reported outcomes following total hip arthroplasty: a longitudinal cohort study. J Patient Rep Outcomes 2022; 6:93. [PMID: 36064834 PMCID: PMC9445109 DOI: 10.1186/s41687-022-00498-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 08/21/2022] [Indexed: 11/10/2022] Open
Abstract
Background Total hip arthroplasty (THA) is a successful procedure that provides pain relief, restores function, and improves quality of life (QOL) for patients with advanced arthritis in their hip joint. To date, little research has examined the role of cognitive appraisal processes in THA outcomes. This study examined the role of cognitive appraisal processes in THA outcomes in the first year post-surgery. Methods This longitudinal cohort study collected data at pre-surgery, 6 weeks post-surgery, 3 months post-surgery, and 12 months post-surgery. Adults (n = 189) with a primary diagnosis of osteoarthritis were consecutively recruited from an active THA practice at a Canadian academic teaching hospital. Measures included the Hip Disability and Osteoarthritis Outcome Score (HOOS), the Mental Component Score (MCS) of the Rand-36, and the Brief Appraisal Inventory (BAI). Analysis of Variance examined the association between BAI items and the HOOS or MCS scores. Random effects models investigated appraisal main effects and appraisal-by-time interactions for selected BAI items. Results HOOS showed great improvement over the first 12 months after THA, and was mitigated by three appraisal processes in particular: focusing on problems with healthcare or living situation, and preparing one’s family for health changes. MCS was stable and low over time, and the following appraisal processes were implicated by very large effect sizes: not comparing themselves to healthier people, focusing on money problems, preparing their family for their health changes, or trying to shed responsibilities. Conclusions Appraisal processes are relevant to health outcomes after THA, with different processes coming into play at different points in the recovery trajectory. Supplementary Information The online version contains supplementary material available at 10.1186/s41687-022-00498-z.
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Recovery of Muscle Atrophy and Fatty Infiltration in Patients With Acetabular Dysplasia After Total Hip Arthroplasty. J Am Acad Orthop Surg 2022; 30:e317-e326. [PMID: 34910715 DOI: 10.5435/jaaos-d-21-00156] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 09/19/2021] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Hip osteoarthritis (OA) with acetabular dysplasia negatively affects pelvic alignment and muscle function. We aimed to investigate the changes in muscle atrophy and fatty infiltration of the hip and trunk muscles 1 year after total hip arthroplasty (THA) in patients with hip OA with acetabular dysplasia. METHODS This study included 51 female patients who underwent THA for unilateral hip OA with acetabular dysplasia. The cross-sectional area (CSA) and muscle density of the gluteus maximus, gluteus medius, gluteus minimus, piriformis, iliopsoas, rectus abdominis, and abdominal oblique muscles using computer tomography and pelvic inclination angle using radiographs were assessed before and 1 year after THA. RESULTS At the 1-year follow-up, the CSA and muscle density of the gluteus medius (2,078 to 2,522 mm2 and 30.3 to 39.4 hounsfield units [HU]), iliopsoas (715 to 901 mm2 and 40.3 to 50.8 HU), and rectus abdominis (336 to 363 mm2 and 28.6 to 30.6 HU) of the affected limb had increased significantly (P < 0.05). The CSA and muscle density of the gluteus maximus (2,429 versus 2,884 mm2 and 23.7 versus 32.6 HU), gluteus minimus (636 versus 785 mm2 and 14.3 versus 37.1 HU), piriformis (505 versus 607 mm2 and 23.4 versus 31.6 HU), and iliopsoas (901 versus 997 mm2 and 50.8 versus 54.5 HU) in the affected limb were lower than those in the unaffected limb (P < 0.01). Postoperatively, the CSA and muscle density of the rectus abdominis were not significantly different between the limbs, and the pelvic inclination angle (35.2° to 32.1°, P < 0.01) was significantly decreased. DISCUSSION Compared with the nonoperated limb, substantial atrophy and fatty infiltration of most hip muscles persisted in the operated limb 1 year after THA in patients with acetabular dysplasia; asymmetry in the rectus abdominis muscle fully resolved. In patients with acetabular dysplasia, the surgical technique and postoperative rehabilitation should be further considered to optimize hip muscle recovery.
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Objectively Measured Physical Activity, Sedentary Behavior and Functional Performance before and after Lower Limb Joint Arthroplasty: A Systematic Review with Meta-Analysis. J Clin Med 2021; 10:jcm10245885. [PMID: 34945181 PMCID: PMC8709318 DOI: 10.3390/jcm10245885] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/07/2021] [Accepted: 12/13/2021] [Indexed: 12/29/2022] Open
Abstract
Patients after joint arthroplasty tend to be less physically active; however, studies measuring objective physical activity (PA) and sedentary behavior (SB) in these patients provide conflicting results. The aim of this meta-analysis was to assess objectively measured PA, SB and performance at periods up to and greater than 12 months after lower limb arthroplasty. Two electronic databases (PubMed and Medline) were searched to identify prospective and cross-sectional studies from 1 January 2000 to 31 December 2020. Studies including objectively measured SB, PA or specific performance tests in patients with knee or hip arthroplasty, were included in the analyses both pre- and post-operatively. The risk of bias was assessed using the Scottish Intercollegiate Guidelines Network (SIGN). After identification and exclusion, 35 studies were included. The data were analyzed using the inverse variance method with the random effects model and expressed as standardized mean difference and corresponding 95% confidence intervals. In total, we assessed 1943 subjects with a mean age of 64.9 (±5.85). Less than 3 months post-operative, studies showed no differences in PA, SB and performance. At 3 months post-operation, there was a significant increase in the 6 min walk test (6MWT) (SMD 0.65; CI: 0.48, 0.82). After 6 months, changes in moderate to vigorous physical activity (MVPA) (SMD 0.33; CI: 0.20, 0.46) and the number of steps (SMD 0.45; CI: 0.34, 0.54) with a large decrease in the timed-up-and-go test (SMD −0.61; CI: −0.94, −0.28) and increase in the 6MWT (SMD 0.62; CI: 0.26–0.98) were observed. Finally, a large increase in MVPA (SMD 0.70; CI: 0.53–0.87) and a moderate increase in step count (SMD 0.52; CI: 0.36, 0.69) were observed after 12 months. The comparison between patients and healthy individuals pre-operatively showed a very large difference in the number of steps (SMD −1.02; CI: −1.42, −0.62), but not at 12 months (SMD −0.75; −1.89, 0.38). Three to six months after knee or hip arthroplasty, functional performance already exceeded pre-operative levels, yet PA levels from this time period remained the same. Although PA and functional performance seemed to fully restore and exceed the pre-operation levels at six to nine months, SB did not. Moreover, PA remained lower compared to healthy individuals even longer than twelve months post-operation. Novel rehabilitation protocols and studies should focus on the effects of long-term behavioral changes (increasing PA and reducing SB) as soon as functional performance is restored.
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The Symmetry and Predictive Factors in Two-Stage Bilateral Hip Replacement Procedures. Symmetry (Basel) 2021. [DOI: 10.3390/sym13081472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Approximately 10–25% of total hip replacement patients undergo a bilateral procedure. The purpose of this study was to compare selected parameters associated with the first and second hip arthroplasty in patients undergoing two-stage treatment due to bilateral hip osteoarthritis and establish the predictive factors for the second procedure. Methods: This study compared the data on bilateral total hip replacement surgeries conducted in the period between 2017 and 2021 (42 patients). The following parameters from the first and second procedure were compared: the prosthetic stem, head, and insert cup size; type of cup insert; duration of anesthesia; duration of hospitalization; and the number of complications. Results: The mean duration of hospital stay at the time of the first total hip arthroplasty was 5.83 days and 5.4 days during the second stay. The mean stem sizes used during the first and second total hip replacement procedures were 7.11 and 7.09, respectively. The mean sizes of endoprosthetic cups used at the first and second total hip replacement procedures were 52.64 and 53.04, respectively. There were no significant differences between the mean prosthetic head size at the first and second surgery. The cup type used during the first and second surgery showed no difference. The mean duration of anesthesia used during the first and second total hip replacement surgery was 108.09 min and 104.52 min, respectively. We recorded a mean of 0.07 complications per patient at the first surgery and 0.02 at the second surgery. Conclusions: Our study results showed symmetry duration of anesthesia, length of hospital stay, number of complications per patient, stem size, prosthetic head size, cup insert size, and cup insert type at the first and second surgery in patients with two-stage bilateral total hip arthroplasty. We observed a strong correlation between the stem sizes of the first and second hip endoprostheses. There was also a strong correlation between the cup sizes used during the first and second surgery.
