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Monsegue AP, Emans P, van Loon LJC, Verdijk LB. Resistance exercise training to improve post-operative rehabilitation in knee arthroplasty patients: A narrative review. Eur J Sport Sci 2024; 24:938-949. [PMID: 38956794 DOI: 10.1002/ejsc.12114] [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: 10/13/2023] [Revised: 02/27/2024] [Accepted: 04/10/2024] [Indexed: 07/04/2024]
Abstract
Knee osteoarthritis is associated with deficits in muscle strength, muscle mass, and physical functioning. These muscle-related deficits are acutely exacerbated following total knee arthroplasty (TKA) and persist long after surgery, despite the application of standardized rehabilitation programs that include physical/functional training. Resistance exercise training (RET) has been shown to be a highly effective strategy to improve muscle-related outcomes in healthy as well as clinical populations. However, the use of RET in traditional rehabilitation programs after TKA is limited. In this narrative review, we provide an updated view on whether adding RET to the standard rehabilitation (SR) in the recovery period (up to 1 year) after TKA leads to greater improvements in muscle-related outcomes when compared to SR alone. Overall, research findings clearly indicate that both muscle strength and muscle mass can be improved to a greater extent with RET-based rehabilitation compared to SR. Additionally, measures of physical functioning that rely on quadriceps strength and balance (e.g., stair climbing, chair standing, etc.) also appear to benefit more from a RET-based program compared to SR, especially in patients with low levels of physical functioning. Importantly though, for RET to be optimally effective, it should be performed at 70%-80% of the one-repetition maximum, with 3-4 sets per exercise, with a minimum of 3 times per week for 8 weeks. Based upon this narrative review, we recommend that such high-intensity progressive RET should be incorporated into standard programs during rehabilitation after TKA.
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Affiliation(s)
- Alejandra P Monsegue
- Department of Human Biology, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Pieter Emans
- Department of Orthopedics, Joint Preserving Clinic, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Luc J C van Loon
- Department of Human Biology, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Lex B Verdijk
- Department of Human Biology, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre+, Maastricht, The Netherlands
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Annemans M, Van Dyck D, Heylighen A. How does the built environment affect patient safety in relation to physical activity? Experiences at a rehabilitation center. APPLIED ERGONOMICS 2024; 116:104214. [PMID: 38199199 DOI: 10.1016/j.apergo.2023.104214] [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: 07/28/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024]
Abstract
Physical activity benefits patients in rehabilitation yet comes with various safety issues. The built environment impacts on both safety and physical activity. We aim to explore the role of the built environment in safety issues related to being physically active in rehabilitation. We conducted a case study at a free-standing rehabilitation center for patients with Multiple Sclerosis, neurologic, or locomotor issues. Patients participated in two interviews supported by activity tracking data. Care professionals participated in focus group interviews respectively with two therapists and four head nurses. Accessibility and physical barriers, visual connections and (in)dependence, and spatial familiarity are important themes when identifying aspects of the built environment in relation to reducing safety issues patients encounter during physical activity. Raising awareness about each of these among care and design professionals could help them to balance safety issues in relation to physical activity and to communicate about them in a nuanced way.
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Affiliation(s)
- Margo Annemans
- KU Leuven, Department of Architecture, Leuven, Belgium; University of Antwerp, Department of Interior Architecture, Antwerp, Belgium.
| | - Delfien Van Dyck
- Ghent University, Department of Movement and Sport Sciences, Ghent, Belgium.
| | - Ann Heylighen
- KU Leuven, Department of Architecture, Leuven, Belgium.
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Bongiorno G, Biancuzzi H, Dal Mas F, Bednarova R, Vittori A, Miceli L. Pulsed radiofrequency on peripheral nerve as a rehabilitation aid. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2024; 4:22. [PMID: 38504294 PMCID: PMC10949595 DOI: 10.1186/s44158-024-00156-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 03/11/2024] [Indexed: 03/21/2024]
Abstract
The work described below explores the field of the effects of pulsed radiofrequency for pain relief purposes. While the effects of this technique on pain modulation (A-delta and C fibers) are relatively well-known, little has been written yet about the potential of pulsed radiofrequency interactions with other fibers. The proposed algorithm, specifically elaborated, investigates the effect of this technique on neuromuscular fatigue, through a surface electromyographic study of the femoral nerve of a patient with residual pain after knee arthroplasty surgery, before and after the treatment. This work yields a preliminary result that is encouraging for subsequent large-scale studies.
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Affiliation(s)
- Giulia Bongiorno
- Friuli Riabilitazione Rehabilitation Center, City of Roveredo in Piano, Pordenone, Italy
| | - Helena Biancuzzi
- Department of Economics, Ca' Foscari University of Venice, Venice, Italy
| | - Francesca Dal Mas
- Department of Management, Ca' Foscari University of Venice, Venice, Italy
- Collegium Medicum, University of Social Sciences, Lodz, Poland
| | - Rym Bednarova
- Pain Medicine, Hospital of Latisana, Udine, Latisana, Italy
| | - Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO Roma, Ospedale Pediatrico Bambino Gesù IRCCS, Rome, Italy
| | - Luca Miceli
- Department of Pain Medicine, IRCCS C.R.O. National Cancer Institute of Aviano, Pordenone, Aviano, Italy.
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Chang HL, Hsu MF, Wong TH, Chung YC, Huang HL. Effects of a Hybrid Teaching Program on Lower Limb Muscle Strength, Knee Function, and Depression in Older Adults After Total Knee Replacement: A Randomized Controlled Trial. Res Gerontol Nurs 2024; 17:31-40. [PMID: 37738062 DOI: 10.3928/19404921-20230918-01] [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: 09/23/2023]
Abstract
The aim of the current study was to evaluate the effects of a nurse-led hybrid teaching program on lower limb strength, knee function, and depression in older adults after total knee replacement (TKR). This was a single-blind, randomized controlled trial. Fifty-two patients who underwent TKR were randomly assigned to either the experimental group (EG; n = 26), which received routine care plus 16 weeks of home rehabilitation through a hybrid teaching program, or the control group (CG; n = 26), which received routine care only. The intervention included pre-discharge face-to-face education, video instructions to follow at home after discharge, and four monthly telephone-based follow ups during the 16 weeks post-surgery. After the 16-week intervention, participants in the EG exhibited improved quadriceps strength, hamstring strength, and Knee Injury and Osteoarthritis Outcome Score (KOOS) compared to those in the CG. Generalized estimating equation analyses revealed a significant group-by-time interaction effect on quadriceps strength, overall KOOS score, and Geriatric Depression Scale-Short Form score. Findings suggest that a nurse-led hybrid teaching program enhances physical and psychological function after TKR when compared to routine care. This hybrid teaching program, involving exercise and postoperative education, proves to be a feasible and cost-effective intervention for improving outcomes in older adults following TKR. Health care teams should consider it as a viable home rehabilitation option for older adults who undergo TKR. [Research in Gerontological Nursing, 17(1), 31-40.].
