The authors declare that they have no competing interests.
TB wrote the original manuscript, contributed to the data analysis, the interpretation and presentation of the data. FA was responsible for the analysis, the interpretation of the data and the preparation of the manuscript. TB, SL and MLV were responsible for the data preparation, helped in the analysis and the interpretation of the data. PO, RH, CMM, EK and MLV were responsible for the conception, the design, and the resources for the study and helped to prepare the manuscript. All authors read and approved the final manuscript.
Patients after primary hip or knee replacement surgery can benefit from postoperative treatment in terms of improvement of independence in ambulation, transfers, range of motion and muscle strength. After discharge from hospital, patients are referred to different treatment destination and modalities: intensive inpatient rehabilitation (IR), cure (medically prescribed stay at a convalescence center), or ambulatory treatment (AT) at home. The purpose of this study was to 1) measure functional health (primary outcome) and function relevant factors in patients with hip or knee arthroplasty and to compare them in relation to three postoperative management strategies: AT, Cure and IR and 2) compare the post-operative changes in patient’s health status (between preoperative and the 6 month follow-up) for three rehabilitation settings.
Natural observational, prospective two-center study with follow-up. Sociodemographic data and functional mobility tests, Timed Up and Go (TUG) and Iowa Level of Assistance Scale (ILOAS) of 201 patients were analysed before arthroplasty and at the end of acute hospital stay (mean duration of stay: 9.7 days +/− 3.9). Changes in health state were measured with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) before and 6 months after arthroplasty.
Compared to patients referred for IR and Cure, patients referred for AT were significantly younger and less comorbid. Patients admitted to IR had the highest functional disability before arthroplasty. Before rehabilitation, mean TUG was 40.0 s in the IR group, 33.9 s in the Cure group, and 27.5 s in the AT group, and corresponding mean ILOAS was 16.0, 13.0 and 12.2 (50.0 = worst). At the 6 months follow-up, the corresponding effect sizes of the WOMAC global score were 1.32, 1.87, and 1.51 (>0 means improvement).
Age, comorbidity and functional disability are associated with referral for intensive inpatient rehabilitation after hip or knee arthroplasty and partly affect health changes after rehabilitation.
Jordan KM, Arden NK, Doherty M, Bannwarth B, Bijlsma JWJ, Dieppe P, et al. EULAR Recommendations 2003: an evidence based approach to the management of knee osteoarthritis: Report of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann Rheum Dis. 2003;62:1145–55. CrossRefPubMedPubMedCentral
Zhang W, Doherty M, Arden N, Bannwarth B, Bijlsma J, Gunther K, et al. EULAR evidence based recommendations for the management of hip osteoarthritis: report of a task force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis. 2005;64:669–81. CrossRefPubMed
Ethgen O, Bruyère O, Richy F, Dardennes C, Reginster JY. Health-related quality of life in total hip and total knee arthroplasty. A qualitative and systematic review of the literature. J Bone Joint Surg Am. 2004;86:963–74. PubMed
Jones CA, Voaklander DC, Johnston DW, Suarez-Almazor ME. Health related quality of life outcomes after total hip and knee arthroplasties in a community based population. J Rheumatol. 2000;27:1745–52. PubMed
Falbrede I, Widmer M, Kurtz S, Schneidmüller D, Dudda M, Röder C. Utilization rates of lower extremity prostheses in Germany and Switzerland: a comparison of the years 2005–2008. Verwendungsraten von Prothesen der unteren Extremität in Deutschland und der Schweiz. Ein Vergleich der Jahre 2005–2008. Orthopade. 2011;40:793–801. CrossRefPubMed
OECD. Hip and knee replacement. In: OECD, Health at a Glance 2013: OECD Indicators. OECD Publishing. [http://dx.doi.org/ 10.1787/health_glance-2013-38-en]. Access date: 18.04.2014.
Ontario HQ. Physiotherapy rehabilitation after total knee or hip replacement: an evidence-based analysis. Ont Health Technol Assess Ser. 2005;5:1–91.
Bellamy N. WOMAC osteoarthritis index. A user’s guide. London: University of Western Ontario; 1995.
Angst F, Aeschlimann A, Stucki G. Smallest detectable and minimal clinically important differences of rehabilitation intervention with their implications for required sample sizes using WOMAC and SF-36 quality of life measurement instruments in patients with osteoarthritis of the lower extremities. Arthritis Rheum. 2001;45:384–91. CrossRefPubMed
Stucki G, Meier D, Stucki S, Michel BA, Tyndall AG, Dick W, et al. Evaluation of German version of the WOMAC (Western Ontario and McMaster Universities) osteoarthritis index. Z Rheumatol. 1996;55:40–9. PubMed
Shields RK, Enloe LJ, Evans RE, Smith KB, Steckel SD. Reliability, validity, and responsiveness of functional tests in patients with total joint replacement. Phys Ther. 1995;75:169–76. PubMed
Cantieni M, Leensen T, Knuesel O, Oesch P. Is the ILOAS a suitable assessment tool for functional status evaluation of patients with total knee arthroplasty during inpatient rehabilitation? Reproducibility, validity and responsiveness of the ILOAS. Physioscience. 2009;5:165–72. CrossRef
Mathias S, Nayak USL, Isaacs B. Balance in elderly patients: The “Get-up and Go” test. Arch Phys Med Rehabil. 1986;67:387–9. PubMed
Nordin E, Rosendahl E, Lundin-Olsson L. Timed “Up & Go” test: reliability in older people dependent in activities of daily living-focus on cognitive state. Phys Ther. 2006;86:646–55. PubMed
Kazis LE, Anderson JJ, Meenan RF. Effect sizes for interpreting changes in health status. Med Care. 1989;27 Suppl 3:178–89. CrossRef
Mahomed NN, Koo Seen Lin MJ, Levesque J, Lan S, Bogoch ER. Determinants and outcomes of inpatient versus home based rehabilitation following elective hip and knee replacement. J Rheumatol. 2000;27:1753–8. PubMed
- Comparison of patients in three different rehabilitation settings after knee or hip arthroplasty: a natural observational, prospective study
C. Mueller Mebes
- BioMed Central
Neu im Fachgebiet Orthopädie und Unfallchirurgie
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