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Machała E, Redynk M, Gruchała A, Kołomecki K. Analysis of exercise tolerance on the basis of six-minute walk test - 6MWT and Borg RPE scale in men with inguinal hernia before and after Lichtenstein repair. POLISH JOURNAL OF SURGERY 2021; 93:1-8. [PMID: 33729176 DOI: 10.5604/01.3001.0014.4207] [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: 11/13/2022]
Abstract
<b>Introduction:</b> Assessment of exercise tolerance (ET) plays an important role in qualifications for treatment and rehabilitation. <br><b>Aim: </b>The aim of the study was to assess ET in patients before and after inguinal hernia operations with Lichtenstein method. <br><b>Material and methods:</b> The cohort study included men with inguinal hernia divided into the study group (SG) (n = 50) and control (CG) (n = 50) undergone the Lichtenstein surgery. Patients from the SG met the criterion of coexistence of cardiovascular and respiratory diseases. Day before and on the second day after surgery, patients performed 6MWT and subjectively rate the exertion according to Borg- RPE- Scale (before, immediately after and 10 minutes after the test). 6MWT distance, Borg scale ratings were analysed. On the second day after surgery 66% of patients from the SG and 58% from the CG did not complete the test. Patients from the SG before (500,07 ± 40,38 m) and on the second day after surgery (243,46 ± 18,18 m) achieved shorter distances compared to the CG (565,93 ± 20,41 m; 249,47 ± 26,66 m), p < 0,001 i p = 0,481. A statistically significant negative correlation between 6MWT distance before surgery and age of the patients was confirmed. Patients who did not develop complications achieved significantly longer distances on admission (p = 0,003 for SG, p = 0,004 for CG). For 6MWT before surgery and 2 days after surgery, patients from the SG showed a significantly higher level of fatigue compared to the CG after the test (before: p = 0,001, after: p = 0,001). Patients form the SG often discontinued 6MWT and less tolerated effort compared to the CG. Hence, 6MWT is useful tool for ascertaining physical capacity and ET.
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Affiliation(s)
- Ewa Machała
- Department of Endocrine, General and Vascular Surgery Medical University of Lodz
| | - Magdalena Redynk
- Department of Endocrinological, General and Oncological Surgery, Provincial Multispecialist Center of Oncology and Traumatology named after M. Kopernika in Lodz
| | - Aneta Gruchała
- Department of Psychodermatology, Department of Clinical Immunology and Rheumatology, Medical University of Lodz
| | - Krzysztof Kołomecki
- Department of Endocrine, General and Vascular Surgery Medical University of Lodz
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Röhner E, Mayfarth A, Sternitzke C, Layher F, Scheidig A, Groß HM, Matziolis G, Böhle S, Sander K. Mobile Robot-Based Gait Training after Total Hip Arthroplasty (THA) Improves Walking in Biomechanical Gait Analysis. J Clin Med 2021; 10:jcm10112416. [PMID: 34072524 PMCID: PMC8198188 DOI: 10.3390/jcm10112416] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 05/27/2021] [Indexed: 12/15/2022] Open
Abstract
There are multiple attempts to decrease costs in the healthcare system while maintaining a high treatment quality. Digital therapies receive increasing attention in clinical practice, mainly relating to home-based exercises supported by mobile devices, eventually in combination with wearable sensors. The aim of this study was to determine if patients following total hip arthroplasty (THA) could benefit from gait training on crutches conducted by a mobile robot in a clinical setting. METHOD This clinical trial was conducted with 30 patients following total hip arthroplasty. Fifteen patients received the conventional physiotherapy program in the clinic (including 5 min of gait training supported by a physiotherapist). The intervention group of 15 patients passed the same standard physiotherapy program, but the 5-min gait training supported by a physiotherapist was replaced by 2 × 5 min of gait training conducted by the robot. Length of stay of the patients was set to five days. Biomechanical gait parameters of the patients were assessed pre-surgery and upon patient discharge. RESULTS While before surgery no significant difference in gait parameters was existent, patients from the intervention group showed a significant higher absolute walking speed (0.83 vs. 0.65 m/s, p = 0.029), higher relative walking speed (0.2 vs. 0.16 m/s, p = 0.043) or shorter relative cycle time (3.35 vs. 3.68 s, p = 0.041) than the patients from the control group. CONCLUSION The significant higher walking speed of patients indicates that such robot-based gait training on crutches may shorten length of stay (LOS) in acute clinics. However, the number of patients involved was rather small, thus calling for further studies.
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Affiliation(s)
- Eric Röhner
- Orthopaedic Professorship of the University Hospital Jena, Orthopedic Department of the Waldkliniken Eisenberg, 07607 Eisenberg, Germany; (F.L.); (G.M.); (S.B.); (K.S.)
- Correspondence: ; Tel.: +49-36691-8-1254; Fax: +49-36691-8-1807
| | - Anke Mayfarth
- Tediro GmbH, Ehrenbergstr. 11, 98693 Ilmenau, Germany; (A.M.); (C.S.)
| | | | - Frank Layher
- Orthopaedic Professorship of the University Hospital Jena, Orthopedic Department of the Waldkliniken Eisenberg, 07607 Eisenberg, Germany; (F.L.); (G.M.); (S.B.); (K.S.)
| | - Andrea Scheidig
- TU Ilmenau, Neuroinformatics and Cognitive Robotics Lab, PF 100565, 98684 Ilmenau, Germany; (A.S.); (H.-M.G.)
| | - Horst-Michael Groß
- TU Ilmenau, Neuroinformatics and Cognitive Robotics Lab, PF 100565, 98684 Ilmenau, Germany; (A.S.); (H.-M.G.)
| | - Georg Matziolis
- Orthopaedic Professorship of the University Hospital Jena, Orthopedic Department of the Waldkliniken Eisenberg, 07607 Eisenberg, Germany; (F.L.); (G.M.); (S.B.); (K.S.)
| | - Sabrina Böhle
- Orthopaedic Professorship of the University Hospital Jena, Orthopedic Department of the Waldkliniken Eisenberg, 07607 Eisenberg, Germany; (F.L.); (G.M.); (S.B.); (K.S.)
| | - Klaus Sander
- Orthopaedic Professorship of the University Hospital Jena, Orthopedic Department of the Waldkliniken Eisenberg, 07607 Eisenberg, Germany; (F.L.); (G.M.); (S.B.); (K.S.)
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ÖZÇADIRCI A, ÖZTÜRK F, ÇAĞLAR Ö, COŞKUN G. Are kinesiophobia and functional performance related to ability to forget the artificial joint in patients with total hip arthroplasty? CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2021. [DOI: 10.33808/clinexphealthsci.709392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Taniguchi N, Jinno T, Endo H, Wako M, Tatsuno R, Ochiai S, Haro H. Improvement of locomotive syndrome after total hip arthroplasty: A two-year longitudinal cohort study. Mod Rheumatol 2020; 31:1050-1058. [PMID: 32924686 DOI: 10.1080/14397595.2020.1823552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Patients requiring total hip arthroplasty (THA) may possibly have locomotive syndrome (LS). Therefore, we investigated changes of LS in patients undergoing THA and clarified key factors that affected LS stage. METHODS A prospective cohort study was conducted with 88 patients undergoing THA (74 females, 14 males, mean age: 67.6 years). Data collected using LS stage, stand-up test, two-step test, and 25-question Geriatric Locomotive Function Scale results were evaluated before THA, and 6 months, 1 year, and 2 years after THA. Key factors were determined using multivariate analysis and receiver operating characteristic (ROC) curve analysis. RESULTS Before THA, all patients had fallen LS (stage1: 3.4% and stage2: 96.6%). Overall, 56.8% patients improved their LS stage, and 17.0% of patients overcame LS at 2 years after THA. The key factors that affected LS stage were preoperative two-step test and age. ROC analyses showed a preoperative two-step test score of 0.988 and an age of 67.5 years as a cut-off value for the change of LS stage. CONCLUSIONS Patients experiencing LS due to hip disorders have the potential to recover after THA. Additional postoperative training may be beneficial for patients with low preoperative two-step test scores to improve their LS stage.
