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Berkovic D, Vallance P, Harris IA, Naylor JM, Lewis PL, de Steiger R, Buchbinder R, Ademi Z, Ackerman IN. Barriers and enablers to the implementation and sustainability of short-stay arthroplasty programs for elective primary total hip and knee replacement: A systematic review with qualitative evidence synthesis. Musculoskeletal Care 2024; 22:e1897. [PMID: 38831253 DOI: 10.1002/msc.1897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 05/13/2024] [Indexed: 06/05/2024]
Abstract
INTRODUCTION We aimed to systematically review contemporary evidence on the barriers and enablers to implementing and sustaining short-stay arthroplasty programs for elective primary total hip and knee replacement from the perspectives of patients, health professionals, carers, healthcare administrators, funders and policymakers and to map the findings to the Theoretical Domains Framework (TDF). METHODS Medline, Cumulative Index to Nursing and Allied Health Literature, EMBASE, and the Cochrane Central Register of Controlled Trials were searched (up to 19 August 2023). Primary qualitative or mixed-methods studies reporting on perspectives relating to the review aims that utilised a short-stay programme were eligible for inclusion. Study quality was assessed using the qualitative critical appraisal tool from the Joanna Briggs Institute. Data were analysed inductively. The final themes were mapped to the TDF. The confidence in the findings was assessed using GRADE CERQual. RESULTS Fifteen studies were included. Twelve barrier themes and twelve enabler themes were identified. Three themes were graded with high confidence, 10 were graded with moderate confidence, three were graded with low confidence, and eight were graded with very low confidence. The most pertinent domains that the themes were mapped to for patients were beliefs about capabilities, reinforcement, and the environmental context and resources. Health professionals identified knowledge, environmental context and resources as important domains. Two domains were identified for carers: (1) social/professional role and identity and (2) memory, attention, and decision processes. CONCLUSION We identified key barrier and enabler themes linked to the TDF that can be used to guide implementation initiatives and promote the sustainability of short-stay arthroplasty programs.
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Affiliation(s)
- Danielle Berkovic
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Patrick Vallance
- Department of Physiotherapy, Podiatry, Prosthetics and Orthotics, School of Allied Health, Human Service and Sport, La Trobe University, Melbourne, Victoria, Australia
- Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia
| | - Ian A Harris
- School of Clinical Medicine, UNSW Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Justine M Naylor
- School of Clinical Medicine, UNSW Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
- Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Peter L Lewis
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, South Australia, Australia
- Faculty of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Richard de Steiger
- Department of Surgery, Epworth HealthCare, University of Melbourne, Melbourne, Victoria, Australia
| | - Rachelle Buchbinder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Zanfina Ademi
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Health Economics and Policy Evaluation Research (HEPER), Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Ilana N Ackerman
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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You S, Li N, Guo M, Ji H. Are patients ready for discharge from the hospital after fast-track total knee arthroplasty?-A qualitative study. PLoS One 2024; 19:e0303935. [PMID: 38809900 PMCID: PMC11135671 DOI: 10.1371/journal.pone.0303935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 05/02/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND The fast-track based on evidence-based medicine, has dramatically reduced the length of stay for patients undergoing total knee arthroplasty (TKA). Therefore, patients must assume the responsibility for self-functional exercise and care as early as possible. Also, higher standards and expectations of care delivery have been set. Studies into patients' experiences when faced with a discharge decision under a fast-track program are lacking. OBJECTIVES (1) Increase the knowledge about patients' experiences of discharged from hospital via a fast-track process after TKA. (2) Explore what gaps exist in the current discharge preparation care service for TKA under fast-track and what can be improved. METHODS A qualitative research design was chosen to conduct semi-structured face-to-face interviews with 21 patients from one Chinese hospital who successfully underwent TKA and received discharge orders. Interview data were meticulously analyzed, summarized and thematically distilled using Interpretative Phenomenological Analysis (IPA). RESULTS Three themes emerged from the structural analyses: a) Preparing for discharge despite concerns about symptoms-a sense of joy at discharge despite feelings of helplessness, stigmatisation, anxiety about prosthetic function. b) Managing the rehabilitation difficulties-vigilance is needed for medication management, environmental changes, and intimate relationships. c) Creating conditions for safe transition-compassionate bedside manner, listening to patients, and providing a humanized continuing care and referral services are important for safe transitions. CONCLUSION Findings suggest that patients undergoing fast-track TKA report good discharge preparation experiences. However, closer analysis reveals difficulties with this process and important directions in which discharge readiness care services can strive.
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Affiliation(s)
- Simeng You
- The affiliated hospital of Jiaxing University, The First Hospital of Jiaxing, Jiaxing, Zhejiang, China
| | - Na Li
- Nursing department, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong, China
| | - Manjie Guo
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Hong Ji
- Nursing department, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong, China
- School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong, China
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Longo UG, Corradini A, Marchetti A, Di Sarno C, D’Angelo C, Arias C, De Marinis MG, de Sire A, Denaro V. I Am Afraid I Will Not Be Able to Walk, That Is What Worries Me-The Experience of Patients with Knee Osteoarthritis before Total Knee Arthroplasty: A Qualitative Study. J Clin Med 2024; 13:2878. [PMID: 38792420 PMCID: PMC11122229 DOI: 10.3390/jcm13102878] [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: 12/27/2023] [Revised: 02/02/2024] [Accepted: 05/09/2024] [Indexed: 05/26/2024] Open
Abstract
Background: Knee osteoarthritis is the most prevalent type of osteoarthritis. Patients frequently encounter pain triggered by movement that evolves into impaired joint function. Needing persistent rest or having night-time pain signifies advanced disease. Qualitative research is considered the most effective method for comprehending patients' needs and contexts. Methods: This study employed a qualitative research design, allowing the researchers to acquire insights into the patients' beliefs and values, and the contextual factors influencing the formation and expression of these beliefs and values. Results: A cohort of nine patients awaiting total knee replacement (TKR) surgery was included and they were interviewed until data saturation was achieved. The results of the phenomenological analysis resulted in the identification of three themes: "The existence of pain impedes the capacity to participate in daily life activities"; "TKR induced fears and uncertainties regarding the progression of the disease"; "Severe nighttime pain compromising sleep quality". Conclusions: This study analyzes the experiences of people awaiting TKR surgery, emphasizing the importance of addressing their unique needs to improve preoperative education and rehabilitation. In this way, patients' recovery during the postoperative phase can be improved.
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Affiliation(s)
- Umile Giuseppe Longo
- Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Roma, Italy; (A.C.); (V.D.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, 00128 Roma, Italy; (C.D.S.); (C.D.)
| | - Alessandra Corradini
- Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Roma, Italy; (A.C.); (V.D.)
| | - Anna Marchetti
- Research Unit Nursing Science, Campus Bio-Medico University, 00128 Rome, Italy; (A.M.); (M.G.D.M.)
| | - Chiara Di Sarno
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, 00128 Roma, Italy; (C.D.S.); (C.D.)
| | - Carlotta D’Angelo
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, 00128 Roma, Italy; (C.D.S.); (C.D.)
| | - Claudia Arias
- Hospital Nacional Edgardo Rebagliati Martins, Lima 15072, Peru;
| | - Maria Grazia De Marinis
- Research Unit Nursing Science, Campus Bio-Medico University, 00128 Rome, Italy; (A.M.); (M.G.D.M.)
| | - Alessandro de Sire
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy;
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
| | - Vincenzo Denaro
- Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Roma, Italy; (A.C.); (V.D.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, 00128 Roma, Italy; (C.D.S.); (C.D.)
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VAN Egmond JC, DE Wert LA, Siemons-Beer A, Gosens T. Patients' perspective of fast-track total joint arthroplasty: a systematic review. Acta Orthop Belg 2024; 90:115-122. [PMID: 38669660 DOI: 10.52628/90.1.12623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
The introduction of fast-track protocols decreased length of hospital stay and improved rehabilitation and outcomes in total joint arthroplasty. Despite improved clinical results published in many papers, the patient perspective of these protocols is less investigated. Purpose of this study was to explore the patient perspective of fast-track protocols in arthroplasty. A systematic search for articles of patient experiences in total hip, knee, and shoulder arthroplasty was conducted using EMBASE, MEDLINE, Cochrane, and Web-of-Science for articles published from inception to February 14, 2023. In total 12 studies were included involving 672 patients. Most patients were satisfied with short length of hospital stay and preferred rehabilitation at home with relatives for support. Various experiences were reported regarding pain and postoperative out of hospital physical therapy. Frequently, feelings of insecurity were reported because of lack of personalized information. Based on current qualitative literature, patients are satisfied with short length of hospital stay in fast-track total joint arthroplasty. Improvements in personalized information and physical therapy protocols is needed.
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MESH Headings
- Humans
- Length of Stay/statistics & numerical data
- Patient Satisfaction
- Arthroplasty, Replacement, Hip/rehabilitation
- Arthroplasty, Replacement, Hip/methods
- Arthroplasty, Replacement, Knee/rehabilitation
- Arthroplasty, Replacement, Knee/methods
- Arthroplasty, Replacement/methods
- Arthroplasty, Replacement, Shoulder/methods
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Kinsey D, Carrieri D, Briscoe S, Febrey S, Kneale D, Lovegrove C, Nunns M, Coon JT, McGrath J, Hemsley A, Shaw L. Experiences of interventions to reduce hospital stay for older adults following elective treatment: Qualitative evidence-synthesis. Int J Older People Nurs 2024; 19:e12602. [PMID: 38403945 DOI: 10.1111/opn.12602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 12/15/2023] [Accepted: 01/04/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND AND OBJECTIVES Hospitals streamline treatment pathways to reduce the length of time older adults admitted for planned procedures spend in hospital. However patient perspectives have been poorly evaluated. This systematic review aimed to understand the experiences of older patients, carers, families and staff of multi-component interventions intended to improve recovery following elective treatment. RESEARCH DESIGN AND METHODS Bibliographic databases searched in June 2021 included MEDLINE ALL, HMIC, CENTRAL, CINAHL, AMED and ProQuest Dissertations and Theses. We conducted citation searching and examined reference lists of reviews. Two reviewers independently undertook screening and data extraction, resolving disagreements through discussion. We used an adapted Wallace checklist for quality appraisal and meta-ethnography to synthesise data. Clinician, carer and patient views were incorporated throughout the review. RESULTS Thirty-five papers were included in the synthesis. Thirteen studies were conducted in the UK, with patient views the most frequently represented. We identified six overarching constructs: 'Home as preferred environment for recovery', 'Feeling safe', 'Individualisation of structured programme', 'Taking responsibility', 'Essential care at home' and 'Outcomes'. DISCUSSION AND IMPLICATIONS Findings explore the support patients, families and carers need throughout hospital admission, and may inform commissioning of services to ensure patients and carers receive appropriate follow-up support after hospital discharge. The findings may help hospital and community-based health and social care staff provide person-centred care based upon assessments of emotional and physical wellbeing of patients and family/carers. Research is needed to establish a core-set of patient-reported outcome measures which capture aspects of recovery which are meaningful to patients.
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Affiliation(s)
- Debbie Kinsey
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Daniele Carrieri
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Simon Briscoe
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Sam Febrey
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Dylan Kneale
- EPPI-Centre, UCL Social Research Institute, University College London, London, UK
| | - Chris Lovegrove
- School of Health Professions, Faculty of Health & Human Sciences, University of Plymouth, Plymouth, UK
| | - Michael Nunns
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Jo Thompson Coon
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - John McGrath
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - Anthony Hemsley
- Department of Healthcare for Older People, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - Liz Shaw
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
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Pryce R, Langan E, Tector K, Raggett L, Flynn R, Smart KM. Patients' experiences following total knee arthroplasty: a qualitative evidence synthesis. Disabil Rehabil 2024; 46:214-231. [PMID: 36617965 DOI: 10.1080/09638288.2022.2159548] [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: 06/14/2022] [Accepted: 12/12/2022] [Indexed: 01/10/2023]
Abstract
PURPOSE Total knee arthroplasty (TKA) is a common surgical intervention for patients with advanced arthritis. The aim of this qualitative evidence synthesis was to systematically review the qualitative literature on patients' experiences following primary TKA. MATERIALS AND METHODS Four electronic databases (PubMed, CINAHL, Cochrane and Embase) were searched from inception until October 2021. Pairs of reviewers independently screened search results for eligibility, analysed the quality of included studies and extracted data. We undertook a thematic synthesis and used an interpretive approach to identify recurring themes and draw a conclusion. Data were synthesised using thematic analysis and an interpretive approach was used to identify themes. RESULTS Twenty-three studies exploring patients' experiences following TKA were included. Five main themes emerged: (i) Experience of healthcare staff, (ii) Pain/Medications, (iii) Was it worth it? (iv) Social Support (v) Follow up. CONCLUSIONS This review highlights the variability in patients' experiences following TKA. Whether this experience detailed their pain, function, or encounter with healthcare staff or systems, patients reported a variety of both positive and negative sentiments. Each theme invites attention to an area in which healthcare can improve to enhance patients' experiences. The importance of patient support, individualised rehabilitation and appropriate follow-up are highlighted.