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Redfern RE, Crawford DA, Lombardi AV, Tripuraneni KR, Van Andel DC, Anderson MB, Cholewa JM. Outcomes Vary by Pre-Operative Physical Activity Levels in Total Knee Arthroplasty Patients. J Clin Med 2023; 13:125. [PMID: 38202132 PMCID: PMC10780185 DOI: 10.3390/jcm13010125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/13/2023] [Accepted: 12/23/2023] [Indexed: 01/12/2024] Open
Abstract
Physical activity (PA) is suggested to reduce osteoarthritis pain; however, it may be avoided by patients requiring arthroplasty. Our goal was to investigate objective and patient-reported outcomes as a function of pre-operative PA levels in patients undergoing total knee arthroplasty (TKA). A total of 1941 patients enrolled in a multicenter prospective cohort study investigating a smartphone-based care management platform for self-directed rehabilitation underwent TKA and were included in the analysis. Activity was categorized based on the cohort's step count quartiles into low, moderate, and high pre-operative PA. Pre-operative and post-operative pain, EQ5D5L, KOOS JR, and step counts were compared by ANOVA according to activity group. Pre-operative pain scores increased with the decreasing activity level (all, p < 0.05) and were most improved post-operatively in the low PA group. High PA patients demonstrated the smallest improvements in EQ-5D-5L and KOOS JR. Low and moderate PA patients increased physical activity by three months, reaching 176% and 104% of pre-operative steps; high PA patients did not return to full step counts by one year post-operatively. Patients undergoing TKA who present with higher levels of physical activity report lower levels of pain and higher function pre-operatively but appreciate less improvement up to one year post-operatively. These results may be helpful in appropriate counseling of patient expectations before TKA.
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Affiliation(s)
| | - David A. Crawford
- Joint Implant Surgeons, Inc., New Albany, OH 43054, USA; (D.A.C.); (A.V.L.J.)
| | - Adolph V. Lombardi
- Joint Implant Surgeons, Inc., New Albany, OH 43054, USA; (D.A.C.); (A.V.L.J.)
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Kokic T, Pavic R, Vuksanic M, Jelica S, Sumanovac A, Banic T, Ostović H, Sklempe Kokic I. Effects of Electromyographic Biofeedback-Assisted Exercise on Functional Recovery and Quality of Life in Patients after Total Hip Arthroplasty: A Randomized Controlled Trial. J Pers Med 2023; 13:1716. [PMID: 38138943 PMCID: PMC10744500 DOI: 10.3390/jpm13121716] [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: 10/10/2023] [Revised: 12/07/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023] Open
Abstract
The goal of the trial was to examine the effects of adding electromyographic biofeedback (EMG-BF) to the conventional program of physiotherapy after total hip arthroplasty (THA) on functional recovery and quality of life. The trial was designed as a prospective, interventional, single-blinded randomized controlled study. Ninety patients were randomized into an experimental group (EG) (n = 45; mean age 63.9 ± 8.8) and control group (CG) (n = 45; mean age 63.9 ± 9). All patients received 21 days of physiotherapy which consisted of therapeutic exercise (land-based and aquatic), electrotherapy, and education. Electromyographic biofeedback was added to a portion of the land-based exercise in EG. The Hip Disability and Osteoarthritis Outcome Score (HOOS), Numeric Rating Scale (NRS), Short Form Health Survey-36 (SF-36), use of a walking aid, 30 s chair stand test (CST) as well as the Timed Up and Go (TUG) test were used for outcome measurement. A higher proportion of the participants in both groups did not need a walking aid after the intervention (p < 0.05). All participants improved their 30 s CST and TUG results (p < 0.001), as well as their NRS and HOOS scores (p < 0.05). No significant differences between the groups were found. There were no additional benefits from adding EMG-BF to the conventional physiotherapy protocol.
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Affiliation(s)
- Tomislav Kokic
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Orthopaedics and Trauma Department, General County Hospital Vinkovci, 32100 Vinkovci, Croatia
- Faculty of Kinesiology Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Roman Pavic
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Clinical Hospital of Traumatology, University Hospital Centre “Sestre Milosrdnice”, 10000 Zagreb, Croatia
| | - Matko Vuksanic
- Bizovacke Toplice Rehabilitation Hospital, 31222 Bizovac, Croatia
- Department of Health Studies, College of Applied Sciences “Lavoslav Ruzicka” in Vukovar, 32000 Vukovar, Croatia
| | - Stjepan Jelica
- Department of Health Studies, College of Applied Sciences “Lavoslav Ruzicka” in Vukovar, 32000 Vukovar, Croatia
| | - Antun Sumanovac
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Orthopaedics and Trauma Department, General County Hospital Vinkovci, 32100 Vinkovci, Croatia
| | - Tihomir Banic
- Faculty of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department of Surgery, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
| | - Helena Ostović
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Clinical Department of Anesthesiology, Reanimatology and Intensive Care Medicine, University Hospital Dubrava, 10000 Zagreb, Croatia
| | - Iva Sklempe Kokic
- Faculty of Kinesiology Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
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Tortolano L, Misandeau Q, Inouri T, Paul M, Dompnier M, Flouzat-Lachaniette CH, Archer V. Patient information pathway in orthopedic surgery: Roles of ERAS and pharmacists. Orthop Traumatol Surg Res 2023; 109:103576. [PMID: 36754166 DOI: 10.1016/j.otsr.2023.103576] [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: 01/14/2022] [Revised: 09/06/2022] [Accepted: 01/03/2023] [Indexed: 02/10/2023]
Abstract
INTRODUCTION Enhanced Rehabilitation After Surgery (ERAS) pathways significantly improve the care of patients in orthopedic surgery. However, patient knowledge and memorization of the information provided are currently poorly documented. HYPOTHESIS The information provided by a postoperative pharmacist could have a positive impact on patient care, in particular by improving knowledge about their prosthesis. MATERIAL AND METHOD This prospective feasibility study included a cohort of 80 patients operated on for a hip or knee prosthesis and who received postoperative pharmacist interviews (POPI). These POPIs informed the patient about the prosthesis, the complications, positions to avoid, as well as the postoperative follow-up. The objective was to measure the patient's knowledge before and after the POPI. Qualitative and quantitative analyses, by indication and patient pathway, were performed. RESULTS The patient's knowledge before POPI was 70% correct. After POPI this rate rose to 91%. DISCUSSION Patients' knowledge was weak and heterogeneous, especially regarding the implanted prosthesis. The POPI led to significant improvement and standardization of knowledge which should contribute to the prevention of iatrogenic harm (positions to avoid, infection prevention, compliance with analgesics and anticoagulants). CONCLUSION A POPI with a pharmacist improves overall patient management during hip or knee arthroplasty. LEVEL OF EVIDENCE III; non-randomized prospective feasibility study.