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Affiliation(s)
- Naofumi Taniguchi
- Department of Orthopaedic Surgery, University of Yamanashi, Yamanashi, Japan.,Department of Rehabilitation Medicine, University of Yamanashi, Yamanashi, Japan
| | - Tetsuya Jinno
- Second Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Hiroshi Endo
- Department of Rehabilitation Medicine, University of Yamanashi, Yamanashi, Japan
| | - Masanori Wako
- Department of Orthopaedic Surgery, University of Yamanashi, Yamanashi, Japan
| | - Rikito Tatsuno
- Department of Orthopaedic Surgery, University of Yamanashi, Yamanashi, Japan
| | - Satoshi Ochiai
- Department of Orthopaedic Surgery, Kofu National Hospital, Yamanashi, Japan
| | - Hirotaka Haro
- Department of Orthopaedic Surgery, University of Yamanashi, Yamanashi, Japan
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Relationship between vertical ground reaction force and muscle strength while climbing stairs after total hip arthroplasty. Clin Biomech (Bristol, Avon) 2020; 78:105088. [PMID: 32563726 DOI: 10.1016/j.clinbiomech.2020.105088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 09/09/2019] [Accepted: 06/05/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Little is known about the relationship between vertical ground reaction force (vGRF) and muscle strength while climbing stairs after total hip arthroplasty (THA). METHODS We investigated the relationship between muscle strength and vGRF during stair climbing in 21 women with THA. Differences in the time required to climb stairs and side-to-side differences in muscle strength and vGRF during climbing were examined at 6 and 12 months. The relationship between climbing time and vGRF variables and that between vGRF and muscle strength were analyzed using Spearman's rank correlation coefficient at 6 and 12 months. First peak force (Fz1) was defined as the peak vGRF at heel strike normalized by body weight. FINDINGS Climbing time was related to the time to Fz1 at 6 and 12 months post-THA (r = 0.50-0.64). At 6 months, time to Fz1 was related to the strength of muscles involved in hip extension in the operated limb (r = -0.46). At 12 months, time to Fz1 was related to the strength of muscles responsible for knee extension in the operated limb (r = -0.45). INTERPRETATION At 6 months, climbing stairs depended on muscle strength in the hip extensors. Conversely, at 12 months, the functional recovery of knee extensors was important for transferring weight upward while climbing stairs. Therefore, to improve the climbing function of patients with THA, it is important to not only focus on the recovery of muscle strength in the hip extensors but also improve muscle strength in the knee extensors.
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Early improvement in physical activity and function after total hip arthroplasty: Predictors of outcomes. Turk J Phys Med Rehabil 2020; 65:379-388. [PMID: 31893275 DOI: 10.5606/tftrd.2019.4695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 09/18/2018] [Indexed: 12/27/2022] Open
Abstract
Objectives This study aims to assess early changes in physical activity and function after total hip arthroplasty (THA) using both subjective and objective methods, and to identify predictors of outcomes of THA. Patients and methods Between October 2014 and October 2015, a total of 50 patients (14 males, 36 females; mean age 57.1±13.0 years; range, 31 to 75 years) with end-stage primary hip osteoarthritis who were scheduled for THA and 50 age- and sex-matched controls (10 males, 40 females; mean age 52.9±9.3 years; range, 36 to 75 years) were included in the study. Pain was evaluated using the Numeric Rating Scale (NRS), physical function using the Lequesne Index, physical capacity using the Six-Minute Walking Test (6MWT), and physical activity using both International Physical Activity Impact Questionnaire Short Form (IPAQ-SF) and step count monitor. Data at baseline and six weeks and six months were recorded. Results Pain severity was significantly lower after THA at six weeks and six months (NRS scores: 2.83 and 0.82, respectively; p<0.001), compared to baseline. Physical function, capacity, and activity significantly improved after THA at six weeks and six months with a mean Lequesne Index score of 2.62 and 1.02, respectively. The mean 6MWT distance was 272.62 at six weeks and 326.16 at six months. The mean IPAQ and 6MWT results were similar between the patient and control groups at six weeks and six months. Age, presence of comorbidities, and baseline Lequesne Index score were found to be effective on functional outcomes of THA. Age and baseline 6MWT scores were correlated with physical capacity after THA. Conclusion Our study showed a significant early improvement in pain severity and physical activity and function at six weeks and six months after THA, compared to baseline values. Baseline values and age were the positive predictors of improved postoperative function and physical capacity.
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Matsunaga-Myoji Y, Fujita K, Makimoto K, Tabuchi Y, Mawatari M. Three-Year Follow-Up Study of Physical Activity, Physical Function, and Health-Related Quality of Life After Total Hip Arthroplasty. J Arthroplasty 2020; 35:198-203. [PMID: 31481288 DOI: 10.1016/j.arth.2019.08.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 08/01/2019] [Accepted: 08/02/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Little is known about the long-term changes in physical activity (PA) after total hip arthroplasty (THA). The purpose of this study is to describe the changes in the number of steps and intensity of PA as measured by accelerometers, patient-reported physical function, and health-related quality of life of THA patient preoperatively and at 1 and 3 years after THA. METHODS This study included 153 patients (mean age, 61.4 years; 86.3% women) who wore an accelerometer for 10 consecutive days and completed the Oxford Hip Score (OHS) and the Short Form 8 at the 5-year follow-up after THA. PA was evaluated based on the mean steps per day and the time spent performing moderate-to-vigorous PA (MVPA) per week. RESULTS All 5 indicators had significantly increased at 1 year after THA, although only MVPA and OHS had further increased significantly at the 3-year follow-up. The predictor of improvement in the number of steps from baseline to 1 year post-THA was younger age, while those of improvement in MVPA from baseline to 3-year post-THA were younger age, higher OHS, and better Short Form 8 mental component scores using mixed-model analysis. Participation in the PA measurements was high (69.9%) at the 3-year follow-up. No significant changes were observed for these outcomes in the remaining cohort beyond 3 years after THA. CONCLUSION In post-THA patients, MVPA continued to increase for 3 years postoperatively. Therefore, PA must be measured over the medium term to long term following THA.
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Affiliation(s)
- Yuriko Matsunaga-Myoji
- Division of Nursing, Saga University, Saga, Japan; Department of Health Science, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kimie Fujita
- Department of Health Science, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kiyoko Makimoto
- Department of Nursing, School of Nursing and Rehabilitation, Konan Women's University, Kobe, Hyogo, Japan
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Winther SB, Foss OA, Husby OS, Wik TS, Klaksvik J, Husby VS. Muscular strength and function after total hip arthroplasty performed with three different surgical approaches: one-year follow-up study. Hip Int 2019; 29:405-411. [PMID: 30421633 DOI: 10.1177/1120700018810673] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Surgical approach influences short-term muscular strength, and leg-strength asymmetry has been demonstrated after total hip arthroplasty (THA). We evaluated muscular strength, physical function and patient-reported outcome measures (PROMs) up to 12 months postoperatively, in patients operated on using 3 different surgical approaches. METHODS 60 patients scheduled for primary THA were allocated to the direct lateral (DLA), posterior (PA) or anterior (AA) approach. The following parameters were evaluated: leg press and abduction strength, pain, 6-minute walking test, Harris Hip Score and Hip disability and Osteoarthritis Outcome Score - Physical Function Shortform (HOOS-PS). RESULTS Abduction strength in the DLA group was significantly more reduced than the PA and AA groups 12 months postoperatively (p < 0.001). A significant interleg difference in abduction (p < 0.01) and leg press (p < 0.03) persisted in all groups up to 6 months, and up to 12 months in the DLA (p < 0.05). In the AA group, interleg difference in leg press was present up to 12 months (p = 0.01). Pain scores were higher in the DLA than the AA group at 6 months (p = 0.01). Patients in the PA group had better HOOS-PS score than those in the DLA group 3 months postoperatively (p = 0.02). No intergroup differences in pain or PROMs were found 12 months postoperatively. CONCLUSION Patients operated via the DLA had reduced muscular strength, HOOS-PS scores and higher pain scores than those who underwent PA and AA type surgery. The non-operated leg was significantly stronger than the operated leg in all groups 6 months postoperatively and this persisted up to 12 months postoperatively for the DLA and AA groups. Clinical Trial Protocol number: ClinicalTrials.gov (NCT01506024).
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Affiliation(s)
- Siri B Winther
- 1 Orthopaedic Research Centre, Department of Orthopaedic Surgery, Clinic of Orthopaedics, Rheumatology and Dermatology, St. Olav's Hospital HF, Trondheim, Norway.,2 Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Olav A Foss
- 1 Orthopaedic Research Centre, Department of Orthopaedic Surgery, Clinic of Orthopaedics, Rheumatology and Dermatology, St. Olav's Hospital HF, Trondheim, Norway.,2 Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Otto S Husby
- 1 Orthopaedic Research Centre, Department of Orthopaedic Surgery, Clinic of Orthopaedics, Rheumatology and Dermatology, St. Olav's Hospital HF, Trondheim, Norway.,2 Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Tina S Wik
- 1 Orthopaedic Research Centre, Department of Orthopaedic Surgery, Clinic of Orthopaedics, Rheumatology and Dermatology, St. Olav's Hospital HF, Trondheim, Norway.,2 Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Jomar Klaksvik
- 1 Orthopaedic Research Centre, Department of Orthopaedic Surgery, Clinic of Orthopaedics, Rheumatology and Dermatology, St. Olav's Hospital HF, Trondheim, Norway
| | - Vigdis S Husby
- 3 Department of Mental Health, Faculty of Medicine and Health Science, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
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Biomechanics and Biotribology of UHMWPE Artificial Hip Joints. SPRINGER SERIES IN BIOMATERIALS SCIENCE AND ENGINEERING 2019. [DOI: 10.1007/978-981-13-6924-7_8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Brunner JH, Foucher KC. Sex specific associations between biomechanical recovery and clinical recovery after total hip arthroplasty. Clin Biomech (Bristol, Avon) 2018; 59:167-173. [PMID: 30266024 DOI: 10.1016/j.clinbiomech.2018.09.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 07/10/2018] [Accepted: 09/20/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND There are sex-specific gait differences in men and women before and after total hip arthroplasty (THA) but we do not know their impact on clinical outcomes. The objective of this study was to identify sex-specific associations between pre- and postoperative changes in pain and function and (i) gait mechanics, (ii) passive range of motion, and (iii) abductor strength. METHODS Pre- and one-year postoperative data were identified from a data repository (n = 124; 64 Women; Age 61 (SD 10); BMI 29 (SD 5)). We used linear regression analysis to identify sex-specific associations between Harris Hip Score pain and function subscores, and sagittal plane hip kinematics and 3D hip kinetics during gait, hip abductor strength, and passive hip range of motion (RoM). FINDINGS Combinations of biomechanical variables predicted up to 24% of the variation in pain improvement and up to 27% of the variation in functional improvement. In men, increased peak external rotation moments were associated with pain improvement. Passive flexion RoM and peak extension moments were associated with functional improvement. In women, increased passive adduction RoM and peak external rotation moments were associated with pain improvement. Peak adduction moments and passive flexion RoM were associated with functional improvement. INTERPRETATIONS The different associations between improvement in clinical outcomes and improvement in gait, passive RoM, and abductor strength suggest that the biomechanical path to recovery may be different in men and women.
