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Naylor J, Brady B. Re-imagining rehabilitation after TKA: Towards the provision of fit-for-purpose sustainable models of care and a redefinition of scope. Osteoarthritis Cartilage 2024; 32:473-475. [PMID: 38035976 DOI: 10.1016/j.joca.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 11/18/2023] [Accepted: 11/23/2023] [Indexed: 12/02/2023]
Affiliation(s)
- Justine Naylor
- Orthopaedic Department, Liverpool Hospital, Sydney, NSW, Australia; South West Sydney Clinical Campuses, School of Clinical Medicine, Medicine and Health, UNSW Sydney, Sydney, NSW, Australia.
| | - Bernadette Brady
- Departments of Physiotherapy and Pain Medicine, Liverpool Hospital, Sydney, NSW, Australia; Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; School of Health Sciences, Western Sydney University, Campbelltown, NSW, Australia
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Larsen JB, Skou ST, Laursen M, Bruun NH, Arendt-Nielsen L, Madeleine P. Exercise and Pain Neuroscience Education for Patients With Chronic Pain After Total Knee Arthroplasty: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2412179. [PMID: 38787559 PMCID: PMC11127128 DOI: 10.1001/jamanetworkopen.2024.12179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 03/15/2024] [Indexed: 05/25/2024] Open
Abstract
Importance Up to 20% of patients develop chronic pain after total knee arthroplasty (TKA), yet there is a scarcity of effective interventions for this population. Objective To evaluate whether neuromuscular exercise and pain neuroscience education were superior to pain neuroscience education alone for patients with chronic pain after TKA. Design, Setting, and Participants A superiority randomized clinical trial was conducted at 3 outpatient clinics at Aalborg University Hospital in Denmark. Participants with moderate-to-severe average daily pain intensity and no signs of prosthesis failure at least 1 year after primary TKA were included. Participant recruitment was initiated on April 12, 2019, and completed on October 31, 2022. The 12-month follow-up was completed on March 21, 2023. Interventions The study included 24 sessions of supervised neuromuscular exercise (2 sessions per week for 12 weeks) and 2 total sessions of pain neuroscience education (6 weeks between each session) or the same pain neuroscience education sessions alone. The interventions were delivered in groups of 2 to 4 participants. Main Outcomes and Measures The primary outcome was change from baseline to 12 months using the mean score of the Knee Injury and Osteoarthritis Outcome Score, covering the 4 subscales pain, symptoms, activity of daily living, and knee-related quality of life (KOOS4; scores range from 0 to 100, with higher scores indicating better outcomes). The outcome assessors and statistician were blinded. All randomized participants were included in the intention-to-treat analysis. Results Among the 69 participants (median age, 67.2 years [IQR, 61.2-71.9 years]; 40 female [58%]) included in the study, 36 were randomly assigned to the neuromuscular exercise and pain neuroscience education group, and 33 to the pain neuroscience education-alone group. The intention-to-treat analysis showed no between-group difference in change from baseline to 12 months for the KOOS4 (7.46 [95% CI, 3.04-11.89] vs 8.65 [95% CI, 4.67-12.63] points; mean difference, -1.33 [95% CI, -7.59 to 4.92]; P = .68). Among the 46 participants who participated in the 12-month assessment in the 2 groups, 16 (34.8%) experienced a clinically important improvement (a difference of ≥10 points on the KOOS4) with no between-group difference. No serious adverse events were observed. Conclusions and Relevance In this randomized clinical trial, the results demonstrated that neuromuscular exercises and pain neuroscience education were not superior to pain neuroscience education alone in participants with chronic pain after TKA. Approximately one-third of the participants, regardless of intervention, experienced clinically important improvements. Future studies should investigate which patient characteristics indicate a favorable response to exercises and/or pain neuroscience education. Trial Registration ClinicalTrials.gov Identifier: NCT03886259.