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Affiliation(s)
- Lionel Tortolano
- Department of Pharmacy, Henri Mondor Hospital, AP-HP, Créteil, France; Université Paris-Saclay, EA Matériaux et santé, 91400, Orsay, France.
| | - Quentin Misandeau
- Department of Pharmacy, Henri Mondor Hospital, AP-HP, Créteil, France
| | - Tinhinane Inouri
- Department of Pharmacy, Henri Mondor Hospital, AP-HP, Créteil, France
| | - Muriel Paul
- Department of Pharmacy, Henri Mondor Hospital, AP-HP, Créteil, France
| | - Mathilde Dompnier
- Department of Pharmacy, Henri Mondor Hospital, AP-HP, Créteil, France
| | - Charles-Henri Flouzat-Lachaniette
- Department of Orthopaedic Surgery, Henri Mondor Hospital, AP-HP, University of Paris, East Créteil, France; Cell and Tissue Engineering for Musculoskeletal Disorders (Group 5)/Biology of the NeuroMuscular System (INSERM Team 10)/Mondor Institute for Biomedical Research, Créteil, France
| | - Valérie Archer
- Department of Pharmacy, Henri Mondor Hospital, AP-HP, Créteil, France
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Wu L, Li X, Hua L, Sun Q. Effects of technology-assisted rehabilitation for patients with hip arthroplasty: A meta-analysis. Medicine (Baltimore) 2023; 102:e35921. [PMID: 37960720 PMCID: PMC10637488 DOI: 10.1097/md.0000000000035921] [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: 04/17/2023] [Accepted: 10/12/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND To investigate the efficacy of technology-assisted rehabilitation compared to that of usual care programs after total hip arthroplasty (THA) through randomized controlled trials (RCTs). METHODS The Medline (PubMed), Cochrane Library, Embase and Web of Science databases were searched for RCTs regarding the efficacy of technology-assisted rehabilitation following THA. Data were analyzed using Stata 12.0 software. RESULTS Eleven RCTs involving 1327 patients were included in the meta-analysis. The pooled effect size showed that compared to usual care, telerehabilitation significantly improved the Harris score (standardized mean difference [SMD] 0.74, 95% confidence interval [CI] 0.58 to 0.90) and functional independence measure (FIM) score (SMD 1.26, 95% CI 0.48 to 2.03). In addition, video-based therapy could significantly improve walk test results (SMD 0.43, 95% CI 0.11 to 0.75). CONCLUSION The findings suggest that technology-assisted rehabilitation, especially telerehabilitation, have been shown to improve the physical function of patients following THA compared to conventional rehabilitation. More robust studies are needed to validate the long-term efficacy and safety of innovative technology-assisted training strategies.
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Affiliation(s)
- Lingyun Wu
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, China
| | - Xiaoyan Li
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, China
| | - Lijiangshan Hua
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, China
| | - Qiuhua Sun
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, China
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Streck LE, Chiu YF, Braun S, Mujaj A, Hanreich C, Boettner F. Activity Following Total Hip Arthroplasty: Which Patients Are Active, and Is Being Active Safe? J Clin Med 2023; 12:6482. [PMID: 37892620 PMCID: PMC10607190 DOI: 10.3390/jcm12206482] [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: 09/02/2023] [Revised: 09/24/2023] [Accepted: 10/08/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Younger and physically active patients demand a return to sport after total hip arthroplasty (THA). However, because of the risk of implant wear and loosening, high-impact activities are often not recommended. The current study evaluates predictive factors and revision rates in patients with higher activity levels. METHODS This retrospective study included 4152 hips in 3828 patients aged 45-75 that underwent primary THA for primary osteoarthritis between 2009 and 2019 with a minimum follow-up of 2 years. Pain and Lower Extremity Activity Scale (LEAS) were assessed before and 2 years after surgery. Activity was classified as low (LEAS 1-6), moderate (LEAS 7-13), or high (LEAS 14-18). RESULTS Pain and LEAS improved from preoperative to 2-years postoperative (p < 0.001). The activity level was low in 6.2%, moderate in 52.9%, and high in 40.9% of the patients. Younger age, lower BMI, ASA, and CCI, male sex, and higher preoperative LEAS correlated with higher activity at 2 years (p < 0.001). The predicted revision-free survival rates between the activity groups were better for more highly active patients (p < 0.001). CONCLUSIONS High physical activity 2 years following THA, with participating in sports like jogging several times a week, did not increase the risk of revision surgery. THA patients should not be prevented from a highly active lifestyle.
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Affiliation(s)
- Laura Elisa Streck
- Adult Reconstruction and Joint Replacement Department, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Yu-Fen Chiu
- Biostats Core, Research Administration, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Sebastian Braun
- Adult Reconstruction and Joint Replacement Department, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
- Center for Musculoskeletal Surgery, Charité Universitätsmedizin Berlin, Member of Freie Universität Berlin and Humboldt University Berlin, Chariteplatz 1, 10117 Berlin, Germany
| | - Anisa Mujaj
- Adult Reconstruction and Joint Replacement Department, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Carola Hanreich
- Adult Reconstruction and Joint Replacement Department, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
- Department for Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland
| | - Friedrich Boettner
- Adult Reconstruction and Joint Replacement Department, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
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Annemans M, Van Dyck D, Heylighen A. What affects physical activity in a rehabilitation centre? Voices of patients, nurses, therapists, and activity trackers. Disabil Rehabil 2023; 45:3108-3117. [PMID: 36083025 DOI: 10.1080/09638288.2022.2118873] [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: 11/29/2021] [Revised: 08/16/2022] [Accepted: 08/21/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE In the context of rehabilitation, research shows a close connection between patients' physical activity, care culture, and the built environment. As these three impact on patients' rehabilitation process, we aim to understand what affects physical activity in a particular rehabilitation centre. MATERIALS AND METHODS We combine insights from literature with a qualitative study informed by quantitative data. Semi-structured and walking interviews with 16 patients were informed by output from activity trackers. Two focus-group interviews with respectively four nurses and two therapists provided extra perspectives. RESULTS We found that patients interpret physical activity rather narrowly, equating it with therapy. Yet, the data of the activity trackers show that daily activities are often as active as therapy, as confirmed by nurses and therapists. Motivation to be physically active was found in setting clear goals, social interaction, allowing choice and control to achieve a sense of normality, and the built environment. How patients act in and interact with the built environment are closely related to how staff approaches and communicates care. CONCLUSIONS The focus on what affects - defines, hampers, or supports - physical activity in a rehabilitation centre allowed developing a better understanding of how care culture and the built environment interrelate.Implications for rehabilitationHow physical activity is perceived by patients reflects the goals they like to achieve through rehabilitation.The built environment is a third factor in the relation between care culture and patients' physical activity.Fully supporting patients to be physically active with respect to their personality and capabilities requires differentiating between patients both in how they are approached (patient- or person-centred) and in how they are spatially facilitated.