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Affiliation(s)
- J Heather Brunner
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, USA
| | - Kharma C Foucher
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA; Department of Bioengineering, University of Illinois at Chicago, Chicago, IL, USA.
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Miura N, Tagomori K, Ikutomo H, Nakagawa N, Masuhara K. Asymmetrical loading during sit-to-stand movement in patients 1 year after total hip arthroplasty. Clin Biomech (Bristol, Avon) 2018; 57:89-92. [PMID: 29966959 DOI: 10.1016/j.clinbiomech.2018.06.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Revised: 03/24/2018] [Accepted: 06/25/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Asymmetrical loading during functional performance can occur after total hip arthroplasty. We hypothesized that during sit-to-stand movements, the loading of the limbs of patients who undergo total hip arthroplasty is more asymmetrical than that of those who do not. The objective of the present study was to compare asymmetrical loading during the sit-to-stand movements of patients at 1 year after undergoing total hip arthroplasty, and that of healthy adults. METHODS Twenty-eight patients at 1 year after undergoing total hip arthroplasty and 16 healthy adults were included. We measured the vertical ground reaction force during the sit-to-stand movement for each leg and calculated the ratio of the peak vertical ground reaction force, and the ratio at the time of peak magnitude of the non-operated limb (control, right limb). FINDINGS The mean peak vertical ground reaction force ratio of the patients was 0.77 (0.2), and it was significantly lower than that of healthy adults. The vertical ground reaction force ratio for these patients at the time of peak magnitude of the non-operated limb was 0.72 (0.2), and was significantly lower than that of healthy adults. INTERPRETATION Loading on the operated leg during the sit-to-stand movement was lower than that on the non-operated leg in patients at 1 year after undergoing total hip arthroplasty. Furthermore, loading during sit-to-stand movement of patients 1 year after undergoing total hip arthroplasty was more asymmetrical than that of healthy adults. Even at 1 year after undergoing total hip arthroplasty, these patients performed the sit-to-stand movement asymmetrically.
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Affiliation(s)
- Namika Miura
- Department of Rehabilitation, Masuhara Clinic, 3-4-2, Tenmabashi, Kita-ku, Osaka 530-0042, Japan.
| | - Keiichi Tagomori
- Department of Rehabilitation, Masuhara Clinic, 3-4-2, Tenmabashi, Kita-ku, Osaka 530-0042, Japan
| | - Hisashi Ikutomo
- Department of Rehabilitation, Masuhara Clinic, 3-4-2, Tenmabashi, Kita-ku, Osaka 530-0042, Japan
| | - Norikazu Nakagawa
- Department of Rehabilitation, Masuhara Clinic, 3-4-2, Tenmabashi, Kita-ku, Osaka 530-0042, Japan
| | - Kensaku Masuhara
- Department of Orthopaedic Surgery, Masuhara Clinic, 3-4-2, Tenmabashi, Kita-ku, Osaka 530-0042, Japan
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Miao NF, Lin PC. A prospective study of joint function and the quality of life of patients undergoing total joint replacement. Int J Nurs Pract 2018; 24:e12675. [PMID: 30009508 DOI: 10.1111/ijn.12675] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 03/01/2018] [Accepted: 06/12/2018] [Indexed: 11/27/2022]
Abstract
AIMS To investigate joint functioning and the quality of life (QOL) before and after total knee and total hip replacement and the factors that influence the QOL. METHODS A longitudinal study was conducted between August 2015 and January 2017. A questionnaire composed of the EQ-5D, Oxford Hip Score, and Oxford Knee Score was used to collect data before surgery and 6 weeks, 3 months, and 6 months after surgery. RESULTS A repeated-measures analysis of variance revealed significant differences in the EQ-5D utility index between the preoperative and all 3 postoperative periods (F = 124.195, P < .05). There were significant differences in knee functioning (F = 133.859, P < .05) and hip functioning (F = 34.717, P < .05) between the preoperative and all 3 postoperative periods. The EQ-5D utility index was significantly higher among patients undergoing total knee replacement than those undergoing total hip replacement (F = 15.490, P < .05) and higher among female than male patients (F = 7.613, P < .05). A positive correlation between the QOL and the perceived convenience of living at home was observed (P < .05). CONCLUSIONS The findings are expected to inform patient education for patients undergoing arthroplasty surgery.
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Affiliation(s)
- Nae-Fang Miao
- Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Pi-Chu Lin
- Master Program in Long-term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan
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Unnanuntana A, Ruangsomboon P, Keesukpunt W. Validity and Responsiveness of the Two-Minute Walk Test for Measuring Functional Recovery After Total Knee Arthroplasty. J Arthroplasty 2018; 33:1737-1744. [PMID: 29454556 DOI: 10.1016/j.arth.2018.01.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 12/28/2017] [Accepted: 01/08/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The 2-minute walk test (2mwt) is a performance-based test that evaluates functional recovery after total knee arthroplasty (TKA). This study evaluated its validity compared with the modified Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Oxford Knee Score (OKS), modified Knee Score, Numerical Pain Rating Scale, and Timed Up and Go test, and its responsiveness in assessing functional recovery in TKA patients. METHODS This prospective cohort study included 162 patients undergoing primary TKA between 2013 and 2015. We used patient-reported outcome measures (modified WOMAC, OKS, modified Knee Score, Numerical Pain Rating Scale) and performance-based tests (2mwt and Timed Up and Go test) at baseline and 3, 6, and 12 months postoperatively. The construct validity of 2mwt was determined between the 2mwt distances walked and other outcome measurements. To assess responsiveness, effect size and standardized response mean were analyzed. Minimal clinically important difference of 2mwt at 12 months after TKA was also calculated. RESULTS All outcome measurements improved significantly from baseline to 3, 6, and 12 months postoperatively. Bivariate analysis revealed mild to moderate associations between the 2mwt and modified WOMAC function subscales, and moderate to strong associations with OKS. Mild to moderate correlations were found for pain and stiffness between 2mwt and other outcome measurements. The effect size and standardized response mean at 12 months were large, with a minimal clinically important difference of 12.7 m. CONCLUSION 2mwt is a validated performance-based test with responsiveness properties. Being simple and easy to perform, it can be used routinely in clinical practice to evaluate functional recovery after TKA.
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Affiliation(s)
- Aasis Unnanuntana
- Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pakpoom Ruangsomboon
- Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Jo WL, Lee YK, Ha YC, Kim TY, Koo KH. Delay of total hip arthroplasty to advanced stage worsens post-operative hip motion in patients with femoral head osteonecrosis. INTERNATIONAL ORTHOPAEDICS 2018; 42:1599-1603. [PMID: 29700582 DOI: 10.1007/s00264-018-3952-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 04/16/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE Osteonecrosis of the femoral head (ONFH) is commonly detected in young patients and most surgeons tend to delay total hip arthroplasty (THA) until the end stage of the disease. We hypothesised that post-operative range of motion (ROM) of the hip as well as baseline ROM at the time of surgery decreases with the disease progression. The purpose of this study was to determine whether patients, who were operated at an advanced stage, have pre- and post-operative hip ROM similar to ROM of patients, who were operated at earlier stages. METHODS Eight hundred and fifty patients (850 hips) treated with THA for ONFH were classified according to pre-operative stages of Association Research Circulation Osseous (ARCO). Fifty-six patients were operated at stage 2, 458 at stage 3, and 336 at stage 4. Pre-operative and one year post-operative ROM was compared among the stages. RESULTS Pre-operative sum of hip ROM decreased with the progression of ARCO stage (P < 0.001) and correlated with the post-operative sum of hip ROM (correlation coefficient 0.661). Although hip ROM improved after THA in all stages, post-operative ROM in patients with lower pre-operative ROM did not improve to the same level as in those with a higher pre-operative ROM (P < 0.001). CONCLUSIONS The progression of ONFH negatively affected post-operative hip ROM as well as baseline hip ROM at the time of THA. Surgeons should consider a delay of THA negatively affects the hip ROM after the arthroplasty, when they determine the treatment modality for ONFH patients.
