Comparison of patients in three different rehabilitation settings after knee or hip arthroplasty: a natural observational, prospective study

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 modalitie...

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Published in:	BMC musculoskeletal disorders Vol. 16; no. 1; p. 317
Main Authors:	Benz, T, Angst, F, Oesch, P, Hilfiker, R, Lehmann, S, Mueller Mebes, C, Kramer, E, Verra, M L
Format:	Journal Article
Language:	English
Published:	England BioMed Central Ltd 24-10-2015 BioMed Central
Subjects:	Aged Arthritis Arthroplasty, Replacement, Hip - rehabilitation Arthroplasty, Replacement, Knee - rehabilitation Decision making Evidence-based medicine Female Health aspects Health insurance Hospitalization Hospitals Humans Hypotheses Joint replacement surgery Knee Male Middle Aged Mobility Limitation Osteoarthritis Patients Prospective Studies Questionnaires Rehabilitation Rehabilitation Centers - statistics & numerical data Surgeons Surgical outcomes Switzerland
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Summary:	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.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Undefined-1 ObjectType-Feature-3 content type line 23
ISSN:	1471-2474 1471-2474
DOI:	10.1186/s12891-015-0780-2