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Kamp T, Brouwer S, Seeber GH, Overgaard S, Gademan MGJ, Stevens M. Return to work policies and practices after total hip or knee arthroplasty in Denmark, Germany, and the Netherlands: an exploratory study. Disabil Rehabil 2024:1-10. [PMID: 38314658 DOI: 10.1080/09638288.2024.2304084] [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: 06/16/2023] [Accepted: 01/07/2024] [Indexed: 02/06/2024]
Abstract
PURPOSE To explore return-to-work (RTW) policies and practices for total hip arthroplasty (THA) and total knee arthroplasty (TKA) patients in three European countries. MATERIALS AND METHODS An exploratory study in Denmark, Germany, and the Netherlands consisting of three aspects: (1) description of the healthcare and social security systems; (2) identification of national RTW guidelines; (3) a survey to gain insight into RTW practices and perceptions of orthopaedic surgeons, including barriers, facilitators, and needs. RESULTS Healthcare and social security systems differed (e.g. fast-track vs longer postoperative stay; coverage of rehabilitation costs). National guidelines were available in Germany (THA, TKA) and the Netherlands (TKA), containing limited RTW information. The survey was completed by 168 orthopaedic surgeons (Denmark n = 51; Germany n = 39; the Netherlands n = 78). Overall, orthopaedic surgeons reported being in need of more knowledge and better collaboration with other healthcare practitioners. CONCLUSION We found considerable variation in healthcare and social security systems. When available, national guidelines contained limited information. In all three countries surgeons need more knowledge and better collaboration with other healthcare practitioners. We advise that RTW multidisciplinary recommendations post THA/TKA be established by the national associations of the healthcare practitioners involved.
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Affiliation(s)
- Tamara Kamp
- Department of Orthopaedics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Health sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Orthopaedics, Leiden University Medical Centre, University of Leiden, Leiden, the Netherlands
| | - Sandra Brouwer
- Department of Health sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Gesine H Seeber
- Department of Orthopaedics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- University Hospital for Orthopedics and Trauma Surgery Pius-Hospital, Medical Campus University of Oldenburg, Oldenburg, Germany
| | - Søren Overgaard
- Department of Orthopaedic Surgery and Traumatology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Maaike G J Gademan
- Department of Orthopaedics, Leiden University Medical Centre, University of Leiden, Leiden, the Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Centre, University of Leiden, Leiden, the Netherlands
| | - Martin Stevens
- Department of Orthopaedics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Kirschbaum S, Hube R, Perka C, Ley C, Rosaria S, Najfeld M. Bilateral simultaneous hip arthroplasty shows comparable early outcome and complication rate as staged bilateral hip arthroplasty for patients scored ASA 1-3 if performed by a high-volume surgeon. INTERNATIONAL ORTHOPAEDICS 2023; 47:2571-2578. [PMID: 37355529 PMCID: PMC10522735 DOI: 10.1007/s00264-023-05871-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 06/13/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE The aim of this study was to compare early outcomes after simultaneous and staged hip arthroplasty (THA) in patients with bilateral symptomatic pathology. METHODS We conducted a retrospective cohort study including all patients scheduled for primary THA for bilateral hip osteoarthritis (OA, n = 290). Patients either received simultaneous (n = 152, 52.4%) or staged (n = 138, 47.6%) bilateral THA based on individual preference. All operations (n = 428) were performed by one single, high-volume surgeon. Demographic data (e.g., age, ASA score) as well as perioperative parameters (haemoglobin drop (Hb), red blood cell transfusion, length of stay (LOS), operation time, six week complication rate and achievement of inpatient rehabilitation key points) were evaluated. RESULTS Patients in the simultaneous bilateral THA group were younger (62.8 ± 8.9 vs. 65 ± 9.7 years, p = 0.022) and had lower ASA scores (1.8, (34.2% ASA 1, 55.3% ASA 2, 37.2% ASA 3) vs. 2.0 (18.8% ASA 1, 61.6% ASA 2, 19.6% ASA 3)) than the staged group. While the average LOS was 7.1 ± 1.7 days for simultaneous bilateral THA, the combined LOS for the staged group was 12.9 ± 2.4 days (p < 0.001). The cumulative operation time in the simultaneous bilateral THA group was 61.1 ± 11.5 min and 57.6 ± 7.3 min in the staged group (p < 0.015). Cumulative Hb loss was significantly higher in the staged group (2.1 ± 7.2 g/dl vs. 3.7 ± 1.3 g/dl, p < 0.001). No significant differences were found concerning the complication rate or early inpatient rehabilitation. CONCLUSION Simultaneous bilateral hip arthroplasty in patients with symptomatic bilateral hip osteoarthritis is as safe and successful as a staged procedure if performed by a high-volume surgeon.