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Affiliation(s)
- Robert Pryce
- Department of Physiotherapy and Sports Science, UCD School of Public Health, Health Science Centre, University College Dublin, Belfield, Ireland
| | - Emma Langan
- Department of Physiotherapy and Sports Science, UCD School of Public Health, Health Science Centre, University College Dublin, Belfield, Ireland
| | - Katie Tector
- Department of Physiotherapy and Sports Science, UCD School of Public Health, Health Science Centre, University College Dublin, Belfield, Ireland
| | - Leah Raggett
- Department of Physiotherapy and Sports Science, UCD School of Public Health, Health Science Centre, University College Dublin, Belfield, Ireland
| | - Roisin Flynn
- Department of Physiotherapy and Sports Science, UCD School of Public Health, Health Science Centre, University College Dublin, Belfield, Ireland
| | - Keith M Smart
- Department of Physiotherapy and Sports Science, UCD School of Public Health, Health Science Centre, University College Dublin, Belfield, Ireland
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Efford CM, Samuel D. Does rapid mobilisation as part of an enhanced recovery pathway improve length of stay, return to function and patient experience post primary total hip replacement? A randomised controlled trial feasibility study. Disabil Rehabil 2023; 45:4252-4258. [PMID: 36412168 DOI: 10.1080/09638288.2022.2148298] [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: 06/10/2022] [Accepted: 11/12/2022] [Indexed: 11/23/2022]
Abstract
PURPOSE Day-zero ambulation may enable patients to recover and leave hospital quicker following total hip replacement (THR). The present randomised control feasibility study investigated the efficacy of day-zero ambulation as a physiotherapeutic intervention. METHODS Thirty-six non-blinded adults aged 44-85 (Mean 67.1; SD 9.6 years) undergoing primary, uncomplicated THR were block randomized to either a control group (n = 18) with standard post-operative physiotherapy or an intervention group (n = 18) incorporating walking on the same day as the operation. Outcomes were length of hospital stay (LOS), time to reach functional milestones and achieve all physiotherapy discharge criteria, post-operative pain scores, complications and patient experience. RESULTS Participants treated with day-zero ambulation had reduced median hospital LOS of 1 day (p = .096), and median reduced times to reaching functional milestones of 39.7 h quicker to transfer to a chair (p < .001), 24.5 h quicker to walk 10 m (p = .009) and 26.4 h quicker to independently ascend and descend stairs (p = .01). Participants in the intervention group were deemed physiotherapy ready to leave hospital significantly earlier than control group (1.04 days, p = .015). CONCLUSIONS Day-zero ambulation appears safe and may have clinically relevant effects in speeding patient functional recovery and facilitating earlier discharge from hospital. Implications for RehabilitationDay-zero ambulation following total hip replacement (THR) appears safe.Preliminary data suggest that day-zero mobilisation following THR could be efficacious and support the need for a fully powered randomised controlled trial.There may be a clinically relevant effect in speeding patient functional recovery and facilitating an earlier discharge from hospital.
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Affiliation(s)
- Christopher M Efford
- Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- University Hospitals Dorset NHS Foundation Trust, Poole, UK
| | - Dinesh Samuel
- Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
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Chen TLW, Buddhiraju A, Seo HH, Shimizu MR, Bacevich BM, Kwon YM. Can machine learning models predict prolonged length of hospital stay following primary total knee arthroplasty based on a national patient cohort data? Arch Orthop Trauma Surg 2023; 143:7185-7193. [PMID: 37592158 DOI: 10.1007/s00402-023-05013-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 07/23/2023] [Indexed: 08/19/2023]
Abstract
INTRODUCTION The total length of stay (LOS) is one of the biggest determinators of overall care costs associated with total knee arthroplasty (TKA). An accurate prediction of LOS could aid in optimizing discharge strategy for patients in need and diminishing healthcare expenditure. The aim of this study was to predict LOS following TKA using machine learning models developed on a national-scale patient cohort. METHODS The ACS-NSQIP database was queried to acquire 267,966 TKA cases from 2013 to 2020. Four machine learning models-artificial neural network (ANN), random forest, histogram-based gradient boosting, and k-nearest neighbor were trained and tested on the dataset for the prediction of prolonged LOS (LOS exceeded the 75th of all values in the cohort). The model performance was assessed by discrimination (area under the receiver operating characteristic curve [AUC]), calibration, and clinical utility. RESULTS ANN delivered the best performance among the four models. ANN distinguished prolonged LOS in the study cohort with an AUC of 0.71 and accurately predicted the probability of prolonged LOS for individual patients (calibration slope: 0.82; calibration intercept: 0.03; Brier score: 0.089). All models demonstrated clinical utility by generating positive net benefits in decision curve analyses. Operation time, pre-operative transfusion, pre-operative laboratory tests (hematocrit, platelet count, and white blood cell count), and BMI were the strongest predictors of prolonged LOS. CONCLUSION ANN demonstrated modest discrimination capacity and excellent performance in calibration and clinical utility for the prediction of prolonged LOS following TKA. Clinical application of the machine learning models has the potential to improve care coordination and discharge planning for patients at high risk of extended hospitalization after surgery. Incorporating more relevant patient factors may further increase the models' prediction strength.
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Affiliation(s)
- Tony Lin-Wei Chen
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Anirudh Buddhiraju
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Henry Hojoon Seo
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Michelle Riyo Shimizu
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Blake M Bacevich
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Young-Min Kwon
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Zhang S, Ma H, Wang L, Wang M, Li B, Liu J. Effectiveness of an online management platform (Joint Cloud) versus standard process for patients undergoing total knee arthroplasty: study protocol for a prospective randomised controlled trial. BMJ Open 2023; 13:e073058. [PMID: 37996234 PMCID: PMC10668232 DOI: 10.1136/bmjopen-2023-073058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 10/25/2023] [Indexed: 11/25/2023] Open
Abstract
INTRODUCTION Osteoarthritis (OA) is one of the main causes of mobility impairment in the elderly worldwide. Therefore, total knee arthroplasty (TKA) is often performed and is one of the most successful surgery and has resulted in substantial quality-of-life gains for people with end-stage arthritis. There is still room for improvement in the standard treatment process in the preoperative, intraoperative and postoperative period of TKA. Telerehabilitation has the potential to become a positive alternative to face-to-face rehabilitation nowadays. But it remains unclear how well telemedicine interventions cover the entire surgical pathway (preoperation, intraoperation, postoperation). This study aims to explore the effectiveness of Joint Cloud (JC, an online management platform) compared with existing standard process in regulating functional recovery, pain management, muscle strength changes and other health-related outcomes in patients undergoing total knee arthroplasty preoperation, intraoperation and postoperation. METHODS AND ANALYSIS A randomised controlled trial was designed to compare the online management platform (JC) with standard process (SP) in patients undergoing TKA. A total of 186 TKA patients will be randomly assigned to the intervention (n=93) or control (n=93) group. Patients in the intervention group will receive access to the 'JC' mini-program. This mini-program provides popular science information (eg, information about OA and TKA), functional exercise information and communication channels. Patients evaluate their condition and functional level through standardised digital questionnaires. The control group of patients will not accept any functions of this mini-program. The primary outcome is knee functional recovery, and the secondary outcomes are pain management, isometric knee extensor muscle strength, patient satisfaction and cost-benefit analysis. Assessments will be performed 1 month and 3 days before surgery (T0) and 1 month and 3 months after surgery. Data analysis will be performed according to the intent-to-treat (ITT) principle. Repeated measures of linear mixed models and parametric and non-parametric testing will be used for statistical analysis. ETHICS AND DISSEMINATION The study was reviewed and approved by the Tianjin Hospital Medical Ethics Review Committee on 10 February 2023 (2022YLS155). Test data are considered highly sensitive but are available upon request. The findings will be disseminated in peer-reviewed publications. TRIAL REGISTRATION NUMBER ChiCTR2300068486.
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Affiliation(s)
- Shuhao Zhang
- Clinical College of Orthopedics, Tianjin Medical University, Tianjin, China
- Department of Joints, Tianjin Hospital, Tianjin, China
| | - He Ma
- Clinical College of Orthopedics, Tianjin Medical University, Tianjin, China
- Department of Joints, Tianjin Hospital, Tianjin, China
| | - Lei Wang
- Department of Joints, Tianjin Hospital, Tianjin, China
| | - Maopeng Wang
- Clinical College of Orthopedics, Tianjin Medical University, Tianjin, China
- Department of Joints, Tianjin Hospital, Tianjin, China
| | - Bing Li
- Clinical College of Orthopedics, Tianjin Medical University, Tianjin, China
- Department of Joints, Tianjin Hospital, Tianjin, China
| | - Jun Liu
- Clinical College of Orthopedics, Tianjin Medical University, Tianjin, China
- Department of Joints, Tianjin Hospital, Tianjin, China
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Kinsey D, Febrey S, Briscoe S, Kneale D, Thompson Coon J, Carrieri D, Lovegrove C, McGrath J, Hemsley A, Melendez-Torres GJ, Shaw L, Nunns M. Impact of interventions to improve recovery of older adults following planned hospital admission on quality-of-life following discharge: linked-evidence synthesis. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2023; 11:1-164. [PMID: 38140881 DOI: 10.3310/ghty5117] [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: 12/24/2023]
Abstract
Objectives To understand the impact of multicomponent interventions to improve recovery of older adults following planned hospital treatment, we conducted two systematic reviews, one of quantitative and one of qualitative evidence, and an overarching synthesis. These aimed to: • understand the effect of multicomponent interventions which aim to enhance recovery and/or reduce length of stay on patient-reported outcomes and health and social care utilisation • understand the experiences of patients, carers and staff involved in the delivery of interventions • understand how different aspects of the content and delivery of interventions may influence patient outcomes. Review methods We searched bibliographic databases including MEDLINE ALL, Embase and the Health Management Information Consortium, CENTRAL, and Cumulative Index to Nursing and Allied Health Literature and Allied and Complementary Medicine Database, conducted forward and backward citation searching and examined reference lists of topically similar qualitative reviews. Bibliographic database searches were completed in May/June 2021 and updated in April 2022. We sought primary research from high-income countries regarding hospital inpatients with a mean/median age of minimum 60 years, undergoing planned surgery. Patients experienced any multicomponent hospital-based intervention to reduce length of stay or improve recovery. Quantitative outcomes included length of stay and any patient-reported outcome or experience or service utilisation measure. Qualitative research focused on the experiences of patients, carers/family and staff of interventions received. Quality appraisal was undertaken using the Effective Public Health Practice Project Quality Assessment Tool or an adapted version of the Wallace checklist. We used random-effects meta-analysis to synthesise quantitative data where appropriate, meta-ethnography for qualitative studies and qualitative comparative analysis for the overarching synthesis. Results Quantitative review: Included 125 papers. Forty-nine studies met criteria for further synthesis. Enhanced recovery protocols resulted in improvements to length of stay, without detriment to other outcomes, with minimal improvement in patient-reported outcome measures for patients admitted for lower-limb or colorectal surgery. Qualitative review: Included 43 papers, 35 of which were prioritised for synthesis. We identified six themes: 'Home as preferred environment for recovery', 'Feeling safe', 'Individualisation of structured programme', 'Taking responsibility', 'Essential care at home' and 'Outcomes'. Overarching synthesis: Intervention components which trigger successful interventions represent individualised approaches that allow patients to understand their treatment, ask questions and build supportive relationships and strategies to help patients monitor their progress and challenge themselves through early mobilisation. Discussion Interventions to reduce hospital length of stay for older adults following planned surgery are effective, without detriment to other patient outcomes. Findings highlight the need to reconsider how to evaluate patient recovery from the perspective of the patient. Trials did not routinely evaluate patient mid- to long-term outcomes. Furthermore, when they did evaluate patient outcomes, reporting is often incomplete or conducted using a narrow range of patient-reported outcome measures or limited through asking the wrong people the wrong questions, with lack of longer-term evaluation. Findings from the qualitative and overarching synthesis will inform policy-making regarding commissioning and delivering services to support patients, carers and families before, during and after planned admission to hospital. Study registration This trial is registered as PROSPERO registration number CRD42021230620. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 130576) and is published in full in Health and Social Care Delivery Research; Vol. 11, No. 23. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Debbie Kinsey
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Samantha Febrey
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Simon Briscoe
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Dylan Kneale
- EPPI-Centre, UCL Social Research Institute, University College London, London, UK
| | - Jo Thompson Coon
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Daniele Carrieri
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Christopher Lovegrove
- School of Health Professions, Faculty of Health and Human Sciences, University of Plymouth, Plymouth, UK
| | - John McGrath
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - Anthony Hemsley
- Department of Healthcare for Older People, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | | | - Liz Shaw
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Michael Nunns
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
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11
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Burger M, Watson F, van Wyk A. A diarized journey: an interpretative phenomenological analysis of the older person's lived experience of a hip or knee replacement within a fast-track programme. BMC Geriatr 2023; 23:592. [PMID: 37743501 PMCID: PMC10518952 DOI: 10.1186/s12877-023-04276-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 09/04/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND For the older person living with end-stage hip or knee osteoarthritis, a hip or knee replacement can be a traumatic event, influencing the physical, physiological, psychological, social and economic facets of daily living. This interpretative phenomenological study aimed to reveal and interpret the daily lived experiences of the older person before, during and after a primary total hip or knee replacement surgery in a fast-track programme in South Africa. METHODS A qualitative interpretive phenomenological study, collecting data through solicited diaries and reflexive member validation interviews from seven participants aged 65-75 years, who underwent a primary elective hip or knee replacement surgery. The surgical fast-track process and data collection process happened simultaneously. Data collection from the solicited diary started before surgery, continued during the surgery process and finished six weeks after surgery and this was followed with reflexive member validation interviews. Interpretative phenomenological analysis was used throughout the three phases of the fast-track programme. RESULTS Three superordinate themes developed during the three phases of surgery: "The holistic impact of pain on daily quality of life", "Finding ways to cope", and "Transition between independence and dependence and back". Although former research confirms the physical impact of osteoarthritis on the older person and the success of fast-track programmes for subsequent hip and knee replacements, this study contributes to the holistic impact of the surgery on participants' daily lives. The diarized journey of individuals through the psychological, psychosocial, physical, professional, and spiritual experience are described and interpreted in this study. CONCLUSIONS Across the solicited diaries, it was clear that pain as catalyst impacted the daily activities of the individual physically, psychologically, and psychosocially. Pain was subjectively present at different intensities during all the phases of the replacement surgery, impairing mobilization and triggering roller-coaster emotions. In order to cope with physical and emotional difficulties while preparing and adjusting to the environment, participants reflected on social support, physical and professional support, and spirituality. Throughout the preparation, hospitalization and the recovery process, the transition between independence, dependence, and back to independence was significant, reinforcing the individual's determination to recover.