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Affiliation(s)
- Jesper B. Larsen
- Musculoskeletal Health and Implementation, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Søren T. Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark
| | - Mogens Laursen
- Orthopedic Surgery Research Unit, Aalborg University Hospital, Aalborg, Denmark
| | - Niels Henrik Bruun
- Research Data and Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | - Lars Arendt-Nielsen
- Translational Pain Biomarkers, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Pascal Madeleine
- ExerciseTech, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
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Sun J, Xu Y, Zhu J, Zhu B, Gao W. Efficacy and safety of continuous nursing in improving functional recovery after total hip or knee arthroplasty in older adults: A systematic review. Int J Nurs Sci 2024; 11:286-294. [PMID: 38707686 PMCID: PMC11064567 DOI: 10.1016/j.ijnss.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 02/15/2024] [Accepted: 03/08/2024] [Indexed: 05/07/2024] Open
Abstract
Objective This systematic review was conducted to evaluate the efficacy and safety of continuous nursing care for the recovery of joint function in older adults with total hip or knee arthroplasty. Methods Randomized controlled trials and cohort studies of continuous nursing in older patients after joint replacement were searched from the database of Cochrane Library, Web of Science, PubMed, and Embase from their establishment to October 25, 2023. After literature screening, two researchers completed data extraction, and the risk of bias was assessed using the Cochrane risk-of-bias tool. The risk analysis included in cohort studies was based on the Newcastle-Ottawa Scale (NOS). Results The study included a total of 15 articles, comprising 34,186 knee and hip replacement patients. In this review, the effects of continuous nursing on the recovery of joint function of knee replacement and hip replacement in older adults were classified and discussed. Continuous nursing interventions targeted for total hip replacement could greatly increase the range of joint mobility, enhance muscle strength during hip movements like flexion, extension, and abduction, maintain joint stability, relieve pain, improve daily activities, and lower the risk of complications. For older patients with knee arthroplasty, continuous nursing programs could markedly improve knee motion range, joint flexion, joint stability, daily activities, and pain management. Despite the implementation of interventions, the incidence of complications caused by total knee replacement did not decrease. Out of all the studies reviewed, only one used a theoretical framework for interventions provided to patients during the postoperative period of hip arthroplasty. The overall quality of the included studies was very high. Conclusion Continuous nursing can effectively improve the joint function of older patients after joint replacement. However, its effectiveness in terms of clinical outcomes, patient satisfaction, and medical cost of associated continuous nursing needs to be further clarified. In addition, continuous nursing has no significant advantage in the safety of postoperative complications and readmission rates in older adults after knee joint replacement. To enhance the efficacy and safety of continuous nursing effectively, it is crucial to refine the continuous nursing program in the future, thereby elevating the quality of nursing services.
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Affiliation(s)
- Jing Sun
- School of Nursing, Jiangsu Vocational College of Medicine, Yancheng, China
- Department of Nursing, Faculty of Nursing, Lincoln University College, Kuala Lumpur, Malaysia
| | - Yirong Xu
- School of Nursing, Jiangsu Vocational College of Medicine, Yancheng, China
- Department of Nursing, Faculty of Nursing, Lincoln University College, Kuala Lumpur, Malaysia
| | - Juan Zhu
- School of Nursing, Jiangsu Vocational College of Medicine, Yancheng, China
- Department of Nursing, Faculty of Nursing, Lincoln University College, Kuala Lumpur, Malaysia
| | - Bei Zhu
- School of Nursing, Jiangsu Vocational College of Medicine, Yancheng, China
- Department of Nursing, Faculty of Nursing, Lincoln University College, Kuala Lumpur, Malaysia
| | - Wei Gao
- School of Nursing, Jiangsu Vocational College of Medicine, Yancheng, China