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Affiliation(s)
- Margo Annemans
- Research[x]Design, Department of Architecture, KU Leuven, Leuven, Belgium
| | - Delfien Van Dyck
- Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium
| | - Ann Heylighen
- Research[x]Design, Department of Architecture, KU Leuven, Leuven, Belgium
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Ribbons K, Johnson S, Ditton E, Wills A, Mason G, Flynn T, Cochrane J, Pollack M, Walker FR, Nilsson M. Using Presurgical Biopsychosocial Features to Develop an Advanced Clinical Decision-Making Support Tool for Predicting Recovery Trajectories in Patients Undergoing Total Knee Arthroplasty: Protocol for a Prospective Observational Study. JMIR Res Protoc 2023; 12:e48801. [PMID: 37556181 PMCID: PMC10448293 DOI: 10.2196/48801] [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: 05/07/2023] [Revised: 06/12/2023] [Accepted: 07/05/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Following total knee arthroplasty (TKA), 10% to 20% of patients report dissatisfaction with procedural outcomes. There is growing recognition that postsurgical satisfaction is shaped not only by the quality of surgery but also by psychological and social factors. Surprisingly, information on the psychological and social determinants of surgical outcomes is rarely collected before surgery. A comprehensive collection of biopsychosocial information could assist clinicians in making recommendations in relation to rehabilitation, particularly if there is robust evidence to support the ability of presurgical constructs to predict postsurgical outcomes. Clinical decision support tools can help identify factors influencing patient outcomes and support the provision of interventions or services that can be tailored to meet individuals' needs. However, despite their potential clinical benefit, the application of such tools remains limited. OBJECTIVE This study aims to develop a clinical decision tool that will assist with patient stratification and more precisely targeted clinical decision-making regarding prehabilitation and rehabilitation for TKA, based on the identified individual biopsychosocial needs. METHODS In this prospective observational study, all participants provided written or electronic consent before study commencement. Patient-completed questionnaires captured information related to a broad range of biopsychosocial parameters during the month preceding TKA. These included demographic factors (sex, age, and rurality), psychological factors (mood status, pain catastrophizing, resilience, and committed action), quality of life, social support, lifestyle factors, and knee symptoms. Physical measures assessing mobility, balance, and functional lower body strength were performed via video calls with patients in their home. Information related to preexisting health issues and concomitant medications was derived from hospital medical records. Patient recovery outcomes were assessed 3 months after the surgical procedure and included quality of life, patient-reported knee symptoms, satisfaction with the surgical procedure, and mood status. Machine learning data analysis techniques will be applied to determine which presurgery parameters have the strongest power for predicting patient recovery following total knee replacement. On the basis of these analyses, a predictive model will be developed. Predictive models will undergo internal validation, and Bayesian analysis will be applied to provide additional metrics regarding prediction accuracy. RESULTS Patient recruitment and data collection commenced in November 2019 and was completed in June 2022. A total of 1050 patients who underwent TKA were enrolled in this study. CONCLUSIONS Our findings will facilitate the development of the first comprehensive biopsychosocial prediction tool, which has the potential to objectively predict a patient's individual recovery outcomes following TKA once selected by an orthopedic surgeon to undergo TKA. If successful, the tool could also inform the evolution rehabilitation services, such that factors in addition to physical performance can be addressed and have the potential to further enhance patient recovery and satisfaction. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/48801.
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Affiliation(s)
- Karen Ribbons
- Centre for Rehab Innovations, University of Newcastle, New Lambton Heights, Australia
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, Australia
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
| | - Sarah Johnson
- Centre for Rehab Innovations, University of Newcastle, New Lambton Heights, Australia
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, Australia
- College of Science and Engineering, University of Newcastle, Callaghan, Australia
| | - Elizabeth Ditton
- Centre for Rehab Innovations, University of Newcastle, New Lambton Heights, Australia
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, Australia
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
| | - Adrian Wills
- Centre for Rehab Innovations, University of Newcastle, New Lambton Heights, Australia
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, Australia
- College of Science and Engineering, University of Newcastle, Callaghan, Australia
| | - Gillian Mason
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, Australia
| | - Traci Flynn
- College of Human and Social Futures, University of Newcastle, Callaghan, Australia
| | - Jodie Cochrane
- Centre for Rehab Innovations, University of Newcastle, New Lambton Heights, Australia
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, Australia
- College of Science and Engineering, University of Newcastle, Callaghan, Australia
| | - Michael Pollack
- Centre for Rehab Innovations, University of Newcastle, New Lambton Heights, Australia
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
- Hunter New England Local Health District, Rankin Park Centre, New Lambton Heights, Australia
| | - Frederick Rohan Walker
- Centre for Rehab Innovations, University of Newcastle, New Lambton Heights, Australia
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, Australia
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
| | - Michael Nilsson
- Centre for Rehab Innovations, University of Newcastle, New Lambton Heights, Australia
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, Australia
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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12
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Abbasi‐Kesbi R, Fathi M, Najafi M, Nikfarjam A. Assessment of human gait after total knee arthroplasty by dynamic time warping algorithm. Healthc Technol Lett 2023; 10:73-79. [PMID: 37529411 PMCID: PMC10388232 DOI: 10.1049/htl2.12047] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 03/13/2023] [Accepted: 05/02/2023] [Indexed: 08/03/2023] Open
Abstract
Today, the elderly population is increasing, and there are many drawbacks for them, especially defects in their knee joints which lead to improper gait. To solve this problem, their knee joint can be replaced with knee arthroplasty. In this letter, level of improvement in the human gait before and after total knee arthroplasty (TKA) surgery is investigated using the dynamic time warping (DTW) algorithm. For this purpose, several volunteers who have problems with their knees are incorporated in a test before and after TKA surgery. Then, the data of gait analysis is collected and the data is compared with a reference using the DTW algorithm. The outcome results illustrate an improvement of 89%-97% by the proposed algorithm after TKA surgery. Therefore, patients can see improvement with high accuracy and very fast that result in more use this technique in TKR surgery.
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Affiliation(s)
- Reza Abbasi‐Kesbi
- MEMS & NEMS Department, Faculty of New Sciences and TechnologiesUniversity of TehranTehranIran
| | - Mohammad Fathi
- Department of Biomedical Engineering, Faculty of Medical Sciences and TechnologiesIslamic Azad University Science and Research BranchTehranIran
| | - Mohammad Najafi
- Department of Biomedical Engineering, Faculty of Medical Sciences and TechnologiesIslamic Azad University Science and Research BranchTehranIran
| | - Alireza Nikfarjam
- MEMS & NEMS Department, Faculty of New Sciences and TechnologiesUniversity of TehranTehranIran
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13
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Christensen JC, Blackburn BE, Anderson LA, Gililland JM, Peters CL, Archibeck MJ, Pelt CE. Recovery Curve for Patient Reported Outcomes and Objective Physical Activity After Primary Total Knee Arthroplasty - A Multicenter Study Using Wearable Technology. J Arthroplasty 2023; 38:S94-S102. [PMID: 36996947 DOI: 10.1016/j.arth.2023.03.060] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 03/21/2023] [Accepted: 03/21/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND This study aimed to describe the trajectory of recovery based on patient reported outcomes (PROs) and objective metrics of physical activity measures over the first 12 months post-total knee arthroplasty (TKA). METHODS In total, 1,005 participants who underwent a primary unilateral TKA surgery between November 2018 and September 2021 from a multi-site prospective study were analyzed. Generalized estimating equations were used to evaluate PROs and objective physical activity measures over time. RESULTS All Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR), EuroQol-5D (EQ-5D) and steps per day scores were greater than pre-operative scores (P<0.05). The flights of stairs per day, gait speed and walking asymmetry all declined at 1-month (all, P<0.001). However, all subsequent scores improved by 6 months (all, P<0.01). The greatest clinically important differences from previous visit in KOOS JR (β=18.1; 95% Confidence Interval (CI)=17.2, 19.0), EQ-5D (β=0.11; 95% CI=0.10, 0.12), steps per day (β=1169.3; 95% CI=1012.7, 1325.9), gait speed (β=-0.05; 95% CI=-0.06, -0.03), and walking asymmetry (β=0.00; 95% CI=-0.03, 0.03) were observed at 3 months. CONCLUSION The KOOS JR, EQ-5D, and steps per day measures showed earlier improvements than other physical activity metrics, with the greatest magnitude of improvement within the first 3 months post-TKA. The greatest magnitude of improvement in walking asymmetry was not observed until 6 months, while gait speed and flights of stairs per day were not observed until 12 months. This data may further help provide expectation setting information to patients prior to surgery, and may aid in identifying outliers to the normal recovery curve who may benefit from targeted interventions.