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Affiliation(s)
- Marisa Burger
- Quality in Nursing and Midwifery (NuMIQ), Faculty of Health Sciences, North-West University, 11 Hoffman Street, Potchefstroom, 2531, South Africa
| | - Francois Watson
- Quality in Nursing and Midwifery (NuMIQ), Faculty of Health Sciences, North-West University, 11 Hoffman Street, Potchefstroom, 2531, South Africa.
| | - Annemarie van Wyk
- Quality in Nursing and Midwifery (NuMIQ), Faculty of Health Sciences, North-West University, 11 Hoffman Street, Potchefstroom, 2531, South Africa
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12
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Mu Er Ti Zha MEALM, Sun ZJ, Li T, Ai Mai Ti RZY, Fu G, Yao DC, Yu X. Impact of ERAS compliance on the short-term outcomes for distal radius surgery: a single-center retrospective study. J Orthop Surg Res 2023; 18:702. [PMID: 37726824 PMCID: PMC10510143 DOI: 10.1186/s13018-023-04178-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 09/09/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Distal radius fractures (DRF) account for one in five bony injuries in both primary and secondary trauma care. Enhanced recovery after surgery (ERAS) has been adopted successfully to improve clinical outcomes in multiple surgical disciplines; however, no study has investigated the effect of different degrees of compliance with ERAS protocol on short-term outcomes following distal radius surgery. We aimed to analyze whether different degrees of compliance with the ERAS pathway are associated with clinical improvement following surgery for DRF. METHODS We retrospectively analyzed all consecutive patients with ERAS who underwent surgery for DRF at our department between May 2019 and October 2022. Their pre-, peri-, and post-operative compliance with the 22 elements of the ERAS program were assessed. We compared parameters between low- (< 68.1%) and high-compliance (> 68.1%) groups, including patient complications, total length of hospitalization, discharge time after surgery, hospital costs, time taken to return to preinjury level performance level, number of visual analogue scale (VAS) pain scores > 3 points during hospitalization, disabilities of the arm, shoulder and hand (DASH) scores. We performed multiple linear regression analyses to assess the impact of ERAS compliance on the postoperative function level (DASH scores). RESULTS No significant differences were detected between the high- and low-compliance groups with respect to demographics, including sex, age, body mass index (BMI), and comorbidities (P > 0.05). We observed significant differences between the high- and low-compliance groups in terms of the DASH score (32.25 ± 9.97 vs. 40.50 ± 15.65, p < 0.05) at 6 months postoperatively, the discharge time after surgery (2.45 ± 1.46 vs. 3.14 ± 1.50, p < 0.05), and number of times when the VAS pain score was > 3 points during hospitalization (0.88, [0.44, 1.31], p < 0.05). Our study demonstrated a significant negative association between ERAS compliance and the function level of patients postoperatively (DASH scores) when adjusted for age, comorbidity, sex, and BMI. CONCLUSIONS This study provided a realistic evaluation and comparison of the ERAS protocol among patients with DRF and can guide clinical decision making. The ERAS protocol may improve outcomes after surgery, with high postoperative function levels and reduced pain and discharge time after surgery, without increased complication rates or hospital costs.
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Affiliation(s)
- Mi Er A Li Mu Mu Er Ti Zha
- Department of Orthopedic, People's Hospital of Xinjiang Uygur Autonomous Region China, Urumqi, 830001, Xinjiang, China
| | - Zhi Jian Sun
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China
| | - Ting Li
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China.
| | - Re Zi Ya Ai Mai Ti
- College of Traditional Uyghur Medicine, Xinjiang Medical University, Urumqi, 830017, Xinjiang, China
| | - Gang Fu
- Department of Orthopedic, Fuzhou Second Hospital, Fuzhou, 350007, China
| | - Dong Chen Yao
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China
| | - Xiang Yu
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China
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13
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Gavin JP, Burgess LC, Immins T, Wainwright TW. Understanding the Patient Perspective When Designing Future Rehabilitation Interventions after Hip or Knee Replacement Surgery-A Patient and Public Involvement Exercise. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1653. [PMID: 37763772 PMCID: PMC10534474 DOI: 10.3390/medicina59091653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 08/31/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: Following discharge from hospital, there can be variability in the rehabilitation of patients who have undergone total hip or knee replacement surgery. We invited patients who had had hip or knee replacement surgery to take part in patient and public involvement sessions to help us understand their recovery needs and how rehabilitation services could potentially be improved to meet these needs better. Materials: Patients (n = 14) were invited to one of two patient advisory group sessions which took place in a university setting. Results: Feedback from patients highlighted the need for an inclusive, evidence-based intervention that would benefit patients experiencing all levels of pain, with differing motivations for recovery. Patients desired social support with others who have had similar surgery to reduce the burden of isolation during rehabilitation. Furthermore, patients valued the involvement of their partners and carers in their rehabilitation, to provide social support and guidance on recovery. Patients also expressed a need for consistent information and expert guidance on all aspects of their recovery. Conclusions: These findings can be used to guide the design of rehabilitation interventions following hip and knee replacement and ensure that patient perspectives inform future practice.
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Affiliation(s)
- James P. Gavin
- School of Health Sciences, University of Southampton, Southampton SO17 1BJ, UK
| | - Louise C. Burgess
- Department of Rehabilitation and Sport Sciences, Bournemouth University, Bournemouth BH12 5BB, UK
| | - Tikki Immins
- Orthopaedic Research Institute, Bournemouth University, Bournemouth BH8 8EB, UK
| | - Thomas W. Wainwright
- Orthopaedic Research Institute, Bournemouth University, Bournemouth BH8 8EB, UK
- Physiotherapy Department, University Hospitals Dorset, Bournemouth BH7 7DW, UK
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14
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Goetz J, Maderbacher G, Gerg A, Leiss F, Dullien S, Zeman F, Meyer M, Reinhard J, Grifka J, Greimel F. Isokinetic knee muscle strength comparison after enhanced recovery after surgery (ERAS) versus conventional setup in total knee arthroplasty (TKA): a single blinded prospective randomized study. J Exp Orthop 2023; 10:44. [PMID: 37060486 PMCID: PMC10105813 DOI: 10.1186/s40634-023-00604-0] [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] [Received: 11/03/2022] [Accepted: 03/30/2023] [Indexed: 04/16/2023] Open
Abstract
PURPOSE Total knee arthroplasty (TKA) combined with the concept of enhanced recovery is of continued worldwide interest, as it is reported to improve early functional outcome and treatment quality without increasing complications. The aim of the study was to investigate isokinetic knee muscle strength after cemented TKA in combination with an enhanced recovery after surgery (ERAS) compared to a conventional setup. METHODS In the single blinded prospective randomized study, 52 patients underwent navigated primary cemented TKA within an ERAS (n = 30) or a conventional setup (n = 22). Preoperatively, five days and four weeks after surgery isokinetic knee muscle strength with BIODEX-type measuring device (peak torque in Nm, work in Joules and power in Watt) and subjective patient-related outcome measures (PROMs) were investigated. RESULTS The ERAS group showed significantly better outcomes in knee flexion at 180°/s (peak torque (Nm) p = 0.047, work (J) p = 0.040 and power (W) p = 0.016) 5 days postoperatively. The isokinetic measuring at knee extension 60°/s and 180°/s demonstrated no significant difference. The PROMs showed that patients were satisfied with the postoperative results in both groups. After 4 weeks, there was no longer a significant difference in isokinetic measuring at knee extension and flexion between the ERAS and conventional group. CONCLUSIONS TKA with the concept of ERAS improves excellent isokinetic outcome and patient satisfaction. The isokinetic muscle strength measurement can help patients and surgeons to modify expectations and improve patient satisfaction.
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Affiliation(s)
- Julia Goetz
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany.
| | - Günther Maderbacher
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
| | - Anna Gerg
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
| | - Franziska Leiss
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
| | - Silvia Dullien
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
| | - Florian Zeman
- Center for Clinical Studies, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Matthias Meyer
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
| | - Jan Reinhard
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
| | - Joachim Grifka
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
| | - Felix Greimel
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
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15
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Longo UG, Marchetti A, Corradini A, Candela V, Salvatore G, De Marinis MG, Denaro V. Patients' Perceptions and Experiences during the Pre-Admission Phase for Total Hip Replacement Surgery: A Qualitative Phenomenological Study. J Clin Med 2023; 12:jcm12082754. [PMID: 37109091 PMCID: PMC10145484 DOI: 10.3390/jcm12082754] [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: 03/09/2023] [Revised: 03/30/2023] [Accepted: 04/06/2023] [Indexed: 04/29/2023] Open
Abstract
Osteoarthritis negatively impacts the patient's quality of life. Qualitative research is an effective tool in detecting the various emotions experienced by patients with osteoarthritis. Such studies play a crucial role in promoting comprehension of the patient's experiences of health and illness among healthcare professionals, including nurses. The purpose of this study is to examine patients' perceptions during the pre-admission process for total hip replacement (THR). The study utilized a qualitative descriptive methodology with a phenomenological approach. A sample of patients awaiting THR consented to participate in the study and were interviewed until data saturation was achieved. The results of the phenomenological analysis resulted in the identification of three themes: 1-Surgery generates mixed feelings; 2-Pain negatively impacts daily life activities; 3-Pain requires personal strategies to be alleviated. Patients awaiting THR demonstrate frustration and anxiety. They experience intense pain during daily activities, which persists even during night rest.
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Affiliation(s)
- Umile Giuseppe Longo
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Anna Marchetti
- Research Unit Nursing Science, Campus Bio-Medico University, Via Alvaro del Portillo, 21, 00128 Rome, Italy
| | - Alessandra Corradini
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
| | - Vincenzo Candela
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Giuseppe Salvatore
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Maria Grazia De Marinis
- Research Unit Nursing Science, Campus Bio-Medico University, Via Alvaro del Portillo, 21, 00128 Rome, Italy
| | - Vincenzo Denaro
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
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The effectiveness of a mobile application-based programme for rehabilitation after total hip or knee arthroplasty: A randomised controlled trial. Int J Nurs Stud 2023; 140:104455. [PMID: 36821950 DOI: 10.1016/j.ijnurstu.2023.104455] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 01/28/2023] [Accepted: 02/06/2023] [Indexed: 02/12/2023]
Abstract
BACKGROUND Total hip arthroplasty and total knee arthroplasty are widely performed worldwide. Patients undergoing total hip or knee arthroplasty are often discharged after a short hospital stay. Using information and communication technologies, such as mobile applications, to provide rehabilitation services remotely may be a strategy to support patients' postoperative recovery. OBJECTIVE This study aimed to evaluate the effectiveness of a rehabilitation programme delivered via a mobile application among Chinese patients after total hip or knee arthroplasty. DESIGN Randomised controlled trial. SETTING A teaching hospital in Shanghai, China. PARTICIPANTS Eighty-six patients who received a unilateral primary total hip or knee arthroplasty. METHODS The participants were recruited in the hospital and randomised into either the experimental or control group. Once discharged from the hospital, the control group (n = 43) received usual care, and the experimental group (n = 43) received usual care plus a 6-week mobile rehabilitation programme. Outcomes were assessed three times: the day before hospital discharge and 6 and 10 weeks after discharge. Primary outcomes were the changes in scores of self-efficacy and patient-reported physical function from baseline to 6 weeks post-discharge. Secondary outcomes included changes in scores of pain, depression, anxiety, and health-related quality of life. Data were analysed using generalised estimating equations. RESULTS At 6 weeks after hospital discharge, the experimental group showed statistically significant improvements compared to the control in scores of self-efficacy (adjusted mean difference = 0.72, 95% CI 0.31 to 1.14, P < .001) and patient-reported physical function (adjusted mean difference = 4.57, 95% CI 1.24 to 7.90, P = .007). The between-group difference in self-efficacy probably reached clinical significance. At week-10 follow-up, the experimental group had statistically significant improvements in scores of self-efficacy (adjusted mean difference = 0.64, 95% CI 0.33 to 0.95, P < .001), health-related quality of life (adjusted mean difference = 0.06, 95% CI 0.01 to 0.10, P = .018), anxiety (adjusted mean difference = -0.51, 95% CI -0.91 to -0.10, P = .015), and depression (adjusted mean difference = -0.37, 95% CI -0.66 to -0.08, P = .012). The between-group difference in self-efficacy and health-related quality of life may be clinically significant. CONCLUSION Mobile application-based rehabilitation demonstrated potentially positive effects on patients' self-efficacy, patient-reported physical function, health-related quality of life, and levels of anxiety and depression. TRIAL REGISTRATION Registered with the Australian New Zealand Clinical Trials Registry on 6 July 2021 (ACTRN12621000867897).