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Garratt AM, Engen K, Kjeldberg IR, Nordvik JE, Ringheim I, Westskogen L, Becker F. Use of EQ-5D-5L for Assessing Patient-Reported Outcomes in a National Register for Specialized Rehabilitation. Arch Phys Med Rehabil 2024; 105:40-48. [PMID: 37236496 DOI: 10.1016/j.apmr.2023.04.026] [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: 01/02/2023] [Revised: 03/28/2023] [Accepted: 04/24/2023] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To compare problems reported on EQ-5D-5L dimensions, index, and EQ visual analog scale (VAS) scores in patients receiving specialized rehabilitation in Norway with general population norms. DESIGN Multicenter observational study. SETTING Five specialist rehabilitation facilities participating in a national rehabilitation register between March 11, 2020, and April 20, 2022. PARTICIPANTS 1167 inpatients admitted (N=1167), with a mean age of 56.1 (range, 18-91) years; 43% were female. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES EQ-5D-5L dimension, index, and EQ VAS scores. RESULTS At admission, mean±SD EQ-5D-5L index scores were 0.48 (0.31) compared to 0.82 (0.19) for general population norms. EQ VAS scores were 51.29 (20.74) compared to 79.46 (17.53) for population norms. Together with those for the 5 dimensions, these differences were all statistically significant (P<.01). Compared to population norms, patients undergoing rehabilitation had more health states as assessed by the 5 dimensions (550 vs 156) and EQ VAS (98 vs 49). As hypothesized, EQ-5D-5L scores were associated with number of diagnoses, admission to/from secondary care, and help with completion. At discharge there were statistically significant improvements in all EQ-5D-5L scores that compare favorably with available estimates for minimal important differences. CONCLUSIONS The large deviations in scores at admission and score changes at discharge lend support to EQ-5D-5L application in national quality measurement. Evidence for construct validity was found through associations with number of secondary diagnoses and help with completion.
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Affiliation(s)
| | - Kathrine Engen
- Department of Rehabilitation, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | | | - Jan Egil Nordvik
- Division for Quality and Clinical Pathways, Norwegian Directorate of Health, Oslo, Norway; Faculty of Health Sciences, Oslo Metropolitan University, Norway
| | - Inge Ringheim
- Division of Physical Medicine & Rehabilitation, Vestfold Hospital Trust, Tønsberg, Norway
| | - Lise Westskogen
- Division for Quality and Clinical Pathways, Norwegian Directorate of Health, Oslo, Norway
| | - Frank Becker
- Division for Quality and Clinical Pathways, Norwegian Directorate of Health, Oslo, Norway; Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway; Department of Physical Medicine and Rehabilitation, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Zhang H, Wang J, Jiang Z, Deng T, Li K, Nie Y. Home-based tele-rehabilitation versus hospital-based outpatient rehabilitation for pain and function after initial total knee arthroplasty: A systematic review and meta-analysis. Medicine (Baltimore) 2023; 102:e36764. [PMID: 38134064 PMCID: PMC10735162 DOI: 10.1097/md.0000000000036764] [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: 06/19/2023] [Accepted: 12/01/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND This systematic review and meta-analysis aims to compare the effectiveness of home-based tele-rehabilitation programs with hospital-based rehabilitation programs in improving pain and function at various time points (≤6 weeks, ≤14 weeks, and ≤ 52 weeks) following the initial total knee arthroplasty. METHODS This study used PRISMA and AMSTAR reporting guidelines. We systematically searched 5 databases (PubMed, Embase, Web of Science, Cochrane Library, and Medline) to identify randomized controlled trials published from January 1, 2019, to January 1, 2023. The primary outcomes were pain, knee injury and osteoarthritis outcome score, and mobility (knee range of motion). RESULTS We included 9 studies involving 1944 patients. Low-quality evidence showed hospital-based rehabilitation was better than home-based tele-rehabilitation in knee injury and osteoarthritis outcome score (mean difference [MD], -2.62; 95% confidence interval [CI], -4.65 to -0.58; P = .01) at ≤ 14 weeks after total knee arthroplasty. Based on low-quality evidence, home-based tele-rehabilitation was better than hospital-based rehabilitation in knee range of motion (MD, 2.00; 95% CI, 0.60 to 3.40; P = .005). There was no significant difference between hospital-based rehabilitation and home-based tele-rehabilitation in knee pain at ≤ 6 weeks (MD, 0.18; 95% CI, -0.07 to 0.42; P = .16), 14 weeks (MD, 0.12; 95% CI, -0.26 to 0.49; P = .54), and ≤ 52 weeks (MD, 0.16; 95% CI, -0.11 to 0.43; P = .24). CONCLUSION Home-based tele-rehabilitation and hospital-based rehabilitation programs showed comparable long-term outcomes in pain, mobility, physical function, and patient-reported health status after primary total knee arthroplasty. Considering the economic costs, home-based tele-rehabilitation programs are recommended as a viable alternative to hospital-based rehabilitation programs.