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Affiliation(s)
- Woo-Lam Jo
- Seoul St. Mary's Hospital, Department of Orthopaedic Surgery, Catholic University, 222, Banpo-daero, Seocho-gu, Seoul, 06591, South Korea
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam, 13620, South Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Chung-Ang University Hospital, 224-1 Heukseok-dong, Dongjak-gu, Seoul, 06973, South Korea
| | - Tae-Young Kim
- Konkuk University Medical Center, Department of Orthopaedic Surgery, School of Medicine, Konkuk University, 120-1, Neungdong-ro, Gwangjin-gu, Seoul, 05030, South Korea.
| | - Kyung-Hoi Koo
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam, 13620, South Korea
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Hofstede SN, Gademan MGJ, Stijnen T, Nelissen RGHH, Marang-van de Mheen PJ. The influence of preoperative determinants on quality of life, functioning and pain after total knee and hip replacement: a pooled analysis of Dutch cohorts. BMC Musculoskelet Disord 2018; 19:68. [PMID: 29499692 PMCID: PMC5833034 DOI: 10.1186/s12891-018-1991-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 02/23/2018] [Indexed: 11/10/2022] Open
Abstract
Background Previous research has identified preoperative determinants that predict health related quality of life (HRQoL), functioning and pain after total knee or hip arthroplasty (TKA/THA), but these differed between studies and had opposite directions. This may be due to lack of power and not adjusting for confounders. The present study aims to identify the preoperative determinants that influence health related quality of life (HRQoL), functioning and pain after total knee or hip arthroplasty (TKA/THA). Methods We pooled individual patient from 20 cohorts with OA patients data (n = 1783 TKA and n = 2400 THA) in the Netherlands. We examined the influence of age, gender, BMI and preoperative values of HRQoL, functioning and pain on postoperative status and total improvement. Linear mixed models were used to estimate the effect of each preoperative variable on a particular outcome for each cohort separately. These effects were pooled across cohorts using a random effects model. Results For each increase in preoperative point in HRQoL, the postoperative HRQoL increased by 0.51 points in TKA and 0.37 points in THA (SF-36 scale). Similarly, each point increase in preoperative functioning, resulted in a higher postoperative functioning of 0.31 (TKA) and 0.21 (THA) points (KOOS/HOOS-ADL scale). For pain this was 0.18 (TKA) and 0.15 (THA) points higher (KOOS/HOOS-pain scale) (higher means less pain). Even though patients with better preoperative values achieved better postoperative outcomes, their improvement was smaller. Women and patients with a higher BMI had more pain after a TKA and THA. Higher age and higher BMI was associated with lower postoperative HRQoL and functioning and more pain after a THA. Conclusions Patients with a better preoperative health status have better outcomes, but less improvement. Even though the independent effects may seem small, combined results of preoperative variables may result in larger effects on postoperative outcomes.
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Affiliation(s)
- Stefanie N Hofstede
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
| | - Maaike G J Gademan
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Theo Stijnen
- Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands
| | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
| | - Perla J Marang-van de Mheen
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, J10-S, PO Box 9600, 2300 RC, Leiden, The Netherlands.
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Pozzobon D, Ferreira PH, Blyth FM, Machado GC, Ferreira ML. Can obesity and physical activity predict outcomes of elective knee or hip surgery due to osteoarthritis? A meta-analysis of cohort studies. BMJ Open 2018; 8:e017689. [PMID: 29487072 PMCID: PMC5855486 DOI: 10.1136/bmjopen-2017-017689] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 11/14/2017] [Accepted: 11/23/2017] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE The aim of this study was to systematically review the literature to identify whether obesity or the regular practice of physical activity are predictors of clinical outcomes in patients undergoing elective hip and knee arthroplasty due to osteoarthritis. DESIGN Systematic review and meta-analysis. DATA SOURCE AND ELIGIBILITY CRITERIA A systematic search was performed on the Medline, CINAHL, EMBASE and Web of Science electronic databases. Longitudinal cohort studies were included in the review. To be included, studies needed to have assessed the association between obesity or physical activity participation measured at baseline and clinical outcomes (ie, pain, disability and adverse events) following hip or knee arthroplasty. DATA EXTRACTION Two independent reviewers extracted data on pain, disability, quality of life, obesity, physical activity and any postsurgical complications. RESULTS 62 full papers were included in this systematic review. From these, 31 were included in the meta-analyses. Our meta-analysis showed that compared to obese participants, non-obese participants report less pain at both short term (standardised mean difference (SMD) -0.43; 95% CI -0.67 to -0.19; P<0.001) and long term post-surgery (SMD -0.36; 95% CI -0.47 to -0.24; P<0.001), as well as less disability at long term post-surgery (SMD -0.32; 95% CI -0.36 to -0.28; P<0.001). They also report fewer postsurgical complications at short term (OR 0.48; 95% CI 0.25 to 0.91; P<0.001) and long term (OR 0.55; 95% CI 0.41 to 0.74; P<0.001) along with less postsurgical infections after hip arthroplasty (OR 0.33; 95% CI 0.18 to 0.59; P<0.001), and knee arthroplasty (OR 0.42; 95% CI 0.23 to 0.78; P=0.006). CONCLUSIONS Presurgical obesity is associated with worse clinical outcomes of hip or knee arthroplasty in terms of pain, disability and complications in patients with osteoarthritis. No impact of physical activity participation has been observed. PROSPERO REGISTRATION NUMBER CRD42016032711.
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Affiliation(s)
- Daniel Pozzobon
- Institute of Bone and Joint Research, Kolling Institute, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Paulo H Ferreira
- Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Fiona M Blyth
- Concord Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Gustavo C Machado
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Gynaecology and Obstetrics, Botucatu Medical School, Universidade Estadual Paulista (UNESP), Botucatu, Brazil
| | - Manuela L Ferreira
- Institute of Bone and Joint Research, Kolling Institute, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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Jeldi AJ, Deakin AH, Allen DJ, Granat MH, Grant M, Stansfield BW. Total Hip Arthroplasty Improves Pain and Function but Not Physical Activity. J Arthroplasty 2017; 32:2191-2198. [PMID: 28285898 DOI: 10.1016/j.arth.2017.02.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 01/09/2017] [Accepted: 02/02/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND People with hip osteoarthritis are likely to limit physical activity (PA) engagement due to pain and lack of function. Total hip arthroplasty (THA) reduces pain and improves function, potentially allowing increased PA. PA of THA patients was quantified to 12 months postoperation. The hypothesis was that postoperatively levels of PA would increase. METHODS PA of 30 THA patients (67 ± 7 years) was objectively measured preoperatively and 3 and 12 months postoperation. Harris Hip Score (HHS), Oxford Hip Score (OHS), and 6-minute walk test (6MWT) were recorded. Mixed linear modelling was used to examine relationships of outcomes with time, baseline body mass index (BMI), age, gender, and baseline HHS. RESULTS Time was not a significant factor in predicting volume measures of PA, including sit-to-stand transitions, upright time, and steps. Notably, baseline BMI was a significant predictor of upright time, steps, largest number of steps in an upright bout, HHS, and 6MWT. Baseline HHS helped predict longest upright bout, cadence of walking bouts longer than 60 seconds, and OHS. The significant effect of participant as a random intercept in the model for PA outcomes suggested habituation from presurgery to postsurgery. CONCLUSION Volume measures of PA did not change from presurgery to 12 months postsurgery despite improvement in HHS, OHS, and 6MWT. Baseline BMI was a more important predictor of upright activity and stepping than time. Preoperative and postoperative PA promotion could be used to modify apparently habitual low levels of PA to enable full health benefits of THA to be gained.