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17
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Richter J, Matziolis G, Kahl U. [Knee flexion after hospitalisation is no predictor for functional outcome one year after total knee arthroplasty]. ORTHOPADIE (HEIDELBERG, GERMANY) 2023; 52:159-164. [PMID: 36449049 PMCID: PMC9908663 DOI: 10.1007/s00132-022-04327-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/12/2022] [Indexed: 12/02/2022]
Abstract
OBJECTIVE In total knee arthroplasty (TKA), range of motion has become established as an important factor. The criterion of quality is set to flexion of 90° after hospitalisation. Currently, it is supposed to be a predictor for 1‑year postoperative outcome. However, as this correlation has not been proven, this clinical trial was performed. METHODS A total of 182 TKA recipients were analysed retrospectively. Outcomes were assessed before surgery, after hospitalization, 6 weeks and 1 year post surgery. They included knee range of motion (ROM) to answer the main hypothesis, but also KSS, SF-36, WOMAC, EQ-5D and VAS to evaluate knee function and quality of life. The patients were divided into two groups differing in achieving 90° flexion after hospitalisation and compared 6 weeks and 1 year after surgery. RESULTS Knee flexion differed significantly between groups from 91 to 70° in the group without the aim of 90° flexion after hospitalisation (E) (p < 0.001). After 6 weeks, flexion was improved to 112° ± 13° (E > 90°) vs. 106° ± 14° (E < 90°; p = 0.001). One year post surgery, knee flexion averaged 122° ± 10° (E > 90°) vs. 120° ± 10° (E < 90°) with no difference between the groups (p = 0.57) and no significant difference in all other scores concerning knee function and quality of life. CONCLUSION Flexion of 90° after hospitalisation is not adequate to predict medium-term outcomes after TKA. There is no advantage or disadvantage regarding whether the aim of 90° flexion is achieved.
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Affiliation(s)
- Janice Richter
- Deutsches Zentrum für Orthopädie Waldkliniken Eisenberg, Universitätsklinikum Jena, Klosterlausnitzer Str. 81, 07607, Eisenberg, Deutschland.
| | - Georg Matziolis
- Deutsches Zentrum für Orthopädie Waldkliniken Eisenberg, Universitätsklinikum Jena, Klosterlausnitzer Str. 81, 07607 Eisenberg, Deutschland
| | - Uwe Kahl
- Orthopädisches Zentrum, Sportklinik Erfurt, Erfurt, Deutschland Am Urbicher Kreuz 7, 99099
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18
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Manevskiу AA, Sviridov SV, Melekhov AV, Barmotin GV, Demin AK, Nikitin IG. Enhanced Recovery in Total Knee and Hip Arthroplasty: the Need for National Recommendations. MESSENGER OF ANESTHESIOLOGY AND RESUSCITATION 2022. [DOI: 10.21292/2078-5658-2022-19-6-86-96] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- A. A. Manevskiу
- National Medical Research Center, Medical and Rehabilitation Center; Pirogov Russian National Research Medical University
| | | | - A. V. Melekhov
- National Medical Research Center, Medical and Rehabilitation Center; Pirogov Russian National Research Medical University
| | - G. V. Barmotin
- National Medical Research Center, Medical and Rehabilitation Center
| | - A. K. Demin
- National Medical Research Center, Medical and Rehabilitation Center; Institute for Leadership and Health Management, I. M. Sechenov First Moscow State Medical University (Sechenov University)
| | - I. G. Nikitin
- National Medical Research Center, Medical and Rehabilitation Center; Pirogov Russian National Research Medical University
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19
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De Berardinis L, Senarighi M, Ciccullo C, Forte F, Spezia M, Gigante AP. Fast-track surgery and telerehabilitation protocol in unicompartmental knee arthroplasty leads to superior outcomes when compared with the standard protocol: a propensity-matched pilot study. Knee Surg Relat Res 2022; 34:44. [PMID: 36510279 PMCID: PMC9743114 DOI: 10.1186/s43019-022-00173-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 11/24/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Several strategies have been devised to reduce the length of stay after orthopedic surgery. Telerehabilitation has proved effective in functional outcomes after orthopedic procedures and is appreciated by patients. There is limited information on fast-track surgery and telerehabilitation protocols for unicompartmental knee arthroplasty (UKA). The purpose of this pilot study was to report and compare functional outcomes and satisfaction levels during first 12 months of recovery in patients who underwent UKA according to a fast-track and telerehabilitation protocol (G1) or standard surgery and rehabilitation program (G2). METHODS Data were retrospectively collected and reviewed for all elective UKAs from January 2018 to November 2019. A total of seven patients undergoing UKA according to the fast-track and telerehabilitation protocol were propensity score matched (1:3 ratio) to 21 patients undergoing standard surgery and rehabilitation. Patients were matched for age, sex, body mass index (BMI), and laterality. The Western Ontario and McMaster University (WOMAC) osteoarthritis index and range of motion (ROM) were collected pre- and postoperatively in both groups for 12 months. In addition, patient' satisfaction was collected at 40 days. RESULTS The G1 group demonstrated significantly better outcomes in WOMAC index scores at 2, 15, and 40 days (p < 0.001, p < 0.001, p < 0.020, respectively) and a significantly greater knee ROM after surgery and at 2, 15, 40, and 12 months (p < 0.001, p < 0.001, p = 0.014, p < 0.001, p = 0.003, respectively). No patients in either group had postoperative complications. One patient was not completely satisfied in the G2, while no one in G1 reported not being completely satisfied (p = 1.000). CONCLUSIONS This fast-track and telerehabilitation protocol after UKA can potentially be applied to patients as it is safe and effective. At 12-months follow-up, both groups reported favorable outcomes after UKA. However, the G1 score was better regarding WOMAC and ROM when compared with the propensity score-matched G2 program. A larger study is warranted to explore the role of fast-track and telerehabilitation in clinical and functional outcomes of UKA.
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Affiliation(s)
- Luca De Berardinis
- grid.7010.60000 0001 1017 3210Clinical Orthopedics, Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, Via Tronto, 10/a, 60126 Ancona, AN Italy
| | - Marco Senarighi
- grid.7010.60000 0001 1017 3210Clinical Orthopedics, Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, Via Tronto, 10/a, 60126 Ancona, AN Italy
| | - Carlo Ciccullo
- grid.7010.60000 0001 1017 3210Clinical Orthopedics, Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, Via Tronto, 10/a, 60126 Ancona, AN Italy
| | - Fabiana Forte
- Specialist of Physical Medicine & Rehabilitation, COQ (Centro Ortopedico di Quadrante), Madonna del Popolo Hospital, Via Lungolago Buozzi 25, 28887 Omegna, VB Italy
| | - Marco Spezia
- Surgical Director of Department of Orthopaedics, COQ (Centro Ortopedico di Quadrante), Madonna del Popolo Hospital, Via Lungolago Buozzi 25, 28887 Omegna, VB Italy
| | - Antonio Pompilio Gigante
- grid.7010.60000 0001 1017 3210Clinical Orthopedics, Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, Via Tronto, 10/a, 60126 Ancona, AN Italy
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20
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Anderson AM, Drew BT, Antcliff D, Redmond AC, Comer C, Smith TO, McHugh GA. Content and delivery of pre-operative interventions for patients undergoing total knee replacement: a rapid review. Syst Rev 2022; 11:184. [PMID: 36050795 PMCID: PMC9436722 DOI: 10.1186/s13643-022-02019-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 07/07/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Total knee replacement (TKR) is a common operation typically performed for end-stage knee osteoarthritis. Patients awaiting TKR often have poor health-related quality of life. Approximately 20% of patients experience persistent pain post-TKR. Pre-operative TKR interventions could improve pre- and post-operative outcomes, but future research is required to inform their design. This review aimed to identify and synthesize recent literature on the content and delivery of pre-operative TKR interventions to help guide future research and clinical practice. METHODS This rapid review included randomized trials of pre-operative TKR interventions ("outcomes studies") and primary studies exploring patients' and/or health professionals' views of pre-operative TKR interventions ("views studies"). Medline, Embase, PsycINFO, CINAHL and the Cochrane Central Register of Controlled Trials were searched for English language studies published between January 2009 and December 2020. Eligible studies' reference lists were screened. Studies were appraised using the Mixed Methods Appraisal Tool. The findings were narratively synthesized using a convergent segregated approach. RESULTS From 3263 records identified, 52 studies were included (29 outcomes studies, 21 views studies, two outcomes/views studies). The studies' methodological quality varied but was generally highest in qualitative studies. The outcomes studies investigated education (n=5), exercise (n=20), psychological (n=2), lifestyle (n=1), and/or other interventions (n=5). The views studies addressed education (n=20), exercise (n=3), psychological (n=1), lifestyle (n=4), and/or other interventions (n=1). Only three outcomes studies (two randomized controlled trials (RCTs) and a pilot study) compared the effectiveness of intervention components/delivery approaches. The two RCTs' results suggest that pre-operative TKR exercise interventions are equally effective regardless of whether they include strength or strength plus balance training and whether they are hospital- or home-based. Personal tailoring and using more than one delivery format were associated with improved outcomes and/or perceived as beneficial for multiple intervention types. CONCLUSIONS Definitive evidence on the optimal design of pre-operative TKR interventions is lacking. Personal tailoring and employing multiple delivery formats appear to be valuable design elements. Preliminary evidence suggests that including balance training and hospital versus home delivery may not be critical design elements for pre-operative TKR exercise interventions. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019143248 FUNDER: National Institute for Health and Care Research (ICA-CDRF-2018-04-ST2-006).
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Affiliation(s)
- Anna M Anderson
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK. .,NIHR Leeds Biomedical Research Centre, Leeds, UK.
| | - Benjamin T Drew
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Deborah Antcliff
- School of Healthcare, University of Leeds, Leeds, UK.,Physiotherapy Department, Bury Care Organisation, Northern Care Alliance NHS Group, Bury, UK.,School of Medicine, Keele University, Keele, UK
| | - Anthony C Redmond
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,NIHR Leeds Biomedical Research Centre, Leeds, UK
| | - Christine Comer
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,Leeds Community Healthcare NHS Trust Musculoskeletal and Rehabilitation Services, Leeds, UK
| | - Toby O Smith
- School of Health Sciences, University of East Anglia, Norwich, UK.,Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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21
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Salamanna F, Contartese D, Brogini S, Visani A, Martikos K, Griffoni C, Ricci A, Gasbarrini A, Fini M. Key Components, Current Practice and Clinical Outcomes of ERAS Programs in Patients Undergoing Orthopedic Surgery: A Systematic Review. J Clin Med 2022; 11:4222. [PMID: 35887986 PMCID: PMC9322698 DOI: 10.3390/jcm11144222] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/11/2022] [Accepted: 07/19/2022] [Indexed: 11/16/2022] Open
Abstract
Enhanced recovery after surgery (ERAS) protocols have led to improvements in outcomes in several surgical fields, through multimodal optimization of patient pathways, reductions in complications, improved patient experiences and reductions in the length of stay. However, their use has not been uniformly recognized in all orthopedic fields, and there is still no consensus on the best implementation process. Here, we evaluated pre-, peri-, and post-operative key elements and clinical evidence of ERAS protocols, measurements, and associated outcomes in patients undergoing different orthopedic surgical procedures. A systematic literature search on PubMed, Scopus, and Web of Science Core Collection databases was conducted to identify clinical studies, from 2012 to 2022. Out of the 1154 studies retrieved, 174 (25 on spine surgery, 4 on thorax surgery, 2 on elbow surgery and 143 on hip and/or knee surgery) were considered eligible for this review. Results showed that ERAS protocols improve the recovery from orthopedic surgery, decreasing the length of hospital stays (LOS) and the readmission rates. Comparative studies between ERAS and non-ERAS protocols also showed improvement in patient pain scores, satisfaction, and range of motion. Although ERAS protocols in orthopedic surgery are safe and effective, future studies focusing on specific ERAS elements, in particular for elbow, thorax and spine, are mandatory to optimize the protocols.
