Objective To investigate the effectiveness of modified rehabilitation programmes in comparison with standard rehabilitation programmes after total knee arthroplasty through randomized controlled trials. Data sources A search was conducted in PubMed, PubMed Central (PMC) and Cochrane Library databases in December 2020. Study selection Randomized controlled trials were reviewed if they compared a physiotherapy exercise intervention with usual or standard physiotherapy care, or if they compared 2 types of exercise physiotherapy interventions meeting the review criteria, after total knee arthroplasty for osteoarthritis. A total of 18 randomized controlled trials were included at the end of the screening process. Data extraction Two authors independently screened the literature, extracted data, and assessed the quality of included studies. The outcomes were knee extension, knee flexion, pain visual analogue scale, overall Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), 6-minute walking test, and Timed Up and Go test. Data synthesis There was no clear pattern regarding which combination of starting time-point and duration of the rehabilitation programme after total knee arthroplasty significantly improves the clinical outcome when comparing modified rehabilitation programmes with standard programmes. Moreover, no particular modification to the modified programmes could be solely attributed to the improved clinical outcome in the 2 studies that showed significant improvement. Conclusion Modified rehabilitation programmes do not result in systematic improvement in clinical outcome over one-size-fits-all-approaches after total knee arthroplasty. LAY ABSTRACT The aim of this study was to compare modified rehabilitation programmes with standard rehabilitation programmes after total knee replacement. A total of 18 randomized controlled trials were included at the end of the screening process. Six clinical outcomes were used for comparison. To our knowledge, this is the first study to compare modified and standard rehabilitation programmes based on the starting point and the duration of each programme. The results of the comparison showed that there is no clear pattern in the combination of starting time-point and duration of rehabilitation that significantly improves clinical outcomes. Moreover, improved clinical outcomes could not be attributed solely to any particular modification to the programmes. Accordingly, a one-size-fits-all approach to modified rehabilitation programmes does not result in systematic improvement in clinical outcome.
In patients without significant angiographic coronary artery disease, the result of stress MPS is a predictor of long-term prognosis. Quantitative analysis of MPS allows definition of patients with a higher likelihood to develop clinical events or symptoms.
Background: Minimally invasive surgery is the standard technique for many operations. Laparoscopic training has a long learning curve. Robotic solutions may shorten the training pathway. The aim of this study was to compare laparoscopic with robotic training in surgical trainees and medical students. Methods: Surgical trainees (ST group) were randomized to receive 6 h of robotic or laparoscopic simulation training. They then performed three surgical tasks in cadaveric specimens. Medical students (MS group) had 2 h of robotic or laparoscopic simulation training followed by one surgical task. The Global Rating Scale (GRS) score (maximum 30), number of suture errors, and time to complete each procedure were recorded. Results: The median GRS score for the ST group was better for each procedure after robotic training compared with laparoscopic training (total GRS score: 27⋅00 (i.q.r. 22⋅25-28⋅33) versus 18⋅00 (16⋅50-19⋅04) respectively, P < 0⋅001; 10 participants in each arm). The ST group made fewer errors in robotic than in laparoscopic tasks, for both continuous (7⋅00 (4⋅75-9⋅63) versus 22⋅25 (20⋅75-25⋅25); P < 0⋅001) and interrupted (8⋅25 (6⋅38-10⋅13) versus 29⋅50 (23⋅75-31⋅50); P < 0⋅001) sutures. For the MS group, the robotic group completed 8⋅67 interrupted sutures with 15⋅50 errors in 40 min, compared with only 3⋅50 sutures with 40⋅00 errors in the laparoscopic group (P < 0⋅001) (10 participants in each arm). Fatigue and physical comfort levels were better after robotic compared with laparoscopic operating for both groups (P < 0⋅001). Conclusion: The acquisition of surgical skills in surgical trainees and the surgically naive takes less time with a robotic compared with a laparoscopic platform.
Background Symmetry is a sign of physiological and healthy movements, as pathologies are often described by increased asymmetries. Nevertheless, based on precisely measured data, even healthy individuals will show small asymmetries in their movements. However, so far there do not exist commonly accepted methods and reference values for gait symmetry in a healthy collective. Therefore, a comparison and presentation of reference values calculated by 3 different methods of symmetry indices for lower limb joint angles during walking, ascending, and descending stairs were shown. Methods Thirty-five healthy participants were analyzed during walking, ascending, and descending stairs with the help of the inertial measurement system MyoMotion. Using the normalized symmetry index (SInorm), the symmetry index (SI) as the integral of the symmetry function, and another normalized symmetry index (NSI), the symmetry of joint angles was evaluated. For statistical evaluation of differences, repeated measurement models and Bland–Altman-Plots were used. Results Apart from a bias between the symmetry indices, they were comparable in the predefined limits of 5%. For all parameters, significantly higher asymmetry was found for ankle dorsi/-plantarflexion, compared with the hip and knee flexion. Moreover, the interaction effect of the joint and movement factors was significant, with an increased asymmetry of the hip and knee during descending stairs greater than while ascending stairs or walking, but a reduced symmetry of the ankle during walking when compared to descending. The movement only showed significant effects when analyzing the SInorm. Conclusion Even for healthy individuals, small asymmetries of movements were found and presented as reference values using 3 different symmetry indices for dynamic lower limb joint angles during 3 different movements. For the quantification of symmetrical movements differences between the joints, movements, and especially their interaction, are necessary to be taken into account. Moreover, a bias between the methods should be noted. The potential for each presented symmetry index to identify pathological movements or track a rehabilitation process was shown but has to be proven in further research. Trial registration: DRKS00025878.
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