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Affiliation(s)
| | - Brenna E Blackburn
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
| | - Lucas A Anderson
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
| | - Jeremy M Gililland
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
| | | | | | - Christopher E Pelt
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah.
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14
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Bahramian M, Dabbaghipour N, Aria A, Sajadi moghadam fard tehrani B, Dommerholt J. Efficacy of Dry Needling in Treating Scars following Total Hip Arthroplasty: A Case Report. Med J Islam Repub Iran 2022; 36:156. [PMID: 36660004 PMCID: PMC9845656 DOI: 10.47176/mjiri.36.156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Indexed: 12/24/2022] Open
Abstract
Background: In this case report of a 31-year-old female, we describe the effects of dry needling on scar tissue following total hip arthroplasty. Case report: A 31-year-old woman underwent an elective bilateral total hip replacement due to a motor vehicle accident. Based on physical examination, the patient had burning pain at the incision site at the time of menstruation and limited hip range of motion worse on the right side. The treatment program consisted of six sessions of dry needling over a three-week period alongside infrared radiation for 20 minutes during each session. The needles were spaced along the entire length of the scar tissue and rotation was performed back and forth across the scar region to release the adhesion between the scar line and the underlying tissue, focusing more on the painful-to-touch spots and adhesive points. Following the completion of the dry needling treatments hip range of motion and the patient's functional outcome improved. Dry needling may be an effective and rapid treatment for scar tissue adhesion after surgical procedures. High-quality randomized-controlled studies are needed to verify the efficacy of this method.
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Affiliation(s)
- Mehrdad Bahramian
- Department of Physiotherapy, School of Rehabilitation, Iran University of Medical Sciences, Tehran, Iran ,Department of Physical Therapy, College of Health Science &Professions, University of North Georgia, Dahlonega, USA
| | - Narges Dabbaghipour
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran, Corresponding author:Narges Dabbaghipour,
| | - Amir Aria
- Department of Physiotherapy, School of Rehabilitation, Jondishapur University of Medical Sciences, Ahvaz, Iran
| | | | - Jan Dommerholt
- Bethesda Physiocare, Bethesda, MD, USA , Myopain Seminars, Bethesda, MD, USA ,Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of Maryland, Baltimore, MD, USA
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15
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Hirose K, Kuwahara M, Nakata E, Tetsunaga T, Yamada K, Saiga K, Takigawa M, Ozaki T, Kubota S, Hattori T. Elevated Expression of CCN3 in Articular Cartilage Induces Osteoarthritis in Hip Joints Irrespective of Age and Weight Bearing. Int J Mol Sci 2022; 23:ijms232315311. [PMID: 36499638 PMCID: PMC9738275 DOI: 10.3390/ijms232315311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 11/29/2022] [Accepted: 12/02/2022] [Indexed: 12/11/2022] Open
Abstract
Osteoarthritis (OA) occurs not only in the knee but also in peripheral joints throughout the whole body. Previously, we have shown that the expression of cellular communication network factor 3 (CCN3), a matricellular protein, increases with age in knee articular cartilage, and the misexpression of CCN3 in cartilage induces senescence-associated secretory phenotype (SASP) factors, indicating that CCN3 promotes cartilage senescence. Here, we investigated the correlation between CCN3 expression and OA degenerative changes, principally in human femoral head cartilage. Human femoral heads obtained from patients who received total hip arthroplasty were categorized into OA and femoral neck fracture (normal) groups without significant age differences. Gene expression analysis of RNA obtained from femoral head cartilage revealed that CCN3 and MMP-13 expression in the non-weight-bearing part was significantly higher in the OA group than in the normal group, whereas the weight-bearing OA parts and normal cartilage showed no significant differences in the expression of these genes. The expression of COL10A1, however, was significantly higher in weight-bearing OA parts compared with normal weight-bearing parts, and was also higher in weight-bearing parts compared with non-weight-bearing parts in the OA group. In contrast, OA primary chondrocytes from weight-bearing parts showed higher expression of CCN3, p16, ADAMTS4, and IL-1β than chondrocytes from the corresponding normal group, and higher ADAMTS4 and IL-1β in the non-weight-bearing part compared with the corresponding normal group. Acan expression was significantly lower in the non-weight-bearing group in OA primary chondrocytes than in the corresponding normal chondrocytes. The expression level of CCN3 did not show significant differences between the weight-bearing part and non-weight-bearing part in both OA and normal primary chondrocytes. Immunohistochemical analysis showed accumulated CCN3 and aggrecan neoepitope staining in both the weight-bearing part and non-weight-bearing part in the OA group compared with the normal group. The CCN3 expression level in cartilage had a positive correlation with the Mankin score. X-ray analysis of cartilage-specific CCN3 overexpression mice (Tg) revealed deformation of the femoral and humeral head in the early stage, and immunohistochemical analysis showed accumulated aggrecan neoepitope staining as well as CCN3 staining and the roughening of the joint surface in Tg femoral and humeral heads. Primary chondrocytes from the Tg femoral head showed enhanced expression of Ccn3, Adamts5, p16, Il-6, and Tnfα, and decreased expression of Col2a1 and -an. These findings indicate a correlation between OA degenerative changes and the expression of CCN3, irrespective of age and mechanical loading. Furthermore, the Mankin score indicates that the expression level of Ccn3 correlates with the progression of OA.