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Affiliation(s)
- Francesca Salamanna
- Complex Structure Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (F.S.); (D.C.); (A.V.); (M.F.)
| | - Deyanira Contartese
- Complex Structure Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (F.S.); (D.C.); (A.V.); (M.F.)
| | - Silvia Brogini
- Complex Structure Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (F.S.); (D.C.); (A.V.); (M.F.)
| | - Andrea Visani
- Complex Structure Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (F.S.); (D.C.); (A.V.); (M.F.)
| | - Konstantinos Martikos
- Spine Surgery Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (K.M.); (C.G.); (A.G.)
| | - Cristiana Griffoni
- Spine Surgery Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (K.M.); (C.G.); (A.G.)
| | - Alessandro Ricci
- Anesthesia-Resuscitation and Intensive Care, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy;
| | - Alessandro Gasbarrini
- Spine Surgery Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (K.M.); (C.G.); (A.G.)
| | - Milena Fini
- Complex Structure Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (F.S.); (D.C.); (A.V.); (M.F.)
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22
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Quality of pain counseling for orthopaedic patients in the hospital – A cross-sectional study. Int J Orthop Trauma Nurs 2022; 46:100954. [DOI: 10.1016/j.ijotn.2022.100954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 04/24/2022] [Accepted: 05/17/2022] [Indexed: 11/22/2022]
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23
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Patient perspectives of pain and function after knee replacement: a systematic review and meta-synthesis of qualitative studies. Pain Rep 2022; 7:e1006. [PMID: 35558092 PMCID: PMC9088230 DOI: 10.1097/pr9.0000000000001006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/30/2022] [Accepted: 03/05/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Joint replacement surgery typically results in good clinical outcome, although some people experience suboptimal pain relief and functional improvement. Predicting surgical outcome is difficult. Objectives There is merit in better understanding patients' perspectives of pain and function to identify avoidable problems perceived to contribute to their outcome, to inform prognostic expectations, and to identify potential cointerventions to sit alongside surgery that might mitigate pain/functional problems. Here, we aimed to synthesise the available literature exploring perspectives of people with knee osteoarthritis about their pain and function following joint replacement. Methods Six electronic databases and 2 websites were searched. Two independent reviewers completed study inclusion, quality assessment, and data extraction. Data were iteratively synthesised using first-, second-, and third-order analyses. Results Twenty-eight studies were included. Four themes were identified; perceptions of pain and function were inseparable. Theme 1 addressed experiences of recovery after surgery, which often differed from expectations. Theme 2 described the challenges of the pain experience and its functional impact, including the difficulty navigating medication use in context of personal beliefs and perceived stigma. Theme 3 articulated the toll of ongoing problems spanning pain-function-mood, necessitating the need to "endure." Theme 4 encompassed the importance of clinical/social interactions on mood and pain, with reports of concerns dismissed and practical support missing. Conclusions Together, these findings show that numerous individual considerations beyond the technical aspects of surgery influence experiences of pain and function. A tailored approach addressing these considerations from the patient perspective could provide a basis for improved success of knee replacement surgery.
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24
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HANSEN JB, SØRENSEN JFL, GLASSOU EN, HOMILIUS M, HANSEN TB. Reducing patient-staff contact in fast-track total hip arthroplasty has no effect on patient-reported outcomes, but decreases satisfaction amongst patients with self-perceived complications: analysis of 211 patients. Acta Orthop 2022; 93:264-270. [PMID: 35067723 PMCID: PMC8788681 DOI: 10.2340/17453674.2022.1617] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Several studies have compared fast-track with conventional pathways for total hip arthroplasty (THA) patients, but none have compared different fast-track pathways. Due to COVID-19 restrictions, our department had to minimize patient-staff contact in the THA pathway. First, telephone consultations were implemented instead of an outpatient clinic visit and subsequently preoperative patient education was discontinued. This enabled us to compare patient-reported outcomes and satisfaction among 3 fast-track pathways. PATIENTS AND METHODS We collected data from patients treated for hip osteoarthritis with THA at Gødstrup Hospital between 2018 and 2021. The patients had experienced 1 of 3 pathways and were interviewed via telephone between 2 and 6 months after discharge. We analyzed the influence of patient pathway on patient-reported pain and mobility level, self-perceived complications, and compliance using logistic regression. We then compared the pathway's effect on patient satisfaction both for the total sample and for the patients who experienced complications. RESULTS The amount of patient-staff contact in the patient pathway did not have any influence on patientreported outcomes or the probability of self-perceived complications. For the full sample, patient-staff contact had no statistically significant influence on patient satisfaction either, but for the subgroup of patients experiencing complications, the pathways with less patient-staff contact reduced satisfaction. Patient satisfaction was primarily related to pain and mobility outcomes. INTERPRETATION Our results indicate that reducing patient-staff contact in fast-track THA can be done without influencing mobility and pain outcomes, but the overall satisfaction among patients with self-perceived complications will be negatively affected.
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Affiliation(s)
- Jens B HANSEN
- Department of Sociology, Environmental and Business Economics at the University of Southern Denmark, Esbjerg,NIDO
- danmark, Gødstrup Hospital
| | - Jens F L SØRENSEN
- Department of Sociology, Environmental and Business Economics at the University of Southern Denmark, Esbjerg
| | - Eva N GLASSOU
- University Clinic of Hand, Hip and Knee Surgery, Department of Orthopaedics, Gødstrup Hospital,Department of Quality, Gødstrup Hospital
| | - Morten HOMILIUS
- University Clinic of Hand, Hip and Knee Surgery, Department of Orthopaedics, Gødstrup Hospital
| | - Torben B HANSEN
- University Clinic of Hand, Hip and Knee Surgery, Department of Orthopaedics, Gødstrup Hospital,Department of Clinical Medicine, Aarhus University, Denmark
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25
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Hardy A, Gervais-Hupé J, Desmeules F, Hudon A, Perreault K, Vendittoli PA. Comparing ERAS-outpatient versus standard-inpatient hip and knee replacements: a mixed methods study exploring the experience of patients who underwent both. BMC Musculoskelet Disord 2021; 22:978. [PMID: 34814889 PMCID: PMC8611950 DOI: 10.1186/s12891-021-04847-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 11/05/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Optimizing patients' total hip and knee arthroplasty (THA/TKA) experience is as crucial for providing high quality care as improving safety and clinical effectiveness. Yet, little evidence is available on patient experience in standard-inpatient and enhanced recovery after surgery (ERAS)-outpatient programs. Therefore, this study aimed to gain a more in-depth understanding of the patient experience of ERAS-outpatient programs in comparison to standard-inpatient programs. METHODS We conducted a convergent mixed methods study of 48 consecutive patients who experienced both standard-inpatient and ERAS-outpatient THA/TKA contralaterally. A reflective thematic analysis was conducted based on data collected via a questionnaire. Bivariate correlations between the patient experience and patients' characteristics, clinical outcomes and care components satisfaction were performed. Then, the quantitative and qualitative data were integrated together. RESULTS The theme Support makes the difference for better and for worse was identified by patients as crucial to their experience in both joint replacement programs. On the other hand, patients identified 3 themes distinguishing their ERAS-outpatient from their standard-inpatient experience: 1) Minimizing inconvenience, 2) Home sweet home and 3) Returning to normal function and activities. Potential optimization expressed by patients were to receive more preoperative information, additional postoperative rehabilitation sessions, and ensuring better coherence of care between hospital and home care teams. Weak to moderate positive and statistically significant correlations were found between patients' THA/TKA experience and satisfaction with pain management, hospital stay, postoperative recovery, home care, and overall results (rs = + [0.36-0.66], p-value < 0.01). CONCLUSION Whatever the perioperative program, the key to improving patients' THA/TKA experience lies in improving support throughout the care episode. However, compared to standard-inpatient care, the ERAS-outpatient program improves patients' experience by providing dedicated support in postoperative care, reducing postoperative inconvenience, optimizing pain management, returning home sooner, and recovering and regaining function sooner. Patients' THA/TKA experience could further be enhanced by optimizing the information provided to the patient, the rehabilitation program and the coherence between care teams.
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Affiliation(s)
- Alexandre Hardy
- Department of Biomedical Sciences, Faculty of Graduate and Postdoctoral Studies, Université de Montréal, Montreal, Quebec, Canada
- Hôpital Maisonneuve-Rosemont, Surgery Department, Université de Montréal, Montreal, Quebec, Canada
- Centre de recherche de l'Hôpital Maisonneuve-Rosemont, Quebec, Montreal, Canada
| | - Jonathan Gervais-Hupé
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
- Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR), Montreal, Quebec, Canada
- Centre de recherche en éthique (CRÉ), Université de Montréal, Montreal, Quebec, Canada
| | - François Desmeules
- Centre de recherche de l'Hôpital Maisonneuve-Rosemont, Quebec, Montreal, Canada
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Anne Hudon
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
- Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR), Montreal, Quebec, Canada
- Centre de recherche en éthique (CRÉ), Université de Montréal, Montreal, Quebec, Canada
| | - Kadija Perreault
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec, Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Quebec, Canada
| | - Pascal-André Vendittoli
- Hôpital Maisonneuve-Rosemont, Surgery Department, Université de Montréal, Montreal, Quebec, Canada.
- Centre de recherche de l'Hôpital Maisonneuve-Rosemont, Quebec, Montreal, Canada.
- Personalized Arthroplasty Society, Atlanta, Georgia, USA.
- Duval Orthopaedic Clinic, Laval, Quebec, Canada.
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26
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Torres GCS, Fernandez DF, Ledbetter L, Relf MV. Systematic Review of Preoperative Patient Readiness. AORN J 2021; 114:47-59. [PMID: 34181266 DOI: 10.1002/aorn.13425] [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: 07/30/2020] [Revised: 10/07/2020] [Accepted: 10/26/2020] [Indexed: 11/07/2022]
Abstract
Preoperative readiness indicates the patient's capacity to process information, consider possible outcomes, and decide to undergo a surgical procedure. This systematic review examines how the term "patient readiness" is used in the literature and synthesizes how preoperative interventions address readiness. A medical librarian searched five electronic databases to identify articles published between July 1, 2008, and June 30, 2019, that address studies including adult patients scheduled for surgery who participated in programs designed to foster readiness or studies that explored surgical readiness. After extracting 28 studies, the authors assessed the articles for quality and thematically synthesized them to describe actions and indicators of patient readiness according to the Perioperative Patient Focused Model. Readiness can positively influence surgical outcomes (eg, pain, satisfaction); however, there is a paucity of high-level, quality evidence that discusses surgical readiness for perioperative care. Nurses should use the information in this review to improve patient-centered preoperative care.
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27
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Exploring the Role of Social Support between Discharge Teaching and Readiness for Discharge in Ocular Fundus Disease Patients: A Cross-Sectional Study. J Ophthalmol 2021; 2021:5547351. [PMID: 34239719 PMCID: PMC8233073 DOI: 10.1155/2021/5547351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 06/03/2021] [Accepted: 06/08/2021] [Indexed: 11/29/2022] Open
Abstract
Background This study aims to evaluate the quality of discharge teaching and readiness for discharge of fundus disease patients treated with day surgery and understand the role of social support between them. Methods This was a cross-sectional descriptive correlational survey. Through convenient sampling, fundus disease patients treated with day surgery from Zhongshan Ophthalmic Center, China, were recruited. Data were collected using demographic and disease-related information, quality of discharge teaching scale, readiness for hospital discharge scale, and social support scale. Results 255 fundus disease patients treated with day surgery were recruited at last. The mean total score of readiness for discharge, quality of discharge teaching, and social support in patients with fundus disease were 157.91 (SD = 26.68), 122.97 (SD = 21.55), and 36.32 (SD = 7.60), respectively. Participants with stronger social support had better discharge teaching and then had higher readiness for discharge. Social support played a partial mediator role in the relationship between discharge teaching and readiness for discharge. The mediation effect ratio was 5.5%. Conclusions The quality of discharge teaching and social support among fundus disease patients who underwent day surgery was relatively high, and readiness for discharge was good. Social support is essential for the quality of discharge teaching and the improvement of discharge readiness. Clinical nurses need to provide appropriate guidelines to help patients seek effective support and improve quality of discharge teaching to enhance the readiness for discharge of fundus disease patients treated with day surgery.