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Affiliation(s)
- Hui Zhang
- Department of Orthopedics, Orthopedic Research Institute and National Clinical Research Center for Geriatrics, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan Province, China
- West China Biomedical Big Data Center, Sichuan University West China Hospital, Chengdu, Sichuan Province, China
| | - Junqing Wang
- Department of Orthopedics, Orthopedic Research Institute and National Clinical Research Center for Geriatrics, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan Province, China
| | - Zekun Jiang
- West China Biomedical Big Data Center, Sichuan University West China Hospital, Chengdu, Sichuan Province, China
| | - Tao Deng
- School of Mechanical Engineering, Sichuan University, Chengdu, Sichuan Province, China
| | - Kang Li
- West China Biomedical Big Data Center, Sichuan University West China Hospital, Chengdu, Sichuan Province, China
| | - Yong Nie
- Department of Orthopedics, Orthopedic Research Institute and National Clinical Research Center for Geriatrics, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan Province, China
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Fernandes JB, Ferreira N, Domingos J, Ferreira R, Amador C, Pardal N, Castro C, Simões A, Fernandes S, Bernardes C, Vareta DA, Peças D, Ladislau D, Sousa N, Duarte A, Godinho C. Health Professionals' Motivational Strategies to Enhance Adherence in the Rehabilitation of People with Lower Limb Fractures: Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7050. [PMID: 37998282 PMCID: PMC10671680 DOI: 10.3390/ijerph20227050] [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: 09/27/2023] [Revised: 10/28/2023] [Accepted: 11/09/2023] [Indexed: 11/25/2023]
Abstract
Patients with lower limb fractures require rehabilitation but often struggle with adherence to interventions. Adding motivational strategies to rehabilitation programs can increase patient adherence and enhance outcomes. This review aims to identify the motivational strategies used by health professionals in the rehabilitation of people with lower limb fractures. We used Arksey and O'Malley's methodological framework to structure and conduct this scoping review. The literature search was performed using the Scopus, CINAHL, MEDLINE, Nursing & Allied Health, and Cochrane Central Register of Controlled Trials databases. The final search was conducted in February 2023. A total of 1339 articles were identified. After selecting and analyzing the articles, twelve studies were included in this review. Health professionals use several strategies to motivate patients with lower limb fractures to adhere to rehabilitation programs. These strategies include building a therapeutic alliance, increasing patients' health literacy, setting achievable goals, personalizing the rehabilitation program, managing unpleasant sensations of exercise, using persuasion, providing positive reinforcement, avoiding negative emotional stimulation, and helping to seek support. The motivational strategies identified may help professionals to increase patient adherence to rehabilitation for lower limb fractures. This knowledge will allow these professionals to help patients overcome barriers to rehabilitation, enhance their motivation, and ultimately improve their recovery outcomes.
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Affiliation(s)
- Júlio Belo Fernandes
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal; (N.F.); (J.D.); (C.B.); (D.A.V.); (D.P.); (C.G.)
- Nurs* Lab, 2829-511 Almada, Portugal
| | - Noélia Ferreira
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal; (N.F.); (J.D.); (C.B.); (D.A.V.); (D.P.); (C.G.)
