Early inpatient rehabilitation after elective hip and knee arthroplasty
Early inpatient rehabilitation after elective hip and knee arthroplasty
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DOI：
10.1001/jama.279.11.847
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发表时间：
1998-03-18
影响因子：
120.7
通讯作者：
Rubash, HE
中科院分区：
文献类型：
--
作者：
Munin, MC;Rudy, TE;Rubash, HE
背景。-择期髋关节和膝关节置换术后的住院康复对于手术后不久无法在家活动的患者通常是必要的，但手术后多久可以开始住院康复尚未研究。为了检验假设，即如果住院康复在术后第3天而不是第7天开始，接受择期髋关节和膝关节置换术的高风险患者将产生更少的总成本，并经历更快的功能改善，而不会对患者造成不良后果。1994 - 1996年随机对照试验。三级保健中心。内裤。-共86例患者接受择期髋关节或膝关节置换术，符合以下高风险标准：70岁或以上且独居，70岁或以上且有2种或以上共病，或任何年龄且有3种或以上共病。在86名患者中，71名完成了研究。随机分配到术后第3天与术后第7天开始住院康复。骨科和康复住院的总住院时间和费用，使用功能独立性测量子集的医院功能表现，以及使用兰德36项健康调查I和功能状态指数的4个月随访评估。完成研究并在术后第3天开始住院康复治疗的患者的平均（+/-SD）总住院时间较短（11.7+/-2.3天vs 14.5+/-1.9天，P
Context.-Inpatient rehabilitation after elective hip and knee arthroplasty is often necessary for patients who cannot function at home soon after surgery, but how soon after surgery inpatient rehabilitation can be initiated has not been studied.Objective.-To test the hypothesis that high-risk patients undergoing elective hip and knee arthroplasty would incur less total cost and experience more rapid functional improvement if inpatient rehabilitation began on postoperative day 3 rather than day 7, without adverse consequences to the patients.Design.-Randomized controlled trial conducted from 1994 to 1996.Setting.-Tertiary care center.Participants.-A total of 86 patients undergoing elective hip or knee arthroplasty and who met the following criteria for being high risk: 70 years of age or older and living alone, 70 years of age or older with 2 or more comorbid conditions, or any age with 3 or more comorbid conditions. Of the 86 patients, 71 completed the study.Interventions.-Random assignment to begin inpatient rehabilitation on postoperative day 3 vs postoperative day 7.Main Outcome Measures.-Total length of stay and cost from orthopedic and rehabilitation hospital admissions, functional performance in hospitals using a subset of the functional independence measure, and 4-month follow-up assessment using the RAND 36-item health survey I and the functional status index.Results.-Patients who completed the study and began inpatient rehabilitation on postoperative day 3 exhibited shorter mean (+/-SD) total length of stay (11.7+/-2.3 days vs 14.5+/-1.9, P