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Affiliation(s)
- Kazuki Hirose
- Department of Biochemistry and Molecular Dentistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
- Department of Orthopaedic Surgery, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama 700-8558, Japan
| | - Miho Kuwahara
- Department of Biochemistry and Molecular Dentistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Eiji Nakata
- Department of Orthopaedic Surgery, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama 700-8558, Japan
| | - Tomonori Tetsunaga
- Department of Orthopaedic Surgery, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama 700-8558, Japan
| | - Kazuki Yamada
- Department of Orthopaedic Surgery, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama 700-8558, Japan
| | - Kenta Saiga
- Department of Orthopaedic Surgery, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama 700-8558, Japan
| | - Masaharu Takigawa
- Advanced Research Center for Oral and Craniofacial Sciences, Okayama University Dental School/Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama 700-8558, Japan
| | - Satoshi Kubota
- Department of Biochemistry and Molecular Dentistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Takako Hattori
- Department of Biochemistry and Molecular Dentistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
- Correspondence: ; Tel.: +81-86-235-6646; Fax: +81-86-235-6649
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16
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Pournajaf S, Goffredo M, Pellicciari L, Piscitelli D, Criscuolo S, Le Pera D, Damiani C, Franceschini M. Effect of balance training using virtual reality-based serious games in individuals with total knee replacement: A randomized controlled trial. Ann Phys Rehabil Med 2022; 65:101609. [PMID: 34839056 DOI: 10.1016/j.rehab.2021.101609] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 10/25/2021] [Accepted: 11/03/2021] [Indexed: 10/14/2022]
Abstract
BACKGROUND Virtual reality (VR) and serious games (SGs) are widespread in rehabilitation for many orthopedic and neurological diseases. However, few studies have addressed the effects of rehabilitation with VR-based SGs on clinical, gait, and postural outcomes in individuals with total knee replacement (TKR). OBJECTIVE The primary objective was the efficacy of balance training using non-immersive VR-based SGs compared to conventional therapy in TKR patients on the Time Up and Go test. Secondary objectives included the efficacy on clinical, gait, and postural outcomes. METHODS We randomly allocated 56 individuals with unilateral TKR to the experimental group (EG) or control group (CG) for 15 sessions (45 min; 5 times per week) of non-immersive VR-based SGs or conventional balance training, respectively. The primary outcome was functional mobility measured by the Timed Up and Go test; secondary outcomes were walking speed, pain intensity, lower-limb muscular strength, independence in activities of daily living as well as gait and postural parameters. RESULTS We found significant within-group differences in all clinical outcomes and in a subset of gait (p<0.0001) and postural (p ≤ 0.05) parameters. Analysis of the stance time of the affected limb revealed significant between-group differences (p = 0.022): post-hoc analysis revealed within-group differences in the EG (p = 0.002) but not CG (p = 0.834). We found no significant between-group differences in other outcomes. CONCLUSIONS Balance training with non-immersive VR-based SGs can improve clinical, gait, and postural outcomes in TKR patients. It was not superior to the CG findings but could be considered an alternative to the conventional approach and can be added to a regular rehabilitation program in TKR patients. The EG had a more physiological duration of the gait stance phase at the end of the treatment than the CG. CLINICALTRIALS GOV: NCT03454256.
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Affiliation(s)
- Sanaz Pournajaf
- Neurorehabilitation Research Laboratory, Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Roma, Rome, Italy
| | - Michela Goffredo
- Neurorehabilitation Research Laboratory, Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Roma, Rome, Italy
| | - Leonardo Pellicciari
- Neurorehabilitation Research Laboratory, Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Roma, Rome, Italy.
| | - Daniele Piscitelli
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada; School of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
| | - Simone Criscuolo
- Neurorehabilitation Research Laboratory, Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Roma, Rome, Italy
| | - Domenica Le Pera
- Neurorehabilitation Research Laboratory, Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Roma, Rome, Italy
| | - Carlo Damiani
- Neurorehabilitation Research Laboratory, Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Roma, Rome, Italy
| | - Marco Franceschini
- Neurorehabilitation Research Laboratory, Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Roma, Rome, Italy; Department of Human Sciences and Promotion of the Quality of Life, San Raffaele University, Rome, Italy
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17
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Hadamus A, Błażkiewicz M, Wydra KT, Kowalska AJ, Łukowicz M, Białoszewski D, Marczyński W. Effectiveness of Early Rehabilitation with Exergaming in Virtual Reality on Gait in Patients after Total Knee Replacement. J Clin Med 2022; 11:jcm11174950. [PMID: 36078879 PMCID: PMC9456315 DOI: 10.3390/jcm11174950] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/19/2022] [Accepted: 08/20/2022] [Indexed: 11/16/2022] Open
Abstract
Total knee replacement (TKR) is the treatment of choice for advanced stages of osteoarthritis but it requires good postoperative rehabilitation. This study aimed to assess the effectiveness of exercises using virtual reality to improve gait parameters in patients after TKR. Fifty-nine patients 7−14 days after TKR surgery were divided into a study group (VRG, n = 38) and a control group (CG, n = 21). Both groups underwent the same 4-week rehabilitation protocol. The VRG group had 12 additional nonimmersive virtual reality game sessions on the Virtual Balance Clinic prototype system at 30 min each, focusing on gait and balance improvement. Spatiotemporal, force and foot plantar pressure parameters were collected on an instrumented treadmill during a 30 s walk. The most significant improvement was in the symmetry indices of forefoot force, maximum forefoot force, loading response time, and preswing time (p < 0.05) in both groups. Gait speed increased by 31.25% and 44% in the VRG and CG groups, respectively (p < 0.005). However, the extra exergaming sessions did not significantly improve rehabilitation outcomes. Therefore, additional VR training does not improve gait better than standard rehabilitation alone, but the improvement of gait, especially its symmetry, is significant within the first six weeks after surgery.
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Affiliation(s)
- Anna Hadamus
- Department of Rehabilitation, Faculty of Medical Sciences, Medical University of Warsaw, 02-091 Warsaw, Poland
- Correspondence:
| | - Michalina Błażkiewicz
- Faculty of Rehabilitation, The Józef Piłsudski University of Physical Education in Warsaw, 00-809 Warsaw, Poland
| | - Kamil T. Wydra
- Professor Adam Gruca Independent Public Teaching Hospital in Otwock, Rehabilitation Clinic, 05-400 Otwock, Poland
| | - Aleksandra J. Kowalska
- Professor Adam Gruca Independent Public Teaching Hospital in Otwock, Rehabilitation Clinic, 05-400 Otwock, Poland
| | - Małgorzata Łukowicz
- Professor Adam Gruca Independent Public Teaching Hospital in Otwock, Rehabilitation Clinic, 05-400 Otwock, Poland
| | - Dariusz Białoszewski
- Department of Rehabilitation, Faculty of Medical Sciences, Medical University of Warsaw, 02-091 Warsaw, Poland
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18
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Janhunen M, Löppönen A, Walker S, Punsár T, Katajapuu N, Cheng S, Paloneva J, Pamilo K, Luimula M, Korpelainen R, Jämsä T, Heinonen A, Aartolahti E. Movement characteristics during customized exergames after total knee replacement in older adults. Front Sports Act Living 2022; 4:915210. [PMID: 35966111 PMCID: PMC9363837 DOI: 10.3389/fspor.2022.915210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/30/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction There is limited understanding of how older adults can reach kinematic goals in rehabilitation while performing exergames and conventional exercises, and how similar or different the kinematics during exergaming are when compared with conventional therapeutic exercise with similar movement. The aim of this study was to describe the movement characteristics performed during exercise in custom-designed exergames and conventional therapeutic exercises among patients who have undergone unilateral total knee replacement (TKR). In addition, the secondary aim was to assess the relation of these exercise methods, and to assess participants' perceived exertion and knee pain during exergaming and exercising. Materials and methods Patients up to 4 months after the TKR surgery were invited in a single-visit exercise laboratory session. A 2D motion analysis and force plates were employed to evaluate movement characteristics as the volume, range, and intensity of movement performed during custom-designed knee extension-flexion and weight shifting exergames and conventional therapeutic exercises post TKR. The perceived exertion and knee pain were assessed using the Borg Rating of Perceived Exertion and Visual Analog Scale, respectively. Results Evaluation of seven patients with TKR [age median (IQR), 65 (10) years] revealed that the volume and intensity of movement were mostly higher during exergames. Individual goniometer-measured knee range of motion were achieved either with exergames and conventional therapeutic exercises, especially in knee extension exercises. The perceived exertion and knee pain were similar after exergames and conventional therapeutic exercises. Conclusions During custom-designed exergaming the patients with TKR achieve the movement characteristics appropriate for post-TKR rehabilitation without increasing the stress and pain experienced even though the movement characteristics might be partly different from conventional therapeutic exercises by the volume and intensity of movement. Physical therapists could consider implementing such exergames in rehabilitation practice for patients with TKR once effectiveness have been approved and they are widely available.
