Efficacy of multimodal optimization of mobilization and nutrition in patients undergoing hip replacement: a randomized clinical trial

Petersen, Mette K; Madsen, Claus; Andersen, Niels Trolle; Søballe, Kjeld

doi:10.1111/j.1399-6576.2006.01040.x

Cited by 38 publications

(45 citation statements)

References 15 publications

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“…An accelerated intervention is defined as a multimodal intervention taking place in a multidisciplinary organization in order to shorten time to convalescence (Wilmore and Kehlet 2001, Kehlet and Wilmore 2002. Until 2005, the outcome of accelerated perioperative care and rehabilitation interventions was conflicting (Dowsey et al 1999, Kim et al 2003, Reilly et al 2005, Petersen et al 2006. The main intention regarding results from accelerated procedures abroad and in Denmark has been to reduce the length of stay (LOS) and to minimize complications (Rasmussen et al 2001, Husted et al 2004.…”

mentioning

confidence: 99%

Hip arthroplasty patients benefit from accelerated perioperative care and rehabilitation: A quasi-experimental study of 98 patients

2008

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Background and purposeMore than 6,500 hip arthroplasties were performed in Denmark in 2005. Accelerated perioperative interventions are currently implemented, and the length of stay is thereby reduced. An increase in postoperative health-related qualityof-life (HRQOL) has been observed for hip patients after accelerated perioperative procedures compared to standard procedures. However, no studies have used HRQOL as a primary outcome. We therefore performed a before-after trial to investigate whether HRQOL would be improved postoperatively in hip arthroplasty patients undergoing accelerated perioperative care and rehabilitation intervention compared to those undergoing current intervention.Patients and methods 98 elective primary hip arthroplasty patients underwent either a standard procedure or an accelerated perioperative procedure (n = 48 and n = 50, respectively). Primary outcome was difference in HRQOL measured with EQ-5D, which measures HRQOL in 5 dimensions (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) at the 3-month follow-up visit.Results HRQOL was markedly improved in both groups. A significant difference in HRQOL at follow-up of 0.08 (95% CI: 0.01-0.15) in favor of the patients who received the accelerated intervention was observed (p = 0.02).Interpretation Hip arthroplasty patients benefit postoperatively from accelerated perioperative care and rehabilitation procedures, with an HRQOL that is approximately 10% higher than that of patients receiving standard procedures.

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confidence: 99%

Hip arthroplasty patients benefit from accelerated perioperative care and rehabilitation: A quasi-experimental study of 98 patients

2008

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“…In an unblinded RCT, we assessed the efficacy of a fast-track program after elective primary unilateral total hip replacement (THR) and perioperative epidural analgesia (Petersen et al 2006). Randomized controlled trials (RCTs) are frequently considered to be the gold standard of study designs for determining the efficacy of different interventions (Gross et al 2002, Rothwell 2005.…”

mentioning

confidence: 99%

“To whom do the results of this trial apply?”: External validity of a randomized controlled trial involving 130 patients scheduled for primary total hip replacement

Petersen

Andersen

et al. 2007

Acta Orthopaedica

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Background Although the randomized controlled trial (RCT) is regarded as the gold standard for evaluation of the effect of an intervention, its external validity has been questioned. RCTs cannot be expected to produce results that are directly relevant to all patients and all settings, but they should at least allow patients and clinicians to judge to whom trial results can reasonably be applied.We assessed the external validity of an RCT investigating the efficacy of a fast-track program after total hip replacement.Methods 130 patients were identified as potential participants.18 patients were excluded, 33 enrolled patients declined to participate, and 79 patients were enrolled and randomized. We studied the distribution of preoperative characteristics and postoperative clinical variables in these 3 groups.Results A significant difference was found in both preoperative characteristics and clinical outcome variables. The non-consenters were older, less healthy, and needed more help from the home care system. Furthermore, they were hospitalized longer and were more often transferred to a rehabilitation ward.Interpretation Our findings demonstrate the importance of patient inclusion criteria in RCTs. Moreover, they may account for the lack of reproducibility of RCT results in clinical practice dealing with fast-track programs.

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“…This result could be a coincidence caused by multiple testing (pvalues were close to 0.05), but generally speaking the CPC group did better postoperatively than the OPC group. We have no clear explanation for this finding, but as the OPC group was hospitalized for a significantly shorter time than the CPC group (Petersen et al 2006), we cannot eliminate the possibility that length of stay was a confounding factor.…”

Section: Discussionmentioning

confidence: 59%

“…In this paper we present our findings from prolonged follow-up of a cohort defined by a previous randomized controlled trial (RCT) (Petersen et al 2006). The study was approved by the local ethics committee and was carried out in accordance with the Helsinki Declaration.…”

Section: Methodsmentioning

confidence: 99%

Self-reported functional outcome after primary total hip replacement treated with two different periopera-tive regimes: A follow-up study involving 61 patients

2008

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Background and purpose Fast-track surgery has been reported to improve rehabilitation outcome after major surgery, with length of hospitalization and muscle strength as outcome measures. We assessed the effect of optimization of perioperative care during admission on self-reported functional outcome, and compared patient status 6 months after THR with an age-matched healthy cohort.Patients and methods 79 THR patients were randomized to optimized perioperative care (OPC) or conventional perioperative care (CPC). 61 patients fulfilled the requirements of the study protocol. Endpoint outcome was measured by SF-36 and WOMAC. To compare functional outcome in the THR group with that in healthy controls, we used data from a representative sample of 4,098 non-institutionalized Danish adults collected by the Danish National Institute of Public Health.Results We found similar improvements in SF-36 and WOMAC scores for the OPC and CPC groups postoperatively, except for the total WOMAC score and the WOMAC subscore "function"-in which the CPC group did statistically significantly better. The OPC and CPS groups had similar score levels. 6 months after surgery, THR patients scored higher overall in the general health subscale and lower in three physical subscales of SF-36 compared to age-matched healthy controls.Interpretation We found no evidence for the effect of optimization strategies during admission on selfreported functional outcome after THR. Although THR patients improved considerably after treatment, their

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Efficacy of multimodal optimization of mobilization and nutrition in patients undergoing hip replacement: a randomized clinical trial

Abstract: Compared with conventional care, optimal and aggressive nutrition and mobilization resulted in a very moderate reduction in length of stay. There were no differences regarding pain, complications or time until independence in PADL.

Cited by 38 publications

References 15 publications

Hip arthroplasty patients benefit from accelerated perioperative care and rehabilitation: A quasi-experimental study of 98 patients

Hip arthroplasty patients benefit from accelerated perioperative care and rehabilitation: A quasi-experimental study of 98 patients

“To whom do the results of this trial apply?”: External validity of a randomized controlled trial involving 130 patients scheduled for primary total hip replacement

Self-reported functional outcome after primary total hip replacement treated with two different periopera-tive regimes: A follow-up study involving 61 patients

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