The systematic assessment of short‐term functional recovery after major joint arthroplasty

Abstract

Despite extensive information about long‐term recovery from major joint arthroplasty, little attention has been given to the measurement of functional recovery in the immediate postoperative period. Therefore assumptions about the importance of physical therapy during this period remain untested. We devised a way of recording functional recovery before discharge, based primarily on the achievement of objective milestones. This was incorporated into routine physiotherapy practice and applied to sequential patients undergoing elective hip (n = 163) or knee (n = 66) replacement. Six months later, we followed up 160 patients, of whom 145 completed questionnaires to assess subjective physical and emotional state and functional recovery. The method was sensitive to known influences on pace of recovery, including type of arthroplasty (hip vs knee) and surgeons’ differing requirements for mobilization. In addition, we were able to confirm and quantify sources of variation in functional recovery which previously were suspected but unconfirmed: in particular, the timing of early mobilization. Outcome at 6 months was unrelated to objective functional recovery in hospital, although fatigue and wellbeing at this time were predicted by physiotherapists’ subjective assessment of patients’ motivation before discharge. The findings can be used to inform patients and as a source of comparison data for the assessment of functional recovery in other centres. More importantly, the procedure reported may be applied to quantify functional recovery in routine practice and thereby expose variability in recovery to scientific scrutiny.

The effect of perioperative psychological intervention on fatigue after laparoscopic cholecystectomy: a randomized controlled trial

“…This has also been shown in other trials where psychological interventions such as cognitive skills training, relaxation training, and guided imagery have not had positive effects on PSF measures in patients undergoing cardiac surgery [19], abdominal hysterectomy [20], colorectal resections [21], or hip and knee arthroplasty [22]. However, in the current study, fatigue and the impact of fatigue were significantly improved in the intervention group at postoperative day 30.…”

Effectiveness of distance education intervention using video footage in postoperative patients after total hip arthroplasty

“…A patient's outcome is influenced not only by surgical intervention, but also by postoperative rehabilitation and other supportive measures (Peerbhoy et al, 1999). Several studies have Table 2 The mean score of the OHS score, pain NRS, self-efficacy of the exercise behavior SF-8 subscale scores between the intervention group and the control group.…”

Patients with impairment of multiple joints after a total joint replacement benefit from three weeks’ intensive exercise training directly following hospital discharge.

“…for knee and hip joints [1][2]. In order to limit time spent during hospitalisation (primarily) and to restore functional ability rapidly (secondarily), several peri-operative training programmes and clinical pathways have been designed in the past [3][4][5][6][7][8]. These training programmes were used in relatively healthy patients [9][10][11][12].…”