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Affiliation(s)
- Maarit Janhunen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
- *Correspondence: Maarit Janhunen
| | - Antti Löppönen
- Faculty of Sport and Health Sciences, Gerontology Research Center, University of Jyväskylä, Jyväskylä, Finland
- Department of Movement Sciences, Physical Activity, Sports and Health Research Group, Katholieke Universiteit Leuven, Leuven, Belgium
- Antti Löppönen
| | - Simon Walker
- Faculty of Sport and Health Sciences, NeuroMuscular Research Center, University of Jyväskylä, Jyväskylä, Finland
| | - Taavi Punsár
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Niina Katajapuu
- Health and Well-being, Turku University of Applied Sciences, Turku, Finland
| | - Sulin Cheng
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
- Exercise Translational Medicine Center, Shanghai Center for Systems Biomedicine, Shanghai Jiao Tong University, Shanghai, China
| | - Juha Paloneva
- Department of Orthopedics and Traumatology, Hospital Nova of Central Finland, Jyväskylä, Finland
- Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Konsta Pamilo
- Department of Orthopedics, Coxa Hospital for Joint Replacement, Tampere, Finland
| | - Mika Luimula
- Faculty of Business and Engineering, Turku University of Applied Sciences, Turku, Finland
| | - Raija Korpelainen
- Department of Sports and Exercise Medicine, Oulu Deaconess Institute Foundation sr., Oulu, Finland
- Faculty of Medicine, Center for Life Course Health Research, University of Oulu, Oulu, Finland
- Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Timo Jämsä
- Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - Ari Heinonen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Eeva Aartolahti
- Institute of Rehabilitation, Jyväskylä University of Applied Sciences, Jyväskylä, Finland
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Marcu FM, Negrut N, Uivaraseanu B, Ciubara A, Lupu VV, Dragan F, Lupu A, Ciubara AB. Benefits of Combining Physical Therapy with Occupational Therapy in Hip Arthroplasty. J Pers Med 2021; 11:1131. [PMID: 34834483 PMCID: PMC8622613 DOI: 10.3390/jpm11111131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 10/27/2021] [Accepted: 10/31/2021] [Indexed: 02/07/2023] Open
Abstract
(1) Background: Hip arthroplasty (HA) is a surgery that replaces the damaged hip joint with an artificial implant called a hip prosthesis. The increase in life expectancy correlated with the population aging level, to which the increase in the number of prosthetic interventions among the young population is added, translates to the imperative need to analyze the quality of life beyond the immediate postoperative period. Strict adherence to an individualized rehabilitation program (IRP), and adapted to each patient, is followed by an improved quality of life. The main goal is the recovery of the patient with HA. This study was aimed to demonstrate that an IRP, represented by physical therapy associated with occupational therapy, improves the quality of life of patients with HA; (2) Methods: In this study, conducted between 2019 and 2021, 50 patients with HA were divided into two groups: study group-group A (25 subjects compliant with the IRP) and control group-group B (25 subjects, non-compliance with the IRP). To evaluate the two study groups, we monitored the evolution of the modified Harris hip score (mHHS) in both hips (arthroplasty hip (AH), contra lateral hip (CH)), for four months, respectively 30 days before the surgery (T0) and at 90 days after the surgery (T1); (3) Results: We notice significant differences in mHHS values at 90 days-T1 after surgery, both on AH in favor of subjects from group A vs. group B (p = 0.030) and on CH, where mHHS values were statistically higher in group A compared to group B (p < 0.001). The results of our study outline at T1 moment, both on the AH (p = 0.030) and on the CH (p < 0.001), the fact that mHHS values were statistically higher in patients included in group A compared to group B. In terms of the results for mHHS, comparing AH with CH, it is noted that the number of subjects who had a good or excellent mHHS result in group A versus group B is statistically significant in the case of CH (group A: 23 (92%) vs. group B: 11 (44%), p = 0.039); (4) Conclusions: The study reveals clear advantages of HA in both hips, both in subjects who complied with the IRP and those who did not comply; the higher therapeutic benefits of IRP are outlined at the level of CH compared to AH; in patients who comply with the IRP, the mHHS parameters that have improved in both CH and AH are pain, leaning, and shoes and socks activities; in addition, limping was reduced in CH.
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Affiliation(s)
- Florin Mihai Marcu
- Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania; (F.M.M.); (N.N.); (B.U.)
| | - Nicoleta Negrut
- Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania; (F.M.M.); (N.N.); (B.U.)
| | - Bogdan Uivaraseanu
- Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania; (F.M.M.); (N.N.); (B.U.)
| | - Anamaria Ciubara
- Faculty of Medicine and Pharmacy, “Dunarea de Jos” University of Galati, 800008 Galati, Romania; (A.C.); (A.B.C.)
| | - Vasile Valeriu Lupu
- Faculty of General Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Felicia Dragan
- Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania; (F.M.M.); (N.N.); (B.U.)
| | - Ancuta Lupu
- Faculty of General Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Alexandru Bogdan Ciubara
- Faculty of Medicine and Pharmacy, “Dunarea de Jos” University of Galati, 800008 Galati, Romania; (A.C.); (A.B.C.)
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20
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Kaczorowska A, Kaboth J, Lepsy E, Mroczek A. The effects of physiotherapy using proprioceptive neuromuscular facilitation techniques on the gait of patients after hip and knee arthroplasty: a case report. MEDICAL SCIENCE PULSE 2021. [DOI: 10.5604/01.3001.0015.2789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Gait disturbances are a major problem for patients after arthroplasty. After the surgery, walking
speed, the rhythm of locomotion, and the length of the steps are significantly reduced. One of the therapeutic
methods used in gait re-education is proprioceptive neuromuscular facilitation (PNF).
Aim of the study: This study aimed to evaluate the effects of physiotherapy using PNF techniques on the
gait of patients after hip and knee arthroplasty.