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Affiliation(s)
- Stephanie Kirschbaum
- Centre for Musculoskeletal Surgery, Charité-University Hospital Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Robert Hube
- OCM Orthopädische Chirurgie München, Steinerstraße 6, 81369, Munich, Germany
| | - Carsten Perka
- Centre for Musculoskeletal Surgery, Charité-University Hospital Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Christophe Ley
- University of Luxembourg, 2 Av. de l'Universite, 4365, Esch-sur-Alzette, Luxembourg
| | - Simone Rosaria
- University of Napoli Federico II, Corso Umberto I 40, 80138, Naples, Italy
| | - Michael Najfeld
- OCM Orthopädische Chirurgie München, Steinerstraße 6, 81369, Munich, Germany
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Sommers E, D'Amico S, Goldstein L, Gardiner P. Integrative Approaches to Pediatric Chronic Pain in an Urban Safety-Net Hospital: Cost Savings, Clinical Benefits, and Safety. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2022; 28:445-453. [PMID: 35285677 DOI: 10.1089/jicm.2021.0296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Purpose: Chronic pain experienced by children and adolescents represents a significant burden in terms of health, quality of life, and economic costs to U.S. families. In 2015, the Boston Medical Center (BMC) Interdisciplinary Pain Clinic initiated an Integrative Medicine (IM) team model to address chronic pain in children. Team members included a pediatrician, child psychologist, physical therapist, acupuncturist, and massage therapist. Children were referred to the pain clinic from primary care and specialty services within BMC, the largest safety-net hospital in the northeastern United States. For this observational assessment, consent and assent were obtained from parents and pediatric patients. Individualized treatment plans were recommended by the IM team. Methods: Self-reported survey and electronic medical record data were collected about socioeconomic demographics, pain, use of medical and IM services, and quality of life. The authors compared health and quality of life indicators and costs of care for each participant from the year before entering the project with these same indicators for the subsequent year. Results: Eighty-three participants were enrolled. Participants ranged in age from 4 to 22 years (mean 14.7 years). Eighty percent of the group were females. Forty-two percent of the sample were white, 30% were Hispanic/Latinx, and 28% were African American. Primary types of pain were abdominal (52%), headache (23%), musculoskeletal (18%), and other (7%). Quality of life indicators improved (p = 0.049) and pain interference decreased (Wilcoxon p = 0.040). Major economic drivers of cost were emergency department (ED) visits, inpatient hospitalizations, and consultations with medical specialists. For the 46 participants who completed the project, the following total cost savings were noted: $27,819 (surgeries), $17,638 (ED visits), $25,033 (hospitalizations), and $42,843 (specialist consults). No adverse events were reported. Conclusion: The authors' experience demonstrated that the use of IM approaches in an interdisciplinary team approach is safe, feasible, and acceptable to families. Considerable cost savings were observed in the area of surgical procedures, hospitalizations, and consultations with specialists.
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Affiliation(s)
- Elizabeth Sommers
- Department of Family Medicine, Integrative Medicine and Health Disparities Program, Boston Medical Center, Boston, MA, USA
- Department of Family Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Salvatore D'Amico
- Department of Family Medicine, Integrative Medicine and Health Disparities Program, Boston Medical Center, Boston, MA, USA
- Cornell Medical Center, Department of Precision Oncology, Herbert Irving Pavilion Cancer Center, New York, NY, USA
| | - Laura Goldstein
- Department of Family Medicine, Integrative Medicine and Health Disparities Program, Boston Medical Center, Boston, MA, USA
- Department of Child and Adolescent Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Paula Gardiner
- Department of Family Medicine, Integrative Medicine and Health Disparities Program, Boston Medical Center, Boston, MA, USA
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Kimmel LA, Simpson PM, Holland AE, Edwards ER, Cameron PA, de Steiger RS, Page RS, Hau R, Bucknill A, Kasza J, Gabbe BJ. Discharge destination and patient-reported outcomes after inpatient treatment for isolated lower limb fractures. Med J Aust 2020; 212:263-270. [PMID: 32017129 DOI: 10.5694/mja2.50485] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 10/30/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To examine the association between discharge destination (home or inpatient rehabilitation) for adult patients treated in hospital for isolated lower limb fractures and patient-reported outcomes. DESIGN Review of prospectively collected Victorian Orthopaedic Trauma Outcomes Registry (VOTOR) data. SETTING, PARTICIPANTS Adults (18-64 years old) treated for isolated lower limb fractures at four Melbourne trauma hospitals that contribute data to the VOTOR, 1 March 2007 - 31 March 2016. MAIN OUTCOME MEASURES Return to work and functional recovery (assessed with the extended Glasgow Outcomes Scale, GOS-E); propensity score analysis of association between discharge destination and outcome. RESULTS Of 7961 eligible patients, 1432 (18%) were discharged to inpatient rehabilitation, and 6775 (85%) were followed up 12 months after their injuries. After propensity score adjustment, the odds of better functional recovery were 56% lower for patients discharged to inpatient rehabilitation than for those discharged directly home (odds ratio, 0.44; 95% CI, 0.37-0.51); for the 5057 people working before their accident, the odds of return to work were reduced by 66% (odds ratio, 0.34; 95% CI, 0.26-0.46). Propensity score analysis improved matching of the discharge destination groups, but imbalances in funding source remained for both outcome analyses, and for also for site and cause of injury in the GOS-E analysis (standardised differences, 10-16%). CONCLUSIONS Discharge to inpatient rehabilitation after treatment for isolated lower limb fractures was associated with poorer outcomes than discharge home. Factors that remained unbalanced after propensity score analysis could be assessed in controlled trials.