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28
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Bitar C, Krupic F, Felländer-Tsai L, Crnalic S, Wretenberg P. Living with a recalled implant: a qualitative study of patients' experiences with ASR hip resurfacing arthroplasty. Patient Saf Surg 2021; 15:2. [PMID: 33407687 PMCID: PMC7788783 DOI: 10.1186/s13037-020-00278-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 12/07/2020] [Indexed: 11/15/2022] Open
Abstract
Background Total hip arthroplasty is the traditional treatment for osteoarthritis in the hip joint. Hip resurfacing arthroplasty, with metal on metal bearing, is a modern concept initially developed mainly for young active people. The metal-on-metal hip arthroplasty implant, Articular Surface Replacement (ASR), was implanted in approximately 93,000 patients before it was recalled in 2010 due to a high complication rate. This study aimed to evaluate patients’ own experiences living with an implant that they knew had a high complication rate and had been recalled from the market. Methods A total of 14 patients, still living with the implant, of a cohort of 34 patients were available for follow-up. Qualitative semi-structured interviews were conducted with 14 patients where a majority actively sought for metal-on-metal hip resurfacing arthroplasty (HRA), and subsequently underwent HRA with an ASR prosthesis between 11/21/2006 and 09/28/2009. The responses were analyzed using content analysis described by Graneheim and Lundman to compress text and identify categories and subcategories. Results The results showed that most patients had already decided that they wanted a metal-on-metal HRA implant before meeting the surgeon. They expressed that the implant made it possible to live an active life. A majority did not think about the fact that they had a hip implant, because they lacked subjective pain. Most of the patients were positive about the annual exams at the hospital and wanted them to continue. None of them felt that their trust towards the healthcare system had changed after the implant recall. They expressed a belief that they would need new surgery sooner than they first thought. Conclusions Despite all the attention when the ASR prosthesis was recalled, patients with ASR-HRA did not report themselves negatively affected by the recall in this group of patients where a majority had actively sought for an HRA procedure. The healthcare system has an obligation to continue the annual exams, even if the implant provider does not continue reimbursement. Supplementary Information The online version contains supplementary material available at 10.1186/s13037-020-00278-y.
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Affiliation(s)
- Christian Bitar
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden. .,Department of Orthopedics, Karolinska University Hospital, Stockholm, Sweden.
| | - Ferid Krupic
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Li Felländer-Tsai
- Division of Orthopedics and Biothechnology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Department of Orthopedics, Karolinska University Hospital, Stockholm, Sweden
| | - Sead Crnalic
- Department of Surgical and Perioperative Sciences (Orthopaedics), Umeå University, Umeå, Sweden
| | - Per Wretenberg
- Department of Orthopaedics, School of Medical Sciences, Örebro University and Örebro University Hospital, Örebro, Sweden
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Communication Preferences in Total Joint Arthroplasty: Exploring the Patient Experience Through Generative Research. Orthop Nurs 2020; 39:292-302. [PMID: 32956269 DOI: 10.1097/nor.0000000000000694] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Improving communication and information services for people receiving a total joint (knee or hip) arthroplasty (TJA) depends on the differences in patient communication needs and personal characteristics. PURPOSE The purpose of this study was to further examine individual differences in TJA patient preferences regarding communication and information provision. METHODS Nineteen patients participated in generative research, which meant they actively reflected on their TJA experiences and communication preferences through creative exercises (e.g., collage making). Audio transcripts of their shared reflections were qualitatively analyzed through an inductive approach. RESULTS Some participants wanted detailed health education, others did not. Participants also reported different support needs (e.g., at hospital discharge or during rehabilitation). Moreover, participant preferences for social connections with care providers differed. CONCLUSIONS An individual patient's mindset, his or her social support needs, physical condition, and medical history should guide the provision of tailored services.
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30
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Makimoto K, Fujita K, Konno R. Review and synthesis of the experience of patients following total hip or knee arthroplasty in the era of rapidly decreasing hospital length of stay. Jpn J Nurs Sci 2020; 17:e12361. [PMID: 32830912 DOI: 10.1111/jjns.12361] [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: 09/06/2019] [Revised: 05/12/2020] [Accepted: 06/14/2020] [Indexed: 11/27/2022]
Abstract
AIM The hospital length of stay for orthopedic surgery has been decreasing during the last couple of decades. Therefore, this study was performed to explore the postoperative experiences of adult/older patients (age ≥20 years) with osteoarthritis who underwent total hip or knee arthroplasty, focusing on the first 6 weeks following discharge. METHODS A systematic literature search on qualitative studies was conducted using six databases, such as Medline, CINAHL and Mednar. Verbatim interview data and themes or subthemes related to the patients' experience after discharge were extracted. Content analysis was used to code interview data. Codes similar in meaning were grouped, and subcategories were formed. These subcategories were then grouped into categories. RESULTS Sixteen qualitative studies with 253 participants were analyzed. In total, 136 codes were generated and formed 29 subcategories. Six categories were generated: (a) postoperative pain and medication; (b) difficulty in performing activities of daily living; (c) appreciation for support and difficulties associated with receiving support; (d) variability in recovery process and information-seeking; (e) lack of patient-centered care; and (f) transportation problems and social isolation. CONCLUSION Our review suggests that prospective patients and their caregivers need individually tailored presurgical education and advanced planning for postsurgical reduced mobility.
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Affiliation(s)
- Kiyoko Makimoto
- School of Nursing and Rehabilitation, Konan Women's University, Kobe, Japan
| | - Kimie Fujita
- Division of Health Sciences, Graduate School of Medicine, Kyushu University, Fukuoka, Japan
| | - Rie Konno
- School of Nursing, Hyogo Medical University, Nishinomiya, Japan
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31
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Berg U, W-Dahl A, Rolfson O, Nauclér E, Sundberg M, Nilsdotter A. Influence of fast-track programs on patient-reported outcomes in total hip and knee replacement (THR/TKR) at Swedish hospitals 2011-2015: an observational study including 51,169 THR and 8,393 TKR operations. Acta Orthop 2020; 91:306-312. [PMID: 32106731 PMCID: PMC8023888 DOI: 10.1080/17453674.2020.1733375] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Fast-track care programs have been broadly introduced at Swedish hospitals in elective total hip and knee replacement (THR/TKR). We studied the influence of fast-track programs on patient-reported outcomes (PROs) 1 year after surgery, by exploring outcome measures registered in the Swedish arthroplasty registers.Patients and methods - Data were obtained from the Swedish Knee and Hip Arthroplasty Registers and included TKR and THR operations 2011-2015 on patients with osteoarthritis. Based on questionnaires concerning the clinical pathway and care programs at Swedish hospitals, the patients were divided in 2 groups depending on whether they had been operated in a fast-track program or not. PROs of the fast-track group were compared with not fast-track using regression analysis. EQ-5D, EQ VAS, Pain VAS, and Satisfaction VAS were analyzed for both THR and TKR operations. The PROMs for TKR also included KOOS.Results - The differences of EQ-5D, EQ VAS, Pain VAS, and Satisfaction VAS 1 year after surgery were small but all in favor of fast-track for both THR and TKR, also in subscales of KOOS for TKR except KOOS QoL. However, the effect sizes as measured by Cohens' d formula were < 0.2 for all PROs, in both THR and TKR.Interpretation - Our results indicate that the fast-track programs may be at least as good as conventional care from the perspective of PROs 1-year postoperatively.
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Affiliation(s)
- Urban Berg
- Department of Orthopaedics, Clinical Sciences, Sahlgrenska Academy, Gothenburg University; ,Department of Surgery and Orthopaedics, Kungälv Hospital; ,Correspondence:
| | - Annette W-Dahl
- Department of Orthopedics, Clinical Sciences Lund, Lund University; ,The Swedish Knee Arthroplasty Register;
| | - Ola Rolfson
- Department of Orthopaedics, Clinical Sciences, Sahlgrenska Academy, Gothenburg University; ,Department of Orthopedics Sahlgrenska University Hospital; ,The Swedish Hip Arthroplasty Register, Sweden
| | | | - Martin Sundberg
- Department of Orthopedics, Clinical Sciences Lund, Lund University; ,The Swedish Knee Arthroplasty Register;
| | - Anna Nilsdotter
- Department of Orthopaedics, Clinical Sciences, Sahlgrenska Academy, Gothenburg University; ,Department of Orthopedics Sahlgrenska University Hospital;
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32
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[Total knee and hip arthroplasty within 2 days : The Danish Fast-Track Model]. DER ORTHOPADE 2020; 49:218-225. [PMID: 31451893 DOI: 10.1007/s00132-019-03796-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Patients in Denmark undergoing total knee or hip replacement are routinely discharged within 2 days of surgery. A critical examination of traditional treatment methods, combined with focused research, has during the last 20 years increasingly optimized the treatment course in such a way that it has become possible to radically reduce the length of stay (LOS). BASICS OF THE FAST-TRACK MODEL The most important elements of this Fast-Track model are described. The patient motivation and transfer of partial responsibility to the patient through intensive information, optimized operation techniques, as well as modern multi-modal pain therapy with early mobilization are key issues. The relatively small and homogenous health care system of Denmark offers good research conditions and the possibility of a fast implementation of the latest results, as well as a lump-sum based re-imbursement system without minimum stay-both factors have been favorable for the development of the Fast-Track model.
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Wainwright TW, Gill M, McDonald DA, Middleton RG, Reed M, Sahota O, Yates P, Ljungqvist O. Consensus statement for perioperative care in total hip replacement and total knee replacement surgery: Enhanced Recovery After Surgery (ERAS ®) Society recommendations. Acta Orthop 2020; 91:3-19. [PMID: 31663402 PMCID: PMC7006728 DOI: 10.1080/17453674.2019.1683790] [Citation(s) in RCA: 312] [Impact Index Per Article: 78.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background and purpose - There is a large volume of heterogeneous studies across all Enhanced Recovery After Surgery (ERAS®) components within total hip and total knee replacement surgery. This multidisciplinary consensus review summarizes the literature, and proposes recommendations for the perioperative care of patients undergoing total hip replacement and total knee replacement with an ERAS program.Methods - Studies were selected with particular attention being paid to meta-analyses, randomized controlled trials, and large prospective cohort studies that evaluated the efficacy of individual items of the perioperative treatment pathway to expedite the achievement of discharge criteria. A consensus recommendation was reached by the group after critical appraisal of the literature.Results - This consensus statement includes 17 topic areas. Best practice includes optimizing preoperative patient education, anesthetic technique, and transfusion strategy, in combination with an opioid-sparing multimodal analgesic approach and early mobilization. There is insufficient evidence to recommend that one surgical technique (type of approach, use of a minimally invasive technique, prosthesis choice, or use of computer-assisted surgery) over another will independently effect achievement of discharge criteria.Interpretation - Based on the evidence available for each element of perioperative care pathways, the ERAS® Society presents a comprehensive consensus review, for the perioperative care of patients undergoing total hip replacement and total knee replacement surgery within an ERAS® program. This unified protocol should now be further evaluated in order to refine the protocol and verify the strength of these recommendations.
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Affiliation(s)
- Thomas W Wainwright
- Orthopaedic Research Institute, Bournemouth Univesity, Bournemouth, UK
- The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Bournemouth, UK
| | - Mike Gill
- Golden Jubilee National Hospital, Glasgow, Scotland
| | - David A McDonald
- Scottish Government, Glasgow, Scotland
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, Scotland
| | - Robert G Middleton
- Orthopaedic Research Institute, Bournemouth Univesity, Bournemouth, UK
- The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Bournemouth, UK
- Poole Hospital NHS Foundation Trust, Poole, UK
| | - Mike Reed
- Northumbria Healthcare NHS Foundational Trust, Northumbria, UK
- Health Sciences, University of York, York, UK
| | - Opinder Sahota
- Nottingham University Hospital, Nottingham, UK
- Nottingham University, Nottingham, UK
| | - Piers Yates
- University of Western Australia, Perth, Australia
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Song X, Xia C, Li Q, Yao C, Yao Y, Chen D, Jiang Q. Perioperative predictors of prolonged length of hospital stay following total knee arthroplasty: a retrospective study from a single center in China. BMC Musculoskelet Disord 2020; 21:62. [PMID: 32005208 PMCID: PMC6995082 DOI: 10.1186/s12891-020-3042-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 01/06/2020] [Indexed: 02/08/2023] Open
Abstract
Background Decreasing the length of hospital stay is an ideal course of action to appropriately allocate medical resources. The aim of this retrospective study was to identify perioperative factors that may decrease the length of hospital stay (LOS). Methods In this study, we collected the data on 1112 patients who underwent primary total knee arthroplasty surgery (TKAs) at our institution from Jan 1, 2011 to Nov 31, 2017. Based on the published literature, 16 potential factors (12 preoperative variables, 1 intraoperative variable, and 3 postoperative variables) were investigated. The patients requiring a hospital stay longer than the mean LOS (8 days) were defined as patients with a prolonged LOS. The factors with a P value less than 0.1 in the univariate analysis were further analysed in a multivariate model. An ordinal regression was used to determine independent risk factors for a prolonged LOS. Results The mean LOS was 8.3 days (±4.3), with a range of 2 to 30 days. Sixteen variables were analysed by univariate analysis, and 11 of them had p < 0.1 and were included in the multivariable model. Finally, 9 factors were found to be associated with a prolonged LOS. Among the 9 variables, 2 were surgery-related factors (operative time and intraoperative blood loss), and 3 were patient-related factors (age, ASA classification and neurological comorbidities). Conclusion In this study, we found that the clinical protocol, complications, the patient’s age, the ASA classification, neurological comorbidities, the operative time, the ward, intraoperative blood loss and the surgeon were all factors contributing to a prolonged LOS. In clinical practice, these factors provide important information for the surgeon and are useful for identifying patients with a high risk of a prolonged LOS.