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Affiliation(s)
- Artaban J Jeldi
- Department of Psychology, Social Work and Allied Health Sciences, Institute for Applied Health Research, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Department of Orthopaedics, Golden Jubilee National Hospital, Glasgow, UK
| | - Angela H Deakin
- Department of Orthopaedics, Golden Jubilee National Hospital, Glasgow, UK
| | - David J Allen
- Department of Orthopaedics, Golden Jubilee National Hospital, Glasgow, UK
| | | | - Margaret Grant
- Department of Psychology, Social Work and Allied Health Sciences, Institute for Applied Health Research, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Ben W Stansfield
- Department of Psychology, Social Work and Allied Health Sciences, Institute for Applied Health Research, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
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Smith T, Withers T, Luben R, Sackley C, Jones A, MacGregor A. Changes in physical activity following total hip or knee arthroplasty: a matched case-control study from the EPIC-Norfolk cohort. Clin Rehabil 2017; 31:1548-1557. [DOI: 10.1177/0269215517704270] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: To assess self-reported physical activity changes pre- compared to post-operatively in patients undergoing total hip or knee arthroplasty, and to compare this to an age- and gender-matched cohort of people who have not undergone arthroplasty. Design: Population-based prospective cohort study. Setting: Norfolk, United Kingdom. Subjects: People who had undergone hip or knee arthroplasty, compared to an age- and gender-matched non-arthroplasty cohort. Intervention: Primary total hip or knee arthroplasty. Main measures: Physical activity, measured using the EPIC Physical Activity Questionnaire (EPAQ2). Results: A total of 400 people from the EPIC-Norfolk community cohort were identified who had undergone hip or knee arthroplasty. In all, 767 people were identified to form an age- and gender-matched non-arthroplasty cohort. Mean post-operative follow-up was 43 months post-total hip and 41 months post-total knee arthroplasty. There was a statistically significant reduction from pre- to post-arthroplasty in the number of flights of stairs climbed weekly (hip: mean difference (MD): 6.8; P < 0.01; knee: MD: 10.2; P < 0.01), duration of walking (hip: MD: 1.4 hours/week; P = .02; knee: MD: 2.2 hours/week; P < 0.01) and duration of total recreational activity (hip: MD: 1.1 hours/week; P = 0.02). Compared to the non-arthroplasty cohort, duration of physical activity was lower post-total hip arthroplasty (MD: 1.8 hours/week; P = 0.01). The number of flights of stairs climbed weekly (MD: 12.0; P < 0.01), total recreational activity (MD: 1.7 hours/week; P = 0.04) and physical activity energy expenditure (MD: 5.7 Mets-hours/week; P = 0.05) were lower for people post-total knee arthroplasty compared to the matched controls. Conclusions: Physical activity did not increase, and in some instances decreased, following total hip or knee arthroplasty.
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Affiliation(s)
- Toby Smith
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Thomas Withers
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Robert Luben
- EPIC, Strangeways Research Laboratory, University of Cambridge, Cambridge, UK
| | - Catherine Sackley
- Faculty of Life Sciences & Medicine, King’s College London, London, UK
| | - Andy Jones
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Alex MacGregor
- Norwich Medical School, University of East Anglia, Norwich, UK
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Downer B, Veeranki SP, Wong R. A Late Life Risk Index for Severe Cognitive Impairment in Mexico. J Alzheimers Dis 2017; 52:191-203. [PMID: 27060940 DOI: 10.3233/jad-150702] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Several dementia risk indices have been developed for older adults in high-income countries. However, no index has been developed for populations in low- or middle-income countries. OBJECTIVE To create a risk index for predicting severe cognitive impairment among adults aged ≥60 in Mexico and to compare the accuracy of this index to the Dementia Screening Indicator (DSI). METHODS This study included 3,002 participants from the Mexican Health and Aging Study (MHAS) interviewed in 2001 and 2012. The MHAS risk index included sociodemographic, health, and functional characteristics collected in 2001. A point value based on the beta coefficients from a multivariable logistic regression model was assigned to each risk factor and the total score was calculated. RESULTS The MHAS risk index (AUC = 0.74 95% CI = 0.70-0.77) and DSI (AUC = 0.72 95% CI = 0.69-0.77) had similar accuracy for discriminating between participants who developed severe cognitive impairment from those who did not. A score of ≥16 on the MHAS risk index had a sensitivity of 0.69 (95% CI = 0.64-0.70) and specificity of 0.67 (95% CI = 0.66-0.69). A score of ≥23 on the DSI had a sensitivity of 0.56 (95% CI = 0.50-0.63) and specificity of 0.78 (95% CI = 0.76-0.79). DISCUSSION The MHAS risk index and DSI have moderate accuracy for predicting severe cognitive impairment among older adults in Mexico. This provides evidence that existing dementia risk indices may be applicable in low- and middle-income countries such as Mexico. Future research should seek to identify additional risk factors that can improve the accuracy of the MHAS risk index.
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Affiliation(s)
- Brian Downer
- University of Texas Medical Branch, Division of Rehabilitation Sciences, Galveston, TX, USA
| | - Sreenivas P Veeranki
- University of Texas Medical Branch, Preventive Medicine and Community Health, Galveston, TX, USA
| | - Rebeca Wong
- University of Texas Medical Branch, Preventive Medicine and Community Health, Galveston, TX, USA
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Busato M, Quagliati C, Magri L, Filippi A, Sanna A, Branchini M, Marchand AM, Stecco A. Fascial Manipulation Associated With Standard Care Compared to Only Standard Postsurgical Care for Total Hip Arthroplasty: A Randomized Controlled Trial. PM R 2016; 8:1142-1150. [DOI: 10.1016/j.pmrj.2016.04.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 04/16/2016] [Accepted: 04/19/2016] [Indexed: 02/06/2023]
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Abstract
PURPOSE To identify what types of social rules are involved in group interventions led by physiotherapists (PTs), and how these rules influence individual recovery. METHODS Eight patients; six women and two men, which had recently undergone elective hip or knee replacement surgery, were recruited as informants from an intervention group that investigated effect of task specific exercise. The data comprise observational notes from group training sessions and one-on-one semi-structured interviews with the eight patients. Observational notes contributed to the development of the research questions. The interviews were audio-recorded and transcribed, and a theoretically-oriented analytical approach guided by performance theory was conducted to identify the rules. RESULTS Several implicit rules for behavior when attending this group intervention were identified. The compulsory style enhances recovery in an explicit manner. CONCLUSION When giving advice and home exercise PTs must acknowledge that the roles patients are subtly exposed to during the actual clinical encounter are probably quite different from the roles the patients can merge into outside the therapy context. This might shed some light on the notion of patient adherence/concordance. The significance of social rules in group training sessions. Implications for Rehabilitation Health professionals should be aware of the implicit social regulations of the clinical encounter. They will influence whether and how patients adhere to advice. By acknowledging that patients have different roles to merge into, depending on context, health professionals may significantly broaden our understanding of patient adherence and compliance. The social rules identified in this study contribute to individual recovery processes. We encourage health professionals to regard "group dynamics" as something that is going on during the group session, and worthwhile taking advantage of when planning and implementing group interventions.
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Affiliation(s)
- Line Blixt
- a Department of Health Sciences , Institute of Health and Society, University of Oslo , Oslo , Norway
| | - Kari Nyheim Solbrække
- a Department of Health Sciences , Institute of Health and Society, University of Oslo , Oslo , Norway
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Withers TM, Lister S, Sackley C, Clark A, Smith TO. Is there a difference in physical activity levels in patients before and up to one year after unilateral total hip replacement? A systematic review and meta-analysis. Clin Rehabil 2016; 31:639-650. [PMID: 27773874 PMCID: PMC5407512 DOI: 10.1177/0269215516673884] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Objective: To determine the difference in physical activity levels before and up to one year after unilateral primary total hip replacement. Data sources: A search was performed on 13 July 2016. Studies were eligible for inclusion if they presented preoperative and up to one year postoperative measures of physical activity for patients who had undergone unilateral primary total hip replacement. Review methods: Any article that used a measure of physical activity pre and up to one year post-unilateral primary total hip replacement. Data was synthesised using a meta-analysis with 95% confidence intervals (CI), if appropriate. The Critical Appraisal Skills Programme cohort study checklist was used to assess the quality of evidence. Results: From 6024 citations, 17 studies were selected: Nine studies were analysed in a meta-analysis and eight studies were analysed qualitatively. The quality of the evidence was ‘low’ to ‘moderate’. There was no statistically significant difference in physical activity pre- to post-total hip replacement when assessed using: movement-related activity (mean difference (MD): −0.08; 95% CI: 1.60, 1.44; I2 = 0%; n = 77), percentage of 24-hours spent walking (MD: −0.21; 95% CI: −1.36, 0.93; I2 = 12%; n = 65), 6-minute walk test (MD: −60.85; 95% CI: −122.41, 0.72; I2 = 84%; n = 113) or the cardiopulmonary exercise test (MD: −0.24; 95% CI: −1.36, 0.87; I2 = 0%; n = 76). Conclusion: There is no statistically significant difference in physical activity levels before and up to one year after unilateral primary total hip replacement. However, the low to moderate methodological quality of the included articles should be taken into consideration when drawing conclusions.