- Nurs* Lab, 2829-511 Almada, Portugal
| | - Josefa Domingos
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal; (N.F.); (J.D.); (C.B.); (D.A.V.); (D.P.); (C.G.)
| | - Rui Ferreira
- Department of Nursing, Hospital Garcia de Orta, 2805-267 Almada, Portugal (C.A.)
| | - Catarina Amador
- Department of Nursing, Hospital Garcia de Orta, 2805-267 Almada, Portugal (C.A.)
| | - Nelson Pardal
- Department of Nursing, Hospital Garcia de Orta, 2805-267 Almada, Portugal (C.A.)
| | - Cidália Castro
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal; (N.F.); (J.D.); (C.B.); (D.A.V.); (D.P.); (C.G.)
- Nurs* Lab, 2829-511 Almada, Portugal
| | - Aida Simões
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal; (N.F.); (J.D.); (C.B.); (D.A.V.); (D.P.); (C.G.)
- Nurs* Lab, 2829-511 Almada, Portugal
| | - Sónia Fernandes
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal; (N.F.); (J.D.); (C.B.); (D.A.V.); (D.P.); (C.G.)
- Nurs* Lab, 2829-511 Almada, Portugal
| | - Catarina Bernardes
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal; (N.F.); (J.D.); (C.B.); (D.A.V.); (D.P.); (C.G.)
- Nurs* Lab, 2829-511 Almada, Portugal
| | - Diana Alves Vareta
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal; (N.F.); (J.D.); (C.B.); (D.A.V.); (D.P.); (C.G.)
- Nurs* Lab, 2829-511 Almada, Portugal
| | - Dina Peças
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal; (N.F.); (J.D.); (C.B.); (D.A.V.); (D.P.); (C.G.)
- Nurs* Lab, 2829-511 Almada, Portugal
| | - Dora Ladislau
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal; (N.F.); (J.D.); (C.B.); (D.A.V.); (D.P.); (C.G.)
- Nurs* Lab, 2829-511 Almada, Portugal
| | - Natacha Sousa
- Regional Health Administration of Lisbon and Tagus Valley, Community Care Unit-Integrating Health, 1500-534 Lisbon, Portugal
| | - Andreia Duarte
- Department of Nursing, Setúbal Hospital Centre, 2900-182 Setúbal, Portugal
| | - Catarina Godinho
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal; (N.F.); (J.D.); (C.B.); (D.A.V.); (D.P.); (C.G.)
- Nurs* Lab, 2829-511 Almada, Portugal
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Koster A, Stevens M, van Keeken H, Westerveld S, Seeber GH. Effectiveness and therapeutic validity of physiotherapeutic exercise starting within one year following total and unicompartmental knee arthroplasty for osteoarthritis: a systematic review. Eur Rev Aging Phys Act 2023; 20:8. [PMID: 36991323 PMCID: PMC10054030 DOI: 10.1186/s11556-023-00317-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 03/12/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND To determine the effectiveness and therapeutic validity of physiotherapeutic exercise after total and unicompartmental knee arthroplasty for osteoarthritis. It was hypothesized that interventions of high therapeutic validity result in superior functional recovery after total and unicompartmental knee arthroplasty versus interventions of low therapeutic validity. METHODS A systematic review incorporating a comprehensive database search of five major databases relevant to the topic was conducted. Randomized controlled trials were reviewed if they included studies that compared postoperative physiotherapeutic exercise with usual care or compared two types of postoperative physiotherapeutic interventions. All included studies were assessed for risk of bias (using the Cochrane Collaboration's tool) and therapeutic validity (using the Consensus on Therapeutic Exercise Training scale). The characteristics of the included articles and their results on joint and muscle function, functional performance, and participation were extracted. RESULTS Of the 4343 unique records retrieved, 37 articles were included. Six of them showed good therapeutic validity, suggesting low therapeutic validity in 31 studies. Three articles showed a low risk of bias, 15 studies scored some concerns for risk of bias and 19 studies scored high risk of bias. Only one article scored well on both methodological quality and therapeutic validity. CONCLUSION Due to heterogeneity of outcome measures and length of follow-up, as well as limited reporting of details of the physiotherapeutic exercises and control interventions, no clear evidence was found on effectiveness of physiotherapeutic exercises after total and unicompartmental knee arthroplasty. Homogeneity in intervention characteristics and outcome measures would enhance comparability of clinical outcomes between trials. Future studies should incorporate similar methodological approaches and outcome measures. Researchers are encouraged to use the Consensus on Therapeutic Exercise Training scale as a template to prevent insufficient reporting.