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Affiliation(s)
- Xiaoxiao Song
- Department of Sports Medicine and Adult Reconstructive Surgery, Nanjing Drum Tower Hospital, School of Medicine, Nanjing University, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, People's Republic of China
| | - Caiwei Xia
- Department of Orthopedics, Taikang Xianlin Drum Tower Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu, People's Republic of China
| | - Qiangqiang Li
- Department of Sports Medicine and Adult Reconstructive Surgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing, China.,Laboratory for Bone and Joint Diseases, Model Animal Research Center, Nanjing University, Nanjing, 210093, Jiangsu, People's Republic of China
| | - Chen Yao
- Department of Sports Medicine and Adult Reconstructive Surgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing, China.,Laboratory for Bone and Joint Diseases, Model Animal Research Center, Nanjing University, Nanjing, 210093, Jiangsu, People's Republic of China
| | - Yao Yao
- Department of Sports Medicine and Adult Reconstructive Surgery, Nanjing Drum Tower Hospital, School of Medicine, Nanjing University, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, People's Republic of China.,Laboratory for Bone and Joint Diseases, Model Animal Research Center, Nanjing University, Nanjing, 210093, Jiangsu, People's Republic of China
| | - Dongyang Chen
- Department of Sports Medicine and Adult Reconstructive Surgery, Nanjing Drum Tower Hospital, School of Medicine, Nanjing University, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, People's Republic of China. .,Laboratory for Bone and Joint Diseases, Model Animal Research Center, Nanjing University, Nanjing, 210093, Jiangsu, People's Republic of China.
| | - Qing Jiang
- Department of Sports Medicine and Adult Reconstructive Surgery, Nanjing Drum Tower Hospital, School of Medicine, Nanjing University, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, People's Republic of China. .,Laboratory for Bone and Joint Diseases, Model Animal Research Center, Nanjing University, Nanjing, 210093, Jiangsu, People's Republic of China.
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Jansson MM, Harjumaa M, Puhto A, Pikkarainen M. Patients’ satisfaction and experiences during elective primary fast‐track total hip and knee arthroplasty journey: A qualitative study. J Clin Nurs 2019; 29:567-582. [DOI: 10.1111/jocn.15121] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 10/04/2019] [Accepted: 11/19/2019] [Indexed: 12/22/2022]
Affiliation(s)
- Miia Marika Jansson
- Research Group of Medical Imaging Physics and Technology University of Oulu Oulu Finland
- Oulu University Hospital Oulu Finland
| | | | - Ari‐Pekka Puhto
- Division of Operative Care Department of Orthopaedic and Trauma Surgery Oulu University Hospital Oulu Finland
| | - Minna Pikkarainen
- Research Group of Medical Imaging Physics and Technology University of Oulu Oulu Finland
- VTT Technical Research Centre of Finland Oulu Finland
- Martti Ahtisaari Institute Oulu Business School Oulu University Oulu Finland
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Gualandi R, Masella C, Viglione D, Tartaglini D. Exploring the hospital patient journey: What does the patient experience? PLoS One 2019; 14:e0224899. [PMID: 31805061 PMCID: PMC6894823 DOI: 10.1371/journal.pone.0224899] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 10/23/2019] [Indexed: 01/24/2023] Open
Abstract
PURPOSE To understand how different methodologies of qualitative research are able to capture patient experience of the hospital journey. METHODS A qualitative study of orthopaedic patients admitted for hip and knee replacement surgery in a 250-bed university hospital was performed. Eight patients were shadowed from the time they entered the hospital to the time of transfer to rehabilitation. Four patients and sixteen professionals, including orthopaedists, head nurses, nurses and administrative staff, were interviewed. RESULTS Through analysis of the data collected four main themes emerged: the information gap; the covering patient-professionals relationship; the effectiveness of family closeness; and the micro-integration of hospital services. The three different standpoints (patient shadowing, health professionals' interviews and patients' interviews) allowed different issues to be captured in the various phases of the journey. CONCLUSIONS Hospitals can significantly improve the quality of the service provided by exploring and understanding the individual patient journey. When dealing with a key cross-functional business process, the time-space dynamics of the activities performed have to be considered. Further research in the academic field can explore practical, methodological and ethical challenges more deeply in capturing the whole patient journey experience by using multiple methods and integrated tools.
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Affiliation(s)
- Raffaella Gualandi
- Department of Nursing, Università Campus Bio-Medico di Roma, Rome, Italy
- * E-mail:
| | - Cristina Masella
- Department of Management Economics and Industrial Engineering, Politecnico di Milano, Milan, Italy
| | - Daniela Viglione
- Department of Nursing, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Daniela Tartaglini
- Department of Nursing, Università Campus Bio-Medico di Roma, Rome, Italy
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Phillips E, Archer S, Montague J, Bali A. Experiences of enhanced recovery after surgery in general gynaecology patients: An interpretative phenomenological analysis. Health Psychol Open 2019; 6:2055102919860635. [PMID: 31321068 PMCID: PMC6610470 DOI: 10.1177/2055102919860635] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
There is little qualitative research exploring non-cancer gynaecology patients’
experiences of enhanced recovery after surgery (ERAS) protocols. Seven women
participated in audio-recorded interviews, discussing their experiences of
enhanced recovery after surgery for gynaecological surgery. Data were
transcribed and analysed using interpretative phenomenological analysis. Three
themes were identified: meeting informational needs, taking control of pain, and
mobilising when feeling fragile. Control emerged as a key element throughout the
themes and was supported by provision of factual information. While participants
were generally satisfied with their experience, topics such as concerns about
analgesic use, the informal role of staff in mobilisation, and the expressed
desire for more experiential information for participants require further
research.
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38
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Hamilton WG. Protocol Development for Outpatient Total Joint Arthroplasty. J Arthroplasty 2019; 34:S46-S47. [PMID: 30685256 DOI: 10.1016/j.arth.2018.12.043] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 12/30/2018] [Indexed: 02/01/2023] Open
Abstract
Converting from an inpatient to an outpatient total joint arthroplasty program is achievable, with a concerted effort from all members of the clinical team. This paper highlights key factors that allow for a successful implementation of an outpatient center. First, consistent messaging about patient safety is crucial in helping to assuage the patient's concerns of getting an outpatient procedure, and to eliminate inpatient mentality. Next, earlier handout of prescriptions for medications, assisted devices, or web-based educational materials during preoperative preparations can also allow for a rapid home discharge. Finally, multimodal pain management before, during and after surgery can also pave the way for a smoother transition to daily living.
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Berg U, Berg M, Rolfson O, Erichsen-Andersson A. Fast-track program of elective joint replacement in hip and knee-patients' experiences of the clinical pathway and care process. J Orthop Surg Res 2019; 14:186. [PMID: 31227003 PMCID: PMC6587282 DOI: 10.1186/s13018-019-1232-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 06/10/2019] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND The clinical pathway and care program in elective total hip and knee replacement (THR/TKR) has, during the last decade, undergone considerable changes in many countries influenced by the concept of fast-track surgery, resulting in a very short hospital stay. Studies into patients' experiences of the entire fast-track program, from decision-making regarding surgery until recovery 3 months after surgery, are lacking. The aim of the study was to increase the knowledge about patients' experiences of the clinical pathway and care in a fast-track program of elective THR/TKR in order to identify factors that may influence recovery and clinical outcome. METHODS A qualitative research design was chosen with data collected from interviews 3 months after surgery and analyzed using an inductive content analysis method. In total, 24 patients from three hospitals with a fast-track care program were included in the study: 14 women and 10 men, 13 with THR and 11 with TKR. The mean age was 65 years (range 44-85). RESULTS The analysis identified three chronological phases in the clinical pathway: preparation, hospital stay for surgery, and recovery. In the preparation phase, patients' experiences and involvement in the planning of the operation were highlighted. The need to know the risks and expectations of recovery and outcome were also central, although there was great diversity in needs for information and involvement. In the hospital stay for the surgery phase, there were mainly positive experiences regarding admission, early mobilization, and early discharge. Experiences about the recovery phase focused on management of daily life, rehabilitation program, and recovery. Rehabilitation involved uncertainty as to whether or not the progress was normal. The recovery phase was also filled with questions about unfulfilled expectations. Regardless of the different phases, we found the importance of a person-centered care to be a pervasive theme. CONCLUSION Our study supports the view that a person-centered approach, from surgery decision until recovery, is an important element in optimizing care in a THR and TKR fast-track care program. More focus on the period after hospital discharge may improve recovery, patient satisfaction, and functional outcome.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Arthroplasty, Replacement, Hip/methods
- Arthroplasty, Replacement, Hip/psychology
- Arthroplasty, Replacement, Hip/rehabilitation
- Arthroplasty, Replacement, Knee/methods
- Arthroplasty, Replacement, Knee/psychology
- Arthroplasty, Replacement, Knee/rehabilitation
- Critical Pathways
- Female
- Humans
- Interviews as Topic
- Length of Stay
- Male
- Middle Aged
- Patient Satisfaction
- Patient-Centered Care
- Preoperative Care
- Treatment Outcome
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Affiliation(s)
- Urban Berg
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Surgery and Orthopaedics, Kungälv Hospital, Kungälv, Sweden
| | - Marie Berg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ola Rolfson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Swedish Hip Arthroplasty Register, Gothenburg, Sweden
| | - Annette Erichsen-Andersson
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Buus AAØ, Hejlsen OK, Dorisdatter Bjørnes C, Laugesen B. Experiences of pre- and postoperative information among patients undergoing knee arthroplasty: a systematic review and narrative synthesis. Disabil Rehabil 2019; 43:150-162. [PMID: 31106616 DOI: 10.1080/09638288.2019.1615997] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Purpose: The aim of this review was to identify and synthesize knowledge of how patients undergoing knee arthroplasty experience pre- and postoperative information provided by healthcare professionals.Materials and methods: A systematic review and narrative synthesis was conducted in accordance with Popay et al.'s guidelines which involve 1) developing a preliminary synthesis; 2) exploring relationships; and 3) assessing the robustness of the synthesis. Qualitative and quantitative studies were considered for inclusion, and a systematic, extensive search was conducted in scientific databases.Results: A total of 31 studies were included in this review. The analysis resulted in five synthesized themes: 1) Support in the decision to undergo surgery; 2) Confidence versus uncertainty in the preparation for surgery; 3) Prerequisites for feeling secure before discharge; 4) Struggling through rehabilitation at home; and 5) Unmet expectations and endeavoring to accept realities.Conclusions: The findings illustrate the complexities of patients' experiences of information from healthcare professionals and its significance for how they manage challenges throughout the surgical care pathway. Information from healthcare professionals influences patients' knowledge, skills and confidence in the journey through knee arthroplasty. Therefore, it is important that healthcare professionals recognize patients' support requirements and adapt information to their individual needs.Implications for rehabilitationHealthcare professionals should encourage more dialog with patients and adapt information to their individual circumstances and needs throughout the surgical care pathway.It is important that healthcare professionals provide ongoing information and repeat information throughout the entire surgical care pathway in order to facilitate predictability and improve patients' ability to comprehend and assimilate information.Improved access to information and advice from healthcare professionals following knee arthroplasty will offer patients reassurance and increase their confidence in managing postoperatively at home.Patients who require enhanced information and guidance from healthcare professionals need to be identified in order to support their progress and achieve the best possible postoperative outcomes.
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Affiliation(s)
| | - Ole Kristian Hejlsen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | | | - Britt Laugesen
- Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark
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Abstract
Total knee replacement (TKR) surgery has been found to achieve positive outcomes for many patients such as reduced pain and increased function. However, some patients experience suboptimal outcomes including falls, readmission to hospital, and reduced functional performance. Preparation for discharge after TKR surgery is often defined related to pain control, walking, knee function, and ability to climb stairs. These measures may not fully encompass aspects of recovery that impact patients' readiness for discharge after surgery. The purpose of this article is to review discharge readiness following TKR surgery and discuss factors that are known to impact preparedness for discharge.
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Simonÿ C, Specht K, Andersen IC, Johansen KK, Nielsen C, Agerskov H. A Ricoeur-Inspired Approach to Interpret Participant Observations and Interviews. Glob Qual Nurs Res 2018; 5:2333393618807395. [PMID: 30397637 PMCID: PMC6207962 DOI: 10.1177/2333393618807395] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 09/13/2018] [Accepted: 09/14/2018] [Indexed: 01/17/2023] Open
Abstract
In-depth knowledge of what it means to patients to receive health care services is crucial to the development of adequate protocols for nursing. Qualitative research allows us to gain important insight into what is experienced by and meaningful to patients. The French philosopher Paul Ricoeur's thoughts have inspired qualitative researchers to conduct various forms of analysis and interpretation that increase our knowledge of ways of being-in-the-world. This article describes and discusses how a specific approach to derive in-depth knowledge of patients' lived experiences can be taken. A combination of participant observations and interviews was used to generate data. Field notes and transcribed interviews were gathered as one collective text and analyzed and interpreted with inspiration from Ricoeur's thoughts on narratives and interpretation. This approach is argued to be a significant way of developing in-depth knowledge of patients' lived experiences. Such knowledge is important within nursing science.