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Affiliation(s)
- Thomas M Withers
- 1 School of Health Sciences, University of East Anglia, Norwich, UK
| | - Sarah Lister
- 2 Department of Physiotherapy, Norfolk and Norwich University Hospital, Norwich, UK
| | | | - Allan Clark
- 4 Norwich Medical School, University of East Anglia, Norwich, UK
| | - Toby O Smith
- 1 School of Health Sciences, University of East Anglia, Norwich, UK
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Heiberg KE, Figved W. Physical Functioning and Prediction of Physical Activity After Total Hip Arthroplasty: Five-Year Followup of a Randomized Controlled Trial. Arthritis Care Res (Hoboken) 2016; 68:454-62. [PMID: 26239078 DOI: 10.1002/acr.22679] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 06/02/2015] [Accepted: 07/21/2015] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To examine whether the 1-year effects from a previous walking skill training program on walking and stair climbing still persist 5 years following total hip arthroplasty (THA), to examine recovery of physical functioning from before to 5 years after surgery, and to identify predictors of physical activity 5 years after THA from preoperative measures. METHODS We performed a 5-year followup of a randomized controlled trial and a longitudinal study. Sixty participants with a mean age of 70 years (range 50-87 years; 95% confidence interval 68, 72 years) were assessed. Outcome measures were the 6-minute walk test, the stair climbing test (SCT), active hip range of motion (ROM), self-efficacy, Hip Dysfunction and Osteoarthritis Outcome Score (HOOS), and University of California, Los Angeles (UCLA) activity scale. Data were analyzed by Student's t-tests, generalized linear model, and multivariate regression analyses. RESULTS The training and control groups were approximately equal on outcome measures of physical functioning, pain, and self-efficacy at 5 years (P > 0.05). In the total group, the recovery course was unchanged from 1 to 5 years (P > 0.05), except for 9% improvement in ROM (P < 0.001) and an increase in time on SCT of 18% (P = 0.004). Preoperative HOOS pain (P = 0.022) and HOOS sport (P = 0.019) predicted UCLA activity scale 5 years after THA. CONCLUSION At 5 years after THA, the control group had caught up with the training group on physical functioning, and the participants led an active lifestyle. Those with worse preoperative scores on pain and physical functioning in sport were at risk of being less physically active in the long term following THA.
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Affiliation(s)
| | - Wender Figved
- Baerum Hospital, Vestre Viken Hospital Trust, Drammen, Norway
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31
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Blom AW, Artz N, Beswick AD, Burston A, Dieppe P, Elvers KT, Gooberman-Hill R, Horwood J, Jepson P, Johnson E, Lenguerrand E, Marques E, Noble S, Pyke M, Sackley C, Sands G, Sayers A, Wells V, Wylde V. Improving patients’ experience and outcome of total joint replacement: the RESTORE programme. PROGRAMME GRANTS FOR APPLIED RESEARCH 2016. [DOI: 10.3310/pgfar04120] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BackgroundTotal hip replacements (THRs) and total knee replacements (TKRs) are common elective procedures. In the REsearch STudies into the ORthopaedic Experience (RESTORE) programme, we explored the care and experiences of patients with osteoarthritis after being listed for THR and TKR up to the time when an optimal outcome should be expected.ObjectiveTo undertake a programme of research studies to work towards improving patient outcomes after THR and TKR.MethodsWe used methodologies appropriate to research questions: systematic reviews, qualitative studies, randomised controlled trials (RCTs), feasibility studies, cohort studies and a survey. Research was supported by patient and public involvement.ResultsSystematic review of longitudinal studies showed that moderate to severe long-term pain affects about 7–23% of patients after THR and 10–34% after TKR. In our cohort study, 10% of patients with hip replacement and 30% with knee replacement showed no clinically or statistically significant functional improvement. In our review of pain assessment few research studies used measures to capture the incidence, character and impact of long-term pain. Qualitative studies highlighted the importance of support by health and social professionals for patients at different stages of the joint replacement pathway. Our review of longitudinal studies suggested that patients with poorer psychological health, physical function or pain before surgery had poorer long-term outcomes and may benefit from pre-surgical interventions. However, uptake of a pre-operative pain management intervention was low. Although evidence relating to patient outcomes was limited, comorbidities are common and may lead to an increased risk of adverse events, suggesting the possible value of optimising pre-operative management. The evidence base on clinical effectiveness of pre-surgical interventions, occupational therapy and physiotherapy-based rehabilitation relied on small RCTs but suggested short-term benefit. Our feasibility studies showed that definitive trials of occupational therapy before surgery and post-discharge group-based physiotherapy exercise are feasible and acceptable to patients. Randomised trial results and systematic review suggest that patients with THR should receive local anaesthetic infiltration for the management of long-term pain, but in patients receiving TKR it may not provide additional benefit to femoral nerve block. From a NHS and Personal Social Services perspective, local anaesthetic infiltration was a cost-effective treatment in primary THR. In qualitative interviews, patients and health-care professionals recognised the importance of participating in the RCTs. To support future interventions and their evaluation, we conducted a study comparing outcome measures and analysed the RCTs as cohort studies. Analyses highlighted the importance of different methods in treating and assessing hip and knee osteoarthritis. There was an inverse association between radiographic severity of osteoarthritis and pain and function in patients waiting for TKR but no association in THR. Different pain characteristics predicted long-term pain in THR and TKR. Outcomes after joint replacement should be assessed with a patient-reported outcome and a functional test.ConclusionsThe RESTORE programme provides important information to guide the development of interventions to improve long-term outcomes for patients with osteoarthritis receiving THR and TKR. Issues relating to their evaluation and the assessment of patient outcomes are highlighted. Potential interventions at key times in the patient pathway were identified and deserve further study, ultimately in the context of a complex intervention.Study registrationCurrent Controlled Trials ISRCTN52305381.FundingThis project was funded by the NIHR Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 4, No. 12. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Ashley W Blom
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Neil Artz
- School of Health Professions, Faculty of Health and Human Sciences, Plymouth University, Plymouth, UK
| | - Andrew D Beswick
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Amanda Burston
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Paul Dieppe
- Medical School, University of Exeter, Exeter, UK
| | - Karen T Elvers
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Rachael Gooberman-Hill
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Jeremy Horwood
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Paul Jepson
- School of Sport, Exercise and Rehabilitation Sciences, Birmingham, UK
| | - Emma Johnson
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Erik Lenguerrand
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Elsa Marques
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Sian Noble
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Mark Pyke
- North Bristol NHS Trust, Bristol, UK
| | | | - Gina Sands
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Adrian Sayers
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Victoria Wells
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Vikki Wylde
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
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Hofstede SN, Gademan MGJ, Vliet Vlieland TPM, Nelissen RGHH, Marang-van de Mheen PJ. Preoperative predictors for outcomes after total hip replacement in patients with osteoarthritis: a systematic review. BMC Musculoskelet Disord 2016; 17:212. [PMID: 27184266 PMCID: PMC4869370 DOI: 10.1186/s12891-016-1070-3] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 05/11/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This systematic review examines which patient related factors influence functional and clinical outcomes after total hip arthroplasty (THA) in patients with hip osteoarthritis (OA). METHODS We performed a systematic review according to the PRISMA guidelines. We searched databases and trial registries for prospective studies including OA patients who underwent primary THA. Studies with preoperative measurements on predictors, with at least 1 year follow-up were included. Risk of bias and confounding was assessed for two domains: follow-up rate and looking at independent effects. RESULTS Thirty-five studies were included (138,039 patients). Only nine studies (29 %) had low risk of bias for all domains thus suggesting an overall low quality of evidence. Studies were heterogeneous in the predictors tested and in the observed directions of the associations. Overall, preoperative function (13 studies (37 %), 2 with low risk of bias) and radiological OA (6 studies (17 %), 1 with low risk of bias) were predictors with the most consistent findings. Worse preoperative function and more severe radiological OA were associated with larger postoperative improvement. However, these patients never reached the level of postoperative functioning as patients with better preoperative function or less severe radiological OA. For age, gender, comorbidity, pain and quality of life the results of studies were conflicting. For BMI, some studies (n = 5, 2 with low risk of bias) found worse outcomes for patients with higher BMI. However, substantial improvement was still achieved regardless of their BMI. CONCLUSION There is not enough evidence to draw succinct conclusions on preoperative predictors for postoperative outcome in THA, as results of studies are conflicting and the methodological quality is low. Results suggest to focus on preoperative function and radiological osteoarthritis to decide when THA will be most effective. The present mapping of current evidence on the relationship between patient related factors and outcomes provides better information compared to individual studies and may help to set patient expectations before surgery. In addition, these findings may contribute to discussions on how to achieve the best possible postoperative outcome for specific patient groups. TRIAL REGISTRATION This systematic review was registered in Prospero, registration number RD42014009977 .