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Affiliation(s)
- Lara A Kimmel
- Monash University, Melbourne, VIC.,The Alfred Hospital, Melbourne, VIC
| | | | - Anne E Holland
- Monash University, Melbourne, VIC.,The Alfred Hospital, Melbourne, VIC.,La Trobe University, Melbourne, VIC
| | - Elton R Edwards
- Monash University, Melbourne, VIC.,The Alfred Hospital, Melbourne, VIC
| | - Peter A Cameron
- Monash University, Melbourne, VIC.,The Alfred Hospital, Melbourne, VIC
| | | | - Richard S Page
- Barwon Health, Geelong, VIC.,St John of God Hospital, Geelong, VIC.,Deakin University, Geelong, VIC
| | | | - Andrew Bucknill
- Royal Melbourne Hospital, Melbourne, VIC.,University of Melbourne, Melbourne, VIC
| | | | - Belinda J Gabbe
- Monash University, Melbourne, VIC.,Health Data Research UK, Swansea University Medical School, Swansea University, United Kingdom
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Singer S, Vogel HJ, Guntinas-Lichius O, Erdmann-Reusch B, Fuchs M, Taylor K, Meyer A, Keszte J. Multicenter prospective study on the use and outcome of rehabilitation after total laryngectomy in Germany. Head Neck 2018; 41:1070-1079. [PMID: 30548728 DOI: 10.1002/hed.25540] [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: 03/10/2018] [Revised: 08/07/2018] [Accepted: 10/06/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The purpose of this study was to assess the use and outcome of rehabilitation after total laryngectomy in Germany. METHODS We enrolled patients who were scheduled for total laryngectomy, approached them again after surgery, after 3 months and 1 year. Patients completed questionnaires and were interviewed. RESULTS Of 309 participants, 14% had not received any rehabilitation. Reasons for nonuse were primarily ongoing treatment and poor health. Users of rehabilitation had 4 times the odds of attaining any ability to speak compared to nonusers (odds ratio 3.8, P = .02). The main aim of rehabilitation from the perspective of the users was speech rehabilitation, mentioned by 71% before starting rehabilitation. This was also what most users (27%) found the most helpful part of rehabilitation. CONCLUSIONS Patients are interested in attending rehabilitation. They especially want to improve their speech capacity, which indeed is better among users of rehabilitation than in those without.
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Affiliation(s)
- Susanne Singer
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Centre Mainz, Mainz, Germany.,University Cancer Centre Mainz, Mainz, Germany
| | - Hans-Joachim Vogel
- Department of Otorhinolaryngology, Sana-Klinikum Remscheid, Remscheid, Germany
| | | | | | - Michael Fuchs
- Department of Otorhinolaryngology, Section of Phoniatrics and Audiology, University of Leipzig, Leipzig, Germany
| | - Katherine Taylor
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Centre Mainz, Mainz, Germany.,University Cancer Centre Mainz, Mainz, Germany
| | | | - Judith Keszte
- Department of Medical Psychology and Medical Sociology, University Medical Centre Leipzig, Leipzig, Germany
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Rossettini G, Latini TM, Palese A, Jack SM, Ristori D, Gonzatto S, Testa M. Determinants of patient satisfaction in outpatient musculoskeletal physiotherapy: a systematic, qualitative meta-summary, and meta-synthesis. Disabil Rehabil 2018; 42:460-472. [PMID: 30428722 DOI: 10.1080/09638288.2018.1501102] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: To identify and synthesise patient-identified factors that influence satisfaction with outpatient musculoskeletal physiotherapy (O-MSK).Methods: A systematic, qualitative meta-summary and meta-synthesis was conducted by accessing six electronic databases: CINAHL, Embase, MEDLINE, Scopus, Web of Science, and Wiley Online Library, from inception to March 2017. Additional studies were identified by using a "berry-picking" method. Search limits were: primary studies; English language; and involving human subjects. Qualitative peer-reviewed articles describing patient satisfaction in O-MSK were eligible for inclusion. Two reviewers critically appraised eligible studies independently using the critical appraisal of skills programme tool for qualitative studies. Extracted verbatim data of included studies were synthesised using the meta-summary and meta-synthesis by using a purpose-designed form.Results: Eleven studies were included in the article. Factors influencing patient satisfaction were grouped into six broad themes: 1) clinical outcomes; 2) physiotherapist features; 3) patient features; 4) physiotherapist-patient relationship; 5) treatment features, and 6) healthcare setting features.Conclusions: These findings suggest that patient satisfaction in O-MSK is a multidimensional construct influenced by individual patient/provider, clinical, and contextual factors. Future reviews should include a synthesis of findings from both qualitative and quantitative studies to establish a fully comprehensive understanding of this complex health phenomenon.Implications for rehabilitationPatient satisfaction in outpatient musculoskeletal physiotherapy is affected by different factors, thus reflecting a multidimensional construct;Single determinants are not sufficient to affect patient satisfaction;Patient satisfaction is influenced individual patient/provider, clinical outcomes, and contextual factors;Further studies should be designed to investigate the relationships among these factors.