Case report: A 60-year-old woman with advanced osteoarthritis that received bilateral hip and right knee arthroplasties
was examined. Before and after the therapy, the following tests were performed: measurement of
the range of motion (ROM) of hip and knees joints in the sagittal plane using a goniometer, assessment of the
symmetry of the lower limbs loading using the two scales test, assessment of the risk of falls using the “Timed
Up and Go” test, assessment of balance and gait using the Tinetti test, and assessment of pain intensity using
the visual analogue scale (VAS). Rehabilitation was comprised of 15 PNF therapies, including scapular
and pelvic PNF patterns. The stabilization of the upper and lower trunk, lifting, shifting of the body’s weight
from one foot to another, gait cycle (the stance phase and the swing phase), walking forward, backward, and
sideways, and walking up/down the stairs were also used. After the therapy, the flexion ROM in both hip and
knees joints was improved. The lower limb symmetry index decreased from 1.167 to 1.121, and the sum of
the points obtained in the Tinetti test increased from 22 to 26. Pain in the joints also decreased from 6 on the
VAS scale to 4. However, the result obtained in the “Timed Up and Go” test after the therapy was increased by
0.5 s compared to before the therapy.
Conclusions: After hip and knee arthroplasties, physiotherapy using PNF techniques improved the gait
and functional status of the patient. Continuation of this research using a larger number of patients is
needed.
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Affiliation(s)
| | - Jolanta Kaboth
- Institute of Health Sciences, University of Opole, Poland
| | - Ewelina Lepsy
- Institute of Health Sciences, University of Opole, Poland
| | - Agata Mroczek
- Institute of Health Sciences, University of Opole, Poland
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21
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Total Knee Arthroplasty for the Oldest Old. Geriatrics (Basel) 2021; 6:geriatrics6030075. [PMID: 34449627 PMCID: PMC8395921 DOI: 10.3390/geriatrics6030075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 07/30/2021] [Accepted: 08/02/2021] [Indexed: 12/02/2022] Open
Abstract
The present study describes and compares the early functional results after total knee arthroplasty (TKA) of the oldest-old population (aged over 84 years) and a randomly matched younger septuagenarian cohort so treated. We aimed to evaluate the early functional outcomes after patients’ rehabilitation and the yearly requirements for hospital readmission and emergency room visits after TKA. We noted a similar length of hospital stay for octogenarian and septuagenarian patients, and we determined that both groups of patients were improving ROM (both flexion and extension) after the rehabilitation program (p < 0.05, in all cases), but there were no significant differences between octogenarian and septuagenarian improvement of the knee function (p > 0.05, in all cases). Patients from both age groups behaved similarly in terms of mobility before starting rehabilitation and after completion of the rehabilitation program. We noted that older octogenarian patients showed a higher one-year hospital readmission rate than younger septuagenarian patients, but similar early emergency room visits for both age groups. The findings of this study allow us to conclude that advanced age in itself should not be a contraindication for TKA.
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22
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Kaczorowska A, Kaboth J, Lepsy E, Mroczek A. The effects of physiotherapy using proprioceptive neuromuscular facilitation techniques on the gait of patients after hip and knee arthroplasty: a case report. MEDICAL SCIENCE PULSE 2021. [DOI: 10.5604/01.3001.0015.0632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background
Gait disturbances are a major problem for patients after arthroplasty. After the surgery, walking speed, the rhythm of locomotion, and the length of the steps are significantly reduced. One of the therapeutic methods used in gait re-education is proprioceptive neuromuscular facilitation (PNF).
Aim of the study
This study aimed to evaluate the effects of physiotherapy using PNF techniques on the gait of patients after hip and knee arthroplasty.
Case report
A 60-year-old woman with advanced osteoarthritis that received bilateral hip and right knee arthroplasties was examined. Before and after the therapy, the following tests were performed: measurement of the range of motion (ROM) of hip and knees joints in the sagittal plane using a goniometer, assessment of the symmetry of the lower limbs loading using the two scales test, assessment of the risk of falls using the “Timed Up and Go” test, assessment of balance and gait using the Tinetti test, and assessment of pain intensity using the visual analogue scale (VAS). Rehabilitation was comprised of 15 PNF therapies, including scapular and pelvic PNF patterns. The stabilization of the upper and lower trunk, lifting, shifting of the body’s weight from one foot to another, gait cycle (the stance phase and the swing phase), walking forward, backward, and sideways, and walking up/down the stairs were also used. After the therapy, the flexion ROM in both hip and knees joints was improved. The lower limb symmetry index decreased from 1.167 to 1.121, and the sum of the points obtained in the Tinetti test increased from 22 to 26. Pain in the joints also decreased from 6 on the VAS scale to 4. However, the result obtained in the “Timed Up and Go” test after the therapy was increased by 0.5 s compared to before the therapy. Conclusions
After hip and knee arthroplasties, physiotherapy using PNF techniques improved the gait and functional status of the patient. Continuation of this research using a larger number of patients is needed.
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Affiliation(s)
| | - Jolanta Kaboth
- Institute of Health Sciences, University of Opole, Poland
| | - Ewelina Lepsy
- Institute of Health Sciences, University of Opole, Poland
| | - Agata Mroczek
- Institute of Health Sciences, University of Opole, Poland
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23
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Georgiev T. Multimodal approach to intraarticular drug delivery in knee osteoarthritis. Rheumatol Int 2020; 40:1763-1769. [PMID: 32803403 DOI: 10.1007/s00296-020-04681-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 08/08/2020] [Indexed: 12/21/2022]
Abstract
The expectations from any future disease-modifying treatment for knee osteoarthritis (KOA) are extremely high as it has to impact the joint as a whole leading to favorable alterations of diverse tissues and functions. In this light, targeting the knee only from the inside may not be biologically justified for the management of a whole joint disease such as KOA. Our hypothesis to test is whether any injectable therapeutic intervention alone can lead to disease modification of KOA which is viewed in the complexity of the modern concept of osteoarthritis (OA) as a whole joint disease. Therefore, we aimed at analyzing the intraarticular route to the KOA patient in an attempt to unveil its "biological" constraints. A comprehensive search through databases was carried out using specific keywords to add objectivity to the main messages. The literature analysis has shown that "cutting-edge" intraarticular therapies may offer a key to non-invasive symptomatic relief. Changing the course of KOA, however, may necessitate a multimodal approach towards the knee joint including a combination of intraarticular injections with interventions on multiple levels. Importantly, our understanding of OA has evolved redefining the concept of the disease, being in interaction with the human body as a whole. Any future conservative disease-modifying treatment of KOA should aim at a multimodal, holistic approach towards the knee joint including but not limited only to intraarticular injections. A combination with other interventions should be further researched.
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Affiliation(s)
- Tsvetoslav Georgiev
- First Department of Internal Diseases, Faculty of Medicine, Medical University-Varna, Varna, Bulgaria. .,Clinic of Rheumatology, University Hospital "St. Marina", 1, Hristo Smirnenski, 9010, Varna, Bulgaria.
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