The provision of preoperative and postoperative physical therapy in elderly people with hip and knee osteoarthritis undergoing primary joint replacement surgery
The provision of preoperative and postoperative physical therapy in elderly people with hip and knee osteoarthritis undergoing primary joint replacement surgery
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DOI：
10.1097/bco.0000000000000347
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发表时间：
2016-03-01
影响因子：
0.3
通讯作者：
Vlieland, Thea P. M. Vliet
中科院分区：
文献类型：
--
作者：
Peter, Wilfred F.;Tilbury, Claire;Vlieland, Thea P. M. Vliet
背景：尽管物理疗法(PT)在人工全髋关节置换术(THA)和全膝关节置换术(TKA)患者康复中的价值已得到普遍认可，但其实际应用范围和内容却鲜为人知。本研究旨在描述全髋关节置换术(THA)和全膝关节置换术(TKA)术前、术后PT的应用、特点和影响因素。方法：对4所医院1,005例THA或TKA患者的转诊、设置、持续时间、术前术后PT内容以及目前的身体功能水平(髋关节功能障碍和骨关节炎结果[HOOS]、膝关节损伤和骨关节炎结果[KOOS])和生活质量(简表-36[SF-36])进行调查。结果：522例应答者中，210例(54%THA和46%TKA)术前PT(40%；44%；12wk；38%)每周2次；514例术后PT(99%；47%；=12wk；67%；每周2次)。最常见的干预措施(P>；60%的患者)是术前的有氧运动和步行楼梯，以及术后的有氧运动、肌肉强化和活动范围练习、步行楼梯和步态训练。对于术前PT，女性是唯一与其提供相关的因素。此外，医院与骨科医生转诊的比例以及较长的随访时间有关，因为手术与提供物理方式的比率较低有关。对于术后PT，医院与PT的持续时间和被动锻炼的提供有关，而年龄较大的患者骨科医生转诊次数较少且治疗持续时间少于12周，而女性患者的治疗持续时间超过12周。术后PT持续时间越长，患者的生活质量越差，而术前PT的使用和频率与患者目前的健康状况无关。结论：几乎所有接受THA或TKA的患者术后都接受了PT，但只有不到一半的患者在术前接受了PT。手术前和术后PT的提供有相当大的差异，部分与患者和医院的特点以及自手术以来的时间有关，因此有必要对潜在的实践差异进行更多的前瞻性研究。
Background:Although the value of physical therapy ( PT) in the rehabilitation of patients undergoing THA and TKA is generally acknowledged, little is known on the actual extent of its delivery and contents. This study aimed to describe the use, characteristics, and determinants of preoperative and postoperative PT in THA and TKA.Methods:One thousand and five patients who underwent THA or TKA in four hospitals in the preceding 7-22 mo were invited to complete a survey on referral, setting, duration, and content regarding preoperative and postoperative PT as well as their current level of physical functioning (Hip Disability and Osteoarthritis Outcome [HOOS] and Knee Injury and Osteoarthritis Outcome Score [KOOS]) and quality of life (Short Form-36 [SF-36]). The association between patients' characteristics (age and sex), hospital stay, and time since surgery on the one side and the provision of PT on the other and between PT usage and physical function and quality of life were analyzed by multivariable logistic and linear regression analyses.Results:In total, 210 of the 522 responders (54% THA and 46% TKA) patients had preoperative PT (40%; 44% > 12 wk; 38% >= 2 times per week) and 514 postoperative PT (99%; 47% >= 12 wk; 67% >= 2 times per week). The most frequently reported interventions (p > 60% of patients) preoperatively were aerobic exercises and walking stairs and postoperatively, aerobic, muscle strengthening and range of motion exercises, walking stairs, and gait training. Regarding preoperative PT, female sex was the only factor associated with its provision. Moreover, the hospital was related to the proportion of referrals made by the orthopaedic surgeon, and a longer follow-up time since surgery was associated with a lower rate of provision of physical modalities. For postoperative PT, the hospital was associated with duration of PT and the provision of passive exercises, whereas older age was associated with fewer referrals by orthopaedic surgeons and treatment duration less than 12 wk, and female sex was associated with a treatment duration longer than 12 wk. A longer duration of postoperative PT was only associated with a worse physical quality of life, whereas preoperative PT use and the frequency of postoperative PT were not associated with any aspect of the patients' current health status.Conclusions:Almost all patients undergoing THA or TKA received postoperative PT, whereas fewer than half had preoperative PT. There was considerable variation in the provision of preoperative and postoperative PT in part associated with patient and hospital characteristics and time since surgery, warranting the need for more prospective research into potential practice variation.