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Affiliation(s)
- Amarins Koster
- Department of Orthopaedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Martin Stevens
- Department of Orthopaedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Helco van Keeken
- Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sanne Westerveld
- Department of Orthopaedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gesine H Seeber
- Department of Orthopaedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
- University Hospital for Orthopaedics and Trauma Surgery Pius-Hospital, Medical Campus University of Oldenburg, Oldenburg, Germany.
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Barbosa EC, Wylde V, Thorn J, Sanderson E, Lenguerrand E, Artz N, Blom AW, Marques EMR. Cost-Effectiveness of Group-Based Outpatient Physical Therapy After Total Knee Replacement: Results From the Economic Evaluation Alongside the ARENA Multicenter Randomized Controlled Trial. Arthritis Care Res (Hoboken) 2022; 74:1970-1977. [PMID: 35468266 PMCID: PMC10087974 DOI: 10.1002/acr.24903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 02/09/2022] [Accepted: 04/14/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To assess the cost-utility and cost-effectiveness of a group-based outpatient physical therapy intervention delivered 6 weeks after primary total knee replacement (TKR) compared with usual care, alongside the Activity-Orientated Rehabilitation Following Knee Arthroplasty (ARENA) multicenter, randomized, controlled trial. METHODS The economic analyses were performed from the perspective of the health and social care payer. We collected resource use for health and social care and productivity losses and patient outcomes for 12 months after surgery to derive costs and quality-adjusted life years (QALYs). Results were expressed in incremental cost-effectiveness ratios (ICERs), and incremental net monetary benefit statistics (INMBs) for a society willingness-to-pay (WTP) threshold of £20,000 per QALY gained, with sensitivity analyses to model specification and perspective. RESULTS The cost of the ARENA physical therapy classes was mean ± SD £179 ± 39 per patient. Treatment in the year following surgery cost was, on average, £1,739 (95% confidence interval [95% CI] -£742, £4,221) per patient in the intervention group (n = 89), which was an additional £346 (95% CI £38, £653) per patient compared with usual care (n = 91) (£1,393 [95% CI -£780, £3,568]). QALY benefits were 0.0506 higher (95% CI 0.009, 0.09) in the intervention group, corresponding to an additional 19 days in "perfect health." The ICER for the intervention group was £6,842 per QALY gained, and the INMB was £665 (95% CI £139, £1,191), with a 92% probability of being cost-effective, and no less than 73% in all sensitivity analysis scenarios. CONCLUSION The addition of group-based outpatient physical therapy classes to usual care improves quality of life and is a cost-effective treatment option following TKR for a society WTP threshold of £20,000 per QALY gained.