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Affiliation(s)
- Giacomo Rossettini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, Savona, Italy
| | - Teresa Maria Latini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, Savona, Italy
| | - Alvisa Palese
- Department of Medical and Biological Sciences, School of Nursing, University of Udine, Udine, Italy
| | - Susan M Jack
- Department of Health Research Methods, School of Nursing, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Diego Ristori
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, Savona, Italy
| | - Serena Gonzatto
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, Savona, Italy
| | - Marco Testa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, Savona, Italy
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Haas R, O’Brien L, Bowles KA, Haines T. Effectiveness of a weekend physiotherapy service on short-term outcomes following hip and knee joint replacement surgery: a quasi-experimental study. Clin Rehabil 2018; 32:1493-1508. [DOI: 10.1177/0269215518779647] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Romi Haas
- Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, Melbourne, VIC, Australia
- Allied Health Research Unit, Monash Health, Melbourne, VIC, Australia
| | - Lisa O’Brien
- Allied Health Research Unit, Monash Health, Melbourne, VIC, Australia
- Department of Occupational Therapy, Monash University, Melbourne, VIC, Australia
| | - Kelly-Ann Bowles
- Allied Health Research Unit, Monash Health, Melbourne, VIC, Australia
- Department of Community Emergency Health and Paramedic Practice, Monash University, Melbourne, VIC, Australia
| | - Terry Haines
- Allied Health Research Unit, Monash Health, Melbourne, VIC, Australia
- School of Primary and Allied Health Care, Monash University, Melbourne, VIC, Australia
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Kreis K, Neubauer S, Klora M, Lange A, Zeidler J. Status and perspectives of claims data analyses in Germany—A systematic review. Health Policy 2016; 120:213-26. [DOI: 10.1016/j.healthpol.2016.01.007] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 01/04/2016] [Accepted: 01/07/2016] [Indexed: 12/11/2022]
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Cost of illness for patients with arthritis receiving multidisciplinary rehabilitation care. Rehabil Res Pract 2011; 2011:487025. [PMID: 22110975 PMCID: PMC3195367 DOI: 10.1155/2011/487025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Accepted: 04/14/2011] [Indexed: 11/17/2022] Open
Abstract
Purpose. To describe healthcare consumption and costs prior to, during, and after multidisciplinary rehabilitation due to arthritis. Methods. 306 patients (age 18-75 years) with arthritis scheduled for multidisciplinary rehabilitation care in 9 rehabilitation centres and 4 rheumatology hospital departments were included and followed for 6 months. Costs were estimated in Euros (€) for the total sample and five clinical subgroups. Results. Healthcare costs ranged from €3,033 to €91,336 and were significantly higher at hospital departments compared to rehabilitation centres: €9,722 (SD 5,406) and €4,250 (SD 1,040). While total costs prior to and after rehabilitation were stable for those receiving rehabilitation at a hospital, there was a significant increase in costs for those being at a rehabilitation centre. Total mean costs were more than doubled when including social costs: from €32,410 (95% CI 20,074-37,017) to €51,491 (95% CI 49,055-61,657). Conclusions. Healthcare and social costs for arthritis rehabilitation were substantial both before and after a rehabilitation stay. It is important to explore methods to reduce the length of rehabilitation stay and production loss connected to rehabilitation of patients with rheumatic disease.
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Merito M, Breitscheidel L. Cost estimation in health economic evaluations in Germany: a systematic review. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2010. [DOI: 10.1111/j.1759-8893.2010.00022.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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