Predicting Postoperative Course After Total Shoulder Arthroplasty Using a Medical-Social Evaluation Model
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Introduction: The ability to predict successful outcomes is important for patient satisfaction and optimal results after shoulder arthroplasty. We hypothesize that a medical-social scoring tool will predict resource requirements in doing total shoulder arthroplasty (TSA). Methods: A retrospective analysis of 453 patients undergoing TSA was undertaken. Preoperatively, medical and social surveys were completed by each patient. Demographics, comorbidity scores, hospital course, postdischarge disposition, and readmissions were collected. Results: The average length of stay was 1.6 days (0 to 7). There was an association with utilization of home care or inpatient rehabilitation and both the medical (7.3 versus 3.9; P = 0.0002) and social (7.1 versus 3.4; P < 0.0001) components of the survey. There was a weak correlation between hospital length of stay and the social component of the survey (R = 0.29; P < 0.001), but not the medical component (R = 0.04; P = 0.38). No variable was predictive of readmission. Social score of eight was found to be predictive of postoperative requirement of home care or rehabilitation. Conclusion: This study found that Medical and Social Survey Scores can stratify patients who are at risk of requiring more advanced postdischarge care and/or a longer hospital stay. With this, we can match patients to the most appropriate level of postoperative care.Keywords:
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The aim of the study was to improve physical activity (PA), well-being and clinical outcome after total knee and hip arthroplasty through tailored activity counselling during inpatient rehabilitation. 65 patients (aged 70.4 ± 7.3 years, BMI 28.5 ± 4.3) starting inpatient rehabilitation after primary knee or hip arthroplasty due to osteoarthritis were recruited and pseudo-randomized into an intervention (IG) and a control group (CG). Twice a week, the IG was encouraged to increase their daily step count by 5%. PA, e. g. number of steps, step frequency, or active minutes, was measured by step activity monitoring. Well-being and clinical outcome were assessed using the SF-36, Oxford Knee/Hip Score and Global rating of Change. Procedures were conducted at the onset of inpatient rehabilitation, and repeated one and 6 months after inpatient rehabilitation. Data sets were obtained from 49 patients (IG: n = 23, CG: n = 26). Both groups significantly increased their number of daily steps from the 1 month to the 6 months follow up after rehabilitation: CG: 9019 (95%CI: 7812, 10,226), IG: 9280 (7972, 10,588) and CG: 10921 (9571, 12,271), IG: 11326 (9862, 12,791) respectively. Additionally, well-being and clinical outcome improved significantly in both groups. No significant differences in physical activity, clinical outcome and well-being were found between the groups. PA counselling during inpatient rehabilitation does not improve PA, well-being and clinical outcome in patients with primary knee or hip arthroplasty in addition to the rehabilitation program. PA interventions may be more effective after the completion of the inpatient rehabilitation phase. DRKS DRKS00012682 . Registered retrospectively on 03–07- 2017.
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Most patients who receive a total knee arthroplasty (TKA) undergo rehabilitation in the postoperative period. However, these therapies are often not under the direct supervision of the treating physicians, have variable protocols, and have unclear long-term efficacies. The purposes of this study were to assess patient satisfaction with their rehabilitation following TKA and to evaluate whether various factors were different between satisfied and unsatisfied patients. A total of 100 consecutive patients who underwent 107 primary TKA were prospectively surveyed to evaluate their rehabilitation experiences. There were 28 men and 72 women who had a mean age of 61 years (range, 37 to 91 years) at the time of surgery. Patients answered questions regarding the number and duration of therapies, amount of hands-on time with the therapists, number of different therapists, amount of co-pay, and their overall level of satisfaction with their rehabilitation experience. Over one-third of the patients reported not being satisfied with their rehabilitation experiences. The patients who were dissatisfied reported a shorter mean duration of each therapy session spent directly with the therapist, a higher mean number of therapists seen over the duration of their treatment, and an increased number of co-participants during their therapy sessions. The authors believe that to minimize patient dissatisfaction with rehabilitation, surgeons should refer patients to therapists who are willing to spend adequate hands-on time during one-on-one or smaller group therapy sessions with their patients.