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Affiliation(s)
| | - Vikki Wylde
- University of Bristol, Bristol Medical School and NIHR Bristol Medical Research Centre, Bristol, UK
| | - Joanna Thorn
- University of Bristol, Bristol Medical School, Bristol, UK
| | | | | | - Neil Artz
- University of Gloucestershire, Gloucester, UK
| | - Ashley W Blom
- University of Bristol, Bristol Medical School and NIHR Bristol Medical Research Centre, Bristol, UK
| | - Elsa M R Marques
- University of Bristol, Bristol Medical School and NIHR Bristol Medical Research Centre, Bristol, UK
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Barker KL, Room J, Toye F. The challenges and gains of delivering a home-exercise intervention: a qualitative study of physiotherapists and physiotherapy assistants. BMC Musculoskelet Disord 2022; 23:839. [PMID: 36057590 PMCID: PMC9440491 DOI: 10.1186/s12891-022-05790-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 08/30/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES The paper presents insights from the Community based Rehabilitation after Knee Arthroplasty (CORKA) trial. We aimed to explore physiotherapists and physiotherapy assistants' experiences of delivering a home-base exercise intervention following knee replacement surgery. We were particularly interested in the feasibility, potential benefits and barriers of a community-based exercise programme from the perspective of physiotherapists and physiotherapy assistants and to understand any constraints or training needs that arose. DESIGN: Qualitative thematic analysis of semi-structured interviews. SETTING: The Community based Rehabilitation after Knee Arthroplasty (CORKA) trial. PARTICIPANTS Five physiotherapists and six physiotherapy assistants with a range of clinical experience. METHODS Interviews were digitally recorded and transcribed verbatim. We used the stages of reflexive thematic analysis suggested by Braun and Clarke. One researcher conducted the interviewers whilst three researchers with experience in qualitative research methods contributed to the coding and analysis of data. RESULTS We developed seven themes that help to understand the benefits and challenges of delivering treatment interventions in a person's home: seeing the person in their own world; thinking outside the cubicle;developing people skills; enjoying the above and beyond; treading a fine line between patient and friend; feeling outside my comfort zone; needing a support network. CONCLUSIONS Treating people in their own homes facilitates a holistic approach. Our findings highlight areas for clinical education: (1) how do we help clinicians to tread the fine line between friend and professional (2) how do we balance the need to provide support and structure with the freedom to work creatively and independently?
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Affiliation(s)
- Karen L Barker
- Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Windmill Road, Oxford, OX3 7HE, UK. .,Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
| | - Jon Room
- Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Windmill Road, Oxford, OX3 7HE, UK
| | - Francine Toye
- Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Windmill Road, Oxford, OX3 7HE, UK
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Li Z, Hui Z, Zheng Y, Yu J, Zhang J. Efficacy of Phase II Remote Home Rehabilitation in Patients with Acute Myocardial Infarction after Percutaneous Coronary Intervention. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:4634769. [PMID: 35815057 PMCID: PMC9208999 DOI: 10.1155/2022/4634769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/19/2022] [Accepted: 05/06/2022] [Indexed: 11/26/2022]
Abstract
Objective To assess the efficacy of home-based cardiac rehabilitation and traditional outpatient rehabilitation in stage II after percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI). Methods From September 2019 to March 2020, 80 AMI patients in Cangzhou Central Hospital were randomly assigned to one of the two groups: the control group or the observation group, 40 cases in each group. The control group received old-fashioned outpatient rehabilitation treatment, and the study group received long-distance family rehabilitation nursing intervention. The blood pressure, examination results, compliance, satisfaction evaluation, incidence of cardiac events, heart rate, quality of life score, and 6-minute walking test were compared between the two groups. Results There were no deaths in both groups. There were significant differences in heart failure, unstable angina pectoris, unplanned readmission rate, walking compliance, and 6-minute walking test at 6 months after discharge (P < 0.05). There were substantial variances in left ventricular discharge portion, low-density lipoprotein, medication compliance, satisfaction, and quality of life (P < 0.05); there was substantial inconsistency in the 6-minute walking test concerning the two groups afterwards discharge for 3 months (P < 0.05). Conclusion Home rehabilitation is a new home cardiac rehabilitation model with high efficiency, convenience, and whole process monitoring and barrier-free follow-up management. It can effectively improve the cardiac function, workout patience and worth of life expectancy of victims with AMI, improve their self-management awareness and rehabilitation compliance, reduce the risk of cardiac events, and have a positive impact on the prognosis and rehabilitation of patients with AMI.