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Affiliation(s)
- Charlotte Simonÿ
- Institute of Regional Health University of Southern Denmark, Odense, Denmark.,Department of Physiotherapy and Occupational Therapy, Slagelse Hospital, Region Zealand, Denmark.,Extern Lecturer at Institute of Health, Section of Nursing Sience, Aarhus University, Denmark
| | - Kirsten Specht
- Department of Regional Health Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark.,Department of Orthopaedic Surgery, Zealand University Hospital, Køge, Denmark
| | | | - Kirsten Kjær Johansen
- Research Unit, Mental Health Service Esbjerg, Denmark.,OPEN, Institute of Clinical Research, University of Southern Denmark, Odense Denmark
| | - Charlotte Nielsen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Nephrology, Odense University Hospital, Odense, Denmark.,Centre for Innovative Medical Technology, University of Southern Denmark & Odense University Hospital, Odense, Denmark
| | - Hanne Agerskov
- Department of Nephrology, Odense University Hospital, Odense, Denmark.,Centre for Innovative Medical Technology, University of Southern Denmark & Odense University Hospital, Odense, Denmark
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43
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Dore-Smith E, Killingback C. What are the postoperative experiences of patients who have undergone hip and knee joint replacement? A literature review. PHYSICAL THERAPY REVIEWS 2018. [DOI: 10.1080/10833196.2018.1482989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Specht K, Agerskov H, Kjaersgaard-Andersen P, Jester R, Pedersen BD. Patients' experiences during the first 12 weeks after discharge in fast-track hip and knee arthroplasty - a qualitative study. Int J Orthop Trauma Nurs 2018; 31:13-19. [PMID: 30297138 DOI: 10.1016/j.ijotn.2018.08.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 08/13/2018] [Accepted: 08/22/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Due to the shortened length of stay in fast-track total hip and knee arthroplasty, patients must at a very early stage following surgery take responsibility for their postoperative care and treatment. It is important to establish if this treatment modality of fast-track is not only cost-effective, but meets patients' expectations and needs. AIM To explore the lived experience of patients in fast-track total hip and knee arthroplasty during the first 12 weeks after discharge. METHODS A phenomenological-hermeneutic approach was used inspired by Ricoeur's theory of narrative and interpretation. Data were collected through semi-structured interviews with 8 patients 2 and 12 weeks after discharge. FINDINGS Through the structural analysis 3 themes emerged: 1) Dealing with transition between hospital and home, 2) Pain and self-management of medication, 3) Challenges in rehabilitation. CONCLUSION Patients appreciated only 1 or 2 days in hospital. However, they were not sufficiently involved in the discharge planning. There was a feeling of uncertainty and being left on their own after discharge, which could affect their pain management and recovery at home. There is a need to develop in partnership with each individual patient a post discharge plan of care and rehabilitation to meet their individual needs, preferences and mode of motivation.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Arthroplasty, Replacement, Hip/psychology
- Arthroplasty, Replacement, Hip/rehabilitation
- Arthroplasty, Replacement, Knee/psychology
- Arthroplasty, Replacement, Knee/rehabilitation
- Female
- Humans
- Male
- Middle Aged
- Pain Management/methods
- Pain Management/psychology
- Pain, Postoperative/drug therapy
- Pain, Postoperative/psychology
- Patient Discharge
- Patient Satisfaction
- Postoperative Care/methods
- Postoperative Care/psychology
- Qualitative Research
- Surveys and Questionnaires
- Time Factors
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Affiliation(s)
- Kirsten Specht
- Department of Regional Health Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark; Department of Orthopaedic Surgery, Zealand University Hospital, Køge, Denmark.
| | - Hanne Agerskov
- Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark; Department of Nephrology, Odense University Hospital, Denmark.
| | - Per Kjaersgaard-Andersen
- Department of Regional Health Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark; Department of Orthopaedic Surgery, Vejle Hospital, Denmark.
| | - Rebecca Jester
- Institute of Health, University of Wolverhampton, England.
| | - Birthe D Pedersen
- Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark.
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Lovett-Carter D, Sayeed Z, Abaab L, Pallekonda V, Mihalko W, Saleh KJ. Impact of Outpatient Total Joint Replacement on Postoperative Outcomes. Orthop Clin North Am 2018; 49:35-44. [PMID: 29145982 DOI: 10.1016/j.ocl.2017.08.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Total joint arthroplasty (TJA) has demonstrated tremendous benefits to patients with osteoarthritis. Health care reform has influenced surgeons to optimize TJA care pathways as well as playing a role in the formation of outpatient TJA protocols. Understanding the outcomes of outpatient TJA is imperative to surgical predicate decision making. The aim of this review is to compare outcomes of outpatient TJA patients to standard-stay inpatients. Postoperative outcomes assessed include pain, complications, readmissions, reoperation, patient satisfaction, and cost.
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Affiliation(s)
- Danielle Lovett-Carter
- Department of Orthopaedics, Detroit Medical Center, 4201 St Antoine Street, Detroit, MI 48201, USA
| | - Zain Sayeed
- Department of Orthopaedics, Detroit Medical Center, 4201 St Antoine Street, Detroit, MI 48201, USA
| | - Leila Abaab
- Department of Orthopaedics, Detroit Medical Center, 4201 St Antoine Street, Detroit, MI 48201, USA; Department of Anesthesiology - NorthStar Anesthesia, Detroit Medical Center, 4201 St Antoine Street, Detroit, MI 48201, USA
| | - Vinay Pallekonda
- Department of Anesthesiology - NorthStar Anesthesia, Detroit Medical Center, 4201 St Antoine Street, Detroit, MI 48201, USA
| | - William Mihalko
- Campbell Clinic Department of Orthopaedic Surgery & Biomedical Engineering University of Tennessee, 956 Court Avenue, Memphis, TN 32116, USA
| | - Khaled J Saleh
- Department of Orthopaedics, Detroit Medical Center, 4201 St Antoine Street, Detroit, MI 48201, USA.
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Evaluation of analgesic regimens in total knee arthroplasty, retrospective study. North Clin Istanb 2017; 4:124-130. [PMID: 28971169 PMCID: PMC5613259 DOI: 10.14744/nci.2017.88598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 06/12/2017] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE: Analgesic therapies have an immense role in early rehabilitation period after total knee arthroplasty (TKA) and multimodal approaches should be considered as the first choice of treatment. In this retrospective study, the aim was to evaluate the effectiveness of multimodal analgesic therapies for TKA, including femoral nerve block (FNB) and patient controlled analgesia (PCA). METHODS: The data of 79 patients who underwent TKA between January and December 2016 were retrospectively evaluated. In all, 63 patients met the inclusion criteria. Hemodynamic records and Visual Analogue Scale (VAS) pain scores for postoperative 0, 2, 4, 6, 9, and 12 hours were evaluated and patients were separated into 3 groups. Group 1: FNB with 0.25% bupivacaine, Group 2: FNB with 0.166% bupivacaine, and Group 3: No FNB. RESULTS: The average age of the patients was 64.3±14.9 years and average body mass index (BMI) was 32.5±5.3 kg/m2. There was no statistical difference between groups in age, gender, American Society of Anesthesiologists (ASA) classification of physical health scores, BMI, or anesthesia type (p<0.05). When VAS scores at postoperative time intervals were compared, there was a statistically significant difference between Group 1 and Group 2 (p>0.05). When difference between Groups 1 and 3 and Groups 2 and 3 were compared, the difference was statistically significant for VAS 0 (p>0.05). Additional analgesic use was highest in Group 3. CONCLUSION: This study demonstrated that FNB significantly decreases postoperative pain intensity and additional analgesia requirement in patients undergoing TKA. A concentration of 0.166% bupivacaine is as effective as a concentration of 0.25% when used as part of a multimodal analgesia regimen in TKA.
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Høvik LH, Aglen B, Husby VS. Patient experience with early discharge after total knee arthroplasty: a focus group study. Scand J Caring Sci 2017; 32:833-842. [DOI: 10.1111/scs.12514] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 07/18/2017] [Indexed: 01/20/2023]
Affiliation(s)
- Lise Husby Høvik
- Clinic of Anaesthesia and Intensive Care Medicine; Trondheim University Hospital; Trondheim Norway
- Department of Circulation and Medical Imaging; Norwegian University of Science and Technology; Trondheim Norway
| | - Bjørg Aglen
- Department of Nursing Science; Norwegian University of Science and Technology; Trondheim Norway
| | - Vigdis Schnell Husby
- Department of Nursing Science; Norwegian University of Science and Technology; Trondheim Norway
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Uhrenfeldt L, Martinsen B, Jørgensen LB, Sørensen EE. The state of Danish nursing ethnographic research: flowering, nurtured or malnurtured - a critical review. Scand J Caring Sci 2017; 32:56-75. [PMID: 28795475 DOI: 10.1111/scs.12466] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 03/08/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Nursing was established in Denmark as a scholarly tradition in the late nineteen eighties, and ethnography was a preferred method. No critical review has yet summarised accomplishments and gaps and pointing at directions for the future methodological development and research herein. AIM This review critically examines the current state of the use of ethnographic methodology in the body of knowledge from Danish nursing scholars. METHODS We performed a systematic literature search in relevant databases from 2003 to 2016. The studies included were critically appraised by all authors for methodological robustness using the ten-item instrument QARI from Joanna Briggs Institute. RESULTS Two hundred and eight studies met our inclusion criteria and 45 papers were included; the critical appraisal gave evidence of studies with certain robustness, except for the first question concerning the congruity between the papers philosophical perspective and methodology and the seventh question concerning reflections about the influence of the researcher on the study and vice versa. In most studies (n = 34), study aims and arguments for selecting ethnographic research are presented. Additionally, method sections in many studies illustrated that ethnographical methodology is nurtured by references such as Hammersley and Atkinson or Spradley. CONCLUSIONS Evidence exists that Danish nursing scholars' body of knowledge nurtures the ethnographic methodology mainly by the same few authors; however, whether this is an expression of a deliberate strategy or malnutrition in the form of lack of knowledge of other methodological options appears yet unanswered.
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Affiliation(s)
- Lisbeth Uhrenfeldt
- Faculty of Nursing and Health Science, Nord University, Bodø, Norway.,Department of Health Science and Technology, Aalborg University, Aalborg Ø, Denmark.,Danish Centre of Systematic reviews: An Affiliate Center of Joanna Briggs Institute, The Center of Excellence- Clearing House, Aalborg University, Aalborg Ø, Denmark
| | - Bente Martinsen
- Department of Public Medicine, Aarhus University, Aarhus, Denmark
| | | | - Erik Elgaard Sørensen
- Department of Clinical Medicine, Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg University, Aalborg, Denmark
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Thacher RR, Hickernell TR, Grosso MJ, Shah R, Cooper HJ, Maniker R, Brown AR, Geller J. Decreased risk of knee buckling with adductor canal block versus femoral nerve block in total knee arthroplasty: a retrospective cohort study. Arthroplast Today 2017; 3:281-285. [PMID: 29204497 PMCID: PMC5712030 DOI: 10.1016/j.artd.2017.02.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 02/24/2017] [Accepted: 02/27/2017] [Indexed: 11/26/2022] Open
Abstract
Background Femoral nerve (FNB) and adductor canal blocks (ACB) are used in the setting of total knee arthroplasty (TKA), but neither has been demonstrated to be clearly superior. Although dynamometer studies have shown ACBs spare perioperative quadriceps function when compared to FNBs, ACBs have been widely adopted in orthopaedic surgery without significant evidence that they decrease the risk of perioperative falls. Methods All patients who received single-shot FNB (129 patients) or ACB (150 patients) at our institution for unilateral primary TKA from April 2014 to September 2015 were retrospectively reviewed for perioperative falls or near-falls during physical therapy and inpatient care. Results There were significantly more “near-falls” with documented episodes of knee buckling in the FNB group (17 vs 3, P = .0004). These patients’ first buckling episode occurred at an average of 21.1 hours postoperatively (standard deviation 5.83, range 13.83-41.15). There were no significant differences in pain scores between the 2 groups at any of the time periods measured; however, patients in the FNB group consumed significantly fewer opioids on postoperative day 1 than the ACB group (59 morphine equivalents vs 73, P = .004). Conclusions A significantly higher rate of near-falls with knee buckling during in-hospital physical therapy was discovered in the FNB group. With increasing numbers of TKAs being performed on a “fast-track” discharge model, these results must be seriously considered, particularly in patients planning to go home the same day, to reduce the risk of postoperative falls. These data support the recent clinical data trend favoring ACB over FNB in orthopaedic surgery.
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Affiliation(s)
- Ryan R Thacher
- Center for Hip and Knee Replacement, Department of Orthopedics, Columbia University Medical Center, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Thomas R Hickernell
- Center for Hip and Knee Replacement, Department of Orthopedics, Columbia University Medical Center, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Matthew J Grosso
- Center for Hip and Knee Replacement, Department of Orthopedics, Columbia University Medical Center, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Roshan Shah
- Center for Hip and Knee Replacement, Department of Orthopedics, Columbia University Medical Center, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Herbert J Cooper
- Center for Hip and Knee Replacement, Department of Orthopedics, Columbia University Medical Center, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Robert Maniker
- Department of Anesthesiology, Columbia University Medical Center, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Anthony Robin Brown
- Department of Anesthesiology, Columbia University Medical Center, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Jeffrey Geller
- Center for Hip and Knee Replacement, Department of Orthopedics, Columbia University Medical Center, NewYork-Presbyterian Hospital, New York, NY, USA
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