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Affiliation(s)
- Stefanie N Hofstede
- Department of Orthopaedics, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands
| | - Maaike G J Gademan
- Department of Orthopaedics, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands
| | - Thea P M Vliet Vlieland
- Department of Orthopaedics, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands
| | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands
| | - Perla J Marang-van de Mheen
- Department of Medical Decision Making, J10-S, Leiden University Medical Center, P.O. Box 9600, Leiden, 2300 RC, The Netherlands.
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Abujaber SB, Marmon AR, Pozzi F, Rubano JJ, Zeni JA. Sit-To-Stand Biomechanics Before and After Total Hip Arthroplasty. J Arthroplasty 2015; 30:2027-33. [PMID: 26117068 PMCID: PMC4640963 DOI: 10.1016/j.arth.2015.05.024] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 04/27/2015] [Accepted: 05/11/2015] [Indexed: 02/01/2023] Open
Abstract
The purpose of this study was to evaluate changes in movement patterns during a sit-to-stand (STS) task before and after total hip arthroplasty (THA), and to compare biomechanical outcomes after THA to a control group. Forty-five subjects who underwent THA and twenty-three healthy control subjects participated in three-dimensional motion analysis. Pre-operatively, subjects exhibited inter-limb movement asymmetries with lower vertical ground reaction force (VGRF) and smaller moments on the operated limb. Although there were significant improvements in movement symmetry 3 months after THA, patients continued to demonstrate lower VGRF and smaller moments on the operated limb compared to non-operated and to control limbs. Future studies should identify the contributions of physical impairments and the influence of surgical approach on STS biomechanics.
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Affiliation(s)
- Sumayeh B. Abujaber
- Biomechanics and Movement Science Program, University of Delaware, Newark, Delaware,Faculty of Rehabilitation Sciences, The University of Jordan, Amman, Jordan
| | - Adam R. Marmon
- Biomechanics and Movement Science Program, University of Delaware, Newark, Delaware
| | - Federico Pozzi
- Biomechanics and Movement Science Program, University of Delaware, Newark, Delaware
| | | | - Joseph A. Zeni
- Biomechanics and Movement Science Program, University of Delaware, Newark, Delaware,Department of Physical Therapy, University of Delaware, Newark, Delaware
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Lowe CJM, Davies L, Sackley CM, Barker KL. Effectiveness of land-based physiotherapy exercise following hospital discharge following hip arthroplasty for osteoarthritis: an updated systematic review. Physiotherapy 2015; 101:252-65. [PMID: 25724323 DOI: 10.1016/j.physio.2014.12.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 12/31/2014] [Indexed: 01/06/2023]
Abstract
BACKGROUND Existing review required updating. OBJECTIVE To evaluate the effectiveness of physiotherapy exercise after discharge from hospital on function, walking, range of motion, quality of life and muscle strength, for patients following elective primary total hip arthroplasty for osteoarthritis. DESIGN Systematic review from January 2007 to November 2013. DATA SOURCES AMED, CINAHL, EMBASE, MEDLINE, Kingsfund Database, and PEDro. Cochrane CENTRAL, BioMed Central (BMC), The Department of Health National Research Register and Clinical Trials.gov register. Searches were overseen by a librarian. Authors were contacted for missing information. No language restrictions were applied. ELIGIBILITY CRITERIA Trials comparing physiotherapy exercise vs usual/standard care, or comparing two types of relevant exercise physiotherapy, following discharge from hospital after elective primary total hip replacement for osteoarthritis were reviewed. OUTCOMES Functional activities of daily living, walking, quality of life, muscle strength and joint range of motion. STUDY APPRAISAL Quality and risk of bias for studies were evaluated. Data were extracted and meta-analyses considered. RESULTS 11 trials are included in the review. Trial quality was mixed. Newly included studies were assessed as having lower risk of bias than previous studies. Narrative review indicates that physiotherapy exercise after discharge following total hip replacement may potentially benefit patients in terms of function, walking and muscle strengthening. LIMITATIONS The overall quality and quantity of trials, and their diversity, prevented meta-analyses. CONCLUSIONS Disappointingly, insufficient evidence still prevents the effectiveness of physiotherapy exercise following discharge to be determined for this patient group. High quality, adequately powered, trials with long term follow up are required.
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Affiliation(s)
- Catherine J Minns Lowe
- Physiotherapy Research Unit, Oxford University Hospitals NHS Trust, Nuffield Orthopaedic Hospital, Windmill Road, Headington, Oxford, UK.
| | - Linda Davies
- Physiotherapy Research Unit, Oxford University Hospitals NHS Trust, Nuffield Orthopaedic Hospital, Windmill Road, Headington, Oxford, UK
| | - Catherine M Sackley
- School of Rehabilitation Sciences, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Karen L Barker
- Physiotherapy Research Unit, Oxford University Hospitals NHS Trust, Nuffield Orthopaedic Hospital, Windmill Road, Headington, Oxford, UK; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University Hospitals NHS Trust, Oxford, UK
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Judd DL, Dennis DA, Thomas AC, Wolfe P, Dayton MR, Stevens-Lapsley JE. Muscle strength and functional recovery during the first year after THA. Clin Orthop Relat Res 2014; 472:654-64. [PMID: 23817756 PMCID: PMC3890211 DOI: 10.1007/s11999-013-3136-y] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Patients undergoing total hip arthroplasty (THA) often are satisfied with the decrease in pain and improvement in function they achieve after surgery. Even so, strength and functional performance deficits persist after recovery, but these remain poorly characterized; knowledge about any ongoing strength or functional deficits may allow therapists to design rehabilitation programs to optimize recovery after THA. QUESTIONS/PURPOSES The purposes of this study were to (1) evaluate postoperative muscle strength, function, and quality of life during the first year after THA; and (2) compare strength and function in patients 1 year after THA with a cohort of healthy peers. METHODS Twenty-six patients undergoing THA were assessed 1, 3, 6, and 12 months postoperatively, and 19 adults with no hip pathology were tested as a control group. Isometric muscle strength (hip flexors, extensors, abductors, knee extensors, and flexors), functional performance (stair climbing, five times sit-to-stand, timed-up-and-go, 6-minute walk, and single-limb stance tests), and self-reported function (Hip Disability and Osteoarthritis Score, SF-36, and UCLA activity score) were compared. RESULTS One month after THA, patients had 15% less hip flexor and extensor torque, 26% less abductor torque, 14% less knee extensor and flexor torque, and worse performance on the stair climbing, timed-up-and-go, single-limb stance, and 6-minute walk. Compared with healthy adults, patients 12 months after THA had 17% less knee extensor and 23% less knee flexor torque; however, the functional testing (including stair climbing, five times sit-to-stand, and the 6-minute walk) showed no significant differences with the patient numbers available between individuals undergoing THA and healthy control subjects. SF-36 Physical Component Scores, although significantly improved from preoperative levels, were significantly worse than healthy adults 1 year after THA (p < 0.01). CONCLUSIONS Patients experience early postoperative strength losses and decreased functional capacity after THA, yet strength deficits may persist after recovery. This may suggest that rehabilitation may be most effective in the first month after surgery.
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Affiliation(s)
- Dana L Judd
- Physical Therapy Program, University of Colorado, Anschutz Medical Campus, 13121 E 17th Avenue, Mail Stop C244, Aurora, CO, 80045, USA,
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Heiberg KE, Ekeland A, Mengshoel AM. Functional improvements desired by patients before and in the first year after total hip arthroplasty. BMC Musculoskelet Disord 2013; 14:243. [PMID: 23947801 PMCID: PMC3751787 DOI: 10.1186/1471-2474-14-243] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Accepted: 08/13/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the field of rehabilitation, patients are supposed to be experts on their own lives, but the patient's own desires in this respect are often not reported. Our objectives were to describe the patients' desires regarding functional improvements before and after total hip arthroplasty (THA). METHODS Sixty-four patients, 34 women and 30 men, with a mean age of 65 years, were asked to describe in free text which physical functions they desired to improve. They were asked before surgery and at three and 12 months after surgery. Each response signified one desired improvement. The responses were coded according to the International Classification of Functioning, Disability and Health (ICF) to the 1st, 2nd and 3rd category levels. The frequency of the codes was calculated as a percentage of the total number of responses of all assessments times and in percentage of each time of assessment. RESULTS A total of 333 responses were classified under Part 1 of the ICF, Functioning and Disability, and 88% of the responses fell into the Activities and Participation component. The numbers of responses classified into the Activities and Participation component were decreasing over time (p < 0.001). The categories of Walking (d450), Moving around (d455), and Recreation and leisure (d920) included more than half of the responses at all the assessment times. At three months after surgery, there was a trend that fewer responses were classified into the Recreation and leisure category, while more responses were classified into the category of Dressing (d540). CONCLUSIONS The number of functional improvements desired by the patients decreased during the first postoperative year, while the content of the desires before and one year after THA were rather consistent over time and mainly concerned with the ability to walk and participate in recreation and leisure activities. At three months, however, there was a tendency that the patients were more concerned about the immediate problems with putting on socks and shoes.
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