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Affiliation(s)
- Zhe Li
- Department of Cardiac Rehabilitation, Cangzhou Teaching Hospital of Hebei Medical University, Cangzhou Central Hospital, Cangzhou, Hebei, China
| | - Zhi Hui
- ICU, Cangzhou Teaching Hospital of Hebei Medical University, Cangzhou Central Hospital, Cangzhou, Hebei, China
| | - Ye Zheng
- Department of Cardiology, Cangzhou Teaching Hospital of Hebei Medical University, Cangzhou Central Hospital, Cangzhou, Hebei, China
| | - Jing Yu
- Department of Cardiology, Cangzhou Teaching Hospital of Hebei Medical University, Cangzhou Central Hospital, Cangzhou, Hebei, China
| | - Jun Zhang
- Department of Cardiology, Cangzhou Teaching Hospital of Hebei Medical University, Cangzhou Central Hospital, Cangzhou, Hebei, China
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Smith TO, Parsons S, Ooms A, Dutton S, Fordham B, Garrett A, Hing C, Lamb S. Randomised controlled trial of a behaviour change physiotherapy intervention to increase physical activity following hip and knee replacement: the PEP-TALK trial. BMJ Open 2022; 12:e061373. [PMID: 35641012 PMCID: PMC9157340 DOI: 10.1136/bmjopen-2022-061373] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To test the effectiveness of a behaviour change physiotherapy intervention to increase physical activity compared with usual rehabilitation after total hip replacement (THR) or total knee replacement (TKR). DESIGN Multicentre, pragmatic, two-arm, open, randomised controlled, superiority trial. SETTING National Health Service providers in nine English hospitals. PARTICIPANTS 224 individuals aged ≥18 years, undergoing a primary THR or TKR deemed 'moderately inactive' or 'inactive'. INTERVENTION Participants received either six, 30 min, weekly, group-based exercise sessions (usual care) or the same six weekly, group-based, exercise sessions each preceded by a 30 min cognitive behaviour discussion group aimed at challenging barriers to physical inactivity following surgery (experimental). RANDOMISATION AND BLINDING Initial 75 participants were randomised 1:1 before changing the allocation ratio to 2:1 (experimental:usual care). Allocation was based on minimisation, stratifying on comorbidities, operation type and hospital. There was no blinding. MAIN OUTCOME MEASURES Primary: University of California Los Angeles (UCLA) Activity Score at 12 months. Secondary: 6 and 12-month assessed function, pain, self-efficacy, kinesiophobia, psychological distress and quality of life. RESULTS Of the 1254 participants assessed for eligibility, 224 were included (139 experimental: 85 usual care). Mean age was 68.4 years (SD: 8.7), 63% were women, 52% underwent TKR. There was no between-group difference in UCLA score (mean difference: -0.03 (95% CI -0.52 to 0.45, p=0.89)). There were no differences observed in any of the secondary outcomes at 6 or 12 months. There were no important adverse events in either group. The COVID-19 pandemic contributed to the reduced intended sample size (target 260) and reduced intervention compliance. CONCLUSIONS There is no evidence to suggest attending usual care physiotherapy sessions plus a group-based behaviour change intervention differs to attending usual care physiotherapy alone. As the trial could not reach its intended sample size, nor a proportion of participants receive their intended rehabilitation, this should be interpreted with caution. TRIAL REGISTRATION NUMBER ISRCTN29770908.
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Affiliation(s)
- Toby O Smith
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Scott Parsons
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Alexander Ooms
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - Susan Dutton
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - Beth Fordham
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Angela Garrett
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Caroline Hing
- Trauma and Orthopaedic Department, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Sarah Lamb
- College of Medicine and Health, University of Exeter, Exeter, UK
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Saul H, Gursul D. Home based rehabilitation after a knee replacement is as effective as physiotherapy. BMJ 2021; 375:n2593. [PMID: 34725095 DOI: 10.1136/bmj.n2593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The studyBarker KL, Room J, Knight R, et al. Outpatient physiotherapy versus home-based rehabilitation for patients at risk of poor outcomes after knee arthroplasty: CORKA RCT. Health Technol Assess 2020;24:1-116.To read the full NIHR Alert, go to: https://evidence.nihr.ac.uk/alert/knee-replacements-home-based-rehabilitation-as-effective-physiotherapy/.
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Affiliation(s)
- Helen Saul
- NIHR Centre for Engagement and Dissemination, Twickenham, UK
| | - Deniz Gursul
- NIHR Centre for Engagement and Dissemination, Twickenham, UK
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