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Up to 25% of patients after knee arthroplasty are not satisfied with the results of the operation. Revision interventions are performed in 60–80% of cases in the first 2–5 years after the primary arthroplasty. Aim. To evaluate the effectiveness of the early postoperative rehabilitation comprehensive program from the standpoint of the International Classification of Functioning (ICF) to improve the results of rehabilitation after arthroplasty. Material and methods. The results of 180 patients rehabilitation after the total knee arthroplasty (TKA) with simultaneous reconstruction of the lower limb biological axis were evaluated in two groups: I – observations (n=120), II – comparisons (n=60). Postoperative rehabilitation in the group I was carried out according to of the early rehabilitation comprehensive program after TKA, developed in the clinic, in the group II – according to the standard scheme. State of the patient was assessed by the dynamics of the pain syndrome, lower limbs muscle strength, goniometric indicators, the severity of lameness, muscle hypotrophy, limb shortening value, functional activity and quality of life. For analysis of changes in the level of damage according to the ICF, clinical tests were used. Results. From the standpoint of the ICF, the results of patients using the early postoperative rehabilitation program were equal or superior to the results of the comparison group. Conclusion. A rehabilitation program for patients after TKA, formed on the basis of a system for assessing the structural, functional and social adaptation characteristics of the patient, is effective and allows to predict the effectiveness of the rehabilitation technologies.
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Rehabilitation after primary reverse total shoulder arthroplasty (RTSA) is accepted to be an essential component to successful outcome achievement, but successful rehabilitation approaches have yet to be well described in the literature. This retrospective review documents the outcomes of a cohort of 29 patients undergoing RTSA surgery with rehabilitation following the Upper Limb Treatment and Rehabilitation Advice (ULTRA) guideline (Appendix 1). The Oxford Shoulder Score, Quick Disabilities of the Arm, Shoulder and Hand score, range of movement (degrees of flexion, abduction and external rotation) and numerical rating score for pain were prospectively collected pre-operatively and at one- and two-years post-operatively. Scores were then evaluated to establish whether or not there were any significant changes over time. Statistically significant improvements were seen in all outcome domains from pre-operative to one-year post-operative. All improvements met the threshold for achieving substantial clinical benefit as well as exceeding the minimum clinically important difference, and all improvements were maintained at the two-year post-operative time point. The present study showed that following the ULTRA guideline after elective RTSA can give statistically significant improvements in range of movement, pain score and patient-reported outcome at one-year post-operatively, which can be maintained up to two-years post-operatively.
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Although shoulder arthroplasty with ensuing rehabilitation is a relatively common intervention, the factors influencing the functional outcome are still a matter of discussion. These are evaluated based on the outcome as estimated by the Constant Score and patient satisfaction. Consequently, a prediction of the outcome based on initial demographic and diagnostic parameters is shown. 57 patients received an alloplastic shoulder replacement followed by short stay in-patient rehabilitation. To estimate functional results a questionnaire including the Constant Score, clinical examination, numerical rating scale for pain estimation, radiological investigation of the shoulder joint and satisfaction were recorded. A generalized linear model was fitted to evaluate the effect of covariates Constant Score at admission, discharge and the improvement in-between. 47 (82%) patients were content with the treatment received. The median Constant Score at admission of 31 (±3 improved to 64 (±12) at follow-up. Patients treated by senior specialist obtained 13 (±2) points more at discharge than patients treated by less experienced surgeons. Patients with assisted physiotherapy between operation and rehabilitation achieved 8 (±2) points more. Motivated patients did 7 (±2) points. A minimal Constant Score of 40 at admission, 60 at discharge or an improvement of 30 points ensured satisfied patients. Motivated patients receiving assisted physiotherapy between operation by an experienced specialist and rehabilitation have better functional results. Age, gender, type of prosthesis and diagnosis have no effect. A Constant Score of ≥40 at admission is associated with the patients being motivated and satisfied with the treatment.
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