Patient Dissatisfaction With Rehabilitation Following Primary Total Knee Arthroplasty.

Patient Dissatisfaction with Rehabilitation Following Primary Total Knee Arthroplasty.

J Knee Surg. 2013 Apr 16;
Johnson AJ, Issa K, Naziri Q, Harwin SF, Bonutti PM, Mont MA

Most patients who receive a total knee arthroplasty (TKA) undergo rehabilitation in the postoperative period. However, these therapies are often not under the direct supervision of the treating physicians, have variable protocols, and have unclear long-term efficacies. The purposes of this study were to assess patient satisfaction with their rehabilitation following TKA and to evaluate whether various factors were different between satisfied and unsatisfied patients. A total of 100 consecutive patients who underwent 107 primary TKA were prospectively surveyed to evaluate their rehabilitation experiences. There were 28 men and 72 women who had a mean age of 61 years (range, 37 to 91 years) at the time of surgery. Patients answered questions regarding the number and duration of therapies, amount of hands-on time with the therapists, number of different therapists, amount of co-pay, and their overall level of satisfaction with their rehabilitation experience. Over one-third of the patients reported not being satisfied with their rehabilitation experiences. The patients who were dissatisfied reported a shorter mean duration of each therapy session spent directly with the therapist, a higher mean number of therapists seen over the duration of their treatment, and an increased number of co-participants during their therapy sessions. The authors believe that to minimize patient dissatisfaction with rehabilitation, surgeons should refer patients to therapists who are willing to spend adequate hands-on time during one-on-one or smaller group therapy sessions with their patients. HubMed – rehab

Improvements in hip flexibility do not transfer to mobility in functional movement patterns.

J Strength Cond Res. 2013 Apr 15;
Moreside JM, McGill SM

: The purpose of this study was to analyze the transference of increased passive hip ROM and core endurance to functional movement. 24 healthy young men with limited hip mobility were randomly assigned to 4 intervention groups: 1)Stretching; 2)Stretching plus hip/spine disassociation exercises; 3)Core endurance; 4)Control. Previous work has documented the large increase in passive ROM and core endurance that was attained over the 6 week interventions, but whether these changes transferred to functional activities was unclear.Four dynamic activities were analyzed before and after the 6 week interventions: active standing hip extension, lunge, a standing twist/reach maneuver, and exercising on an elliptical trainer. A Vicon motion capture system collected body segment kinematics, with hip and lumbar spine angles subsequently calculated in Visual 3D. Repeated measures ANOVAs determined group effects on various hip and spine angles, with paired t-tests on specific pre/post pairs.Despite the large increases in passive hip ROM, there was no evidence of increased hip ROM utilized during functional movement testing. Similarly, the only significant change in lumbar motion was a reduction in lumbar rotation during the active hip extension manoeuvre (p< 0.05).These results indicate that changes in passive ROM or core endurance do not automatically transfer to changes in functional movement patterns. This implies that training and rehabilitation programs may benefit from an additional focus on 'grooving' new motor patterns if new found movement range is to be utilized. HubMed – rehab

[Possibilities of Surgical Therapy of Lymphedema.]

Wien Med Wochenschr. 2013 Apr 17;
Döller W

The surgical treatment of lymphedema, which was mainly used on limbs, was, up until the beginning of the last century marked by radical resection methods. Over the last 20 years, through the development of microsurgical techniques, lymphatics and lymph nodes are anastomosed after autologous transplantation to bypass blockages that occur after lymphonodal dissection after cancer therapy. As a further efferent surgical method, the lympho-venous anastomosis was propagated during the recent decades.In addition, other minimal invasive surgical techniques concerning dissection have been developed. The well known liposuction technique, which has been frequently and successfully used in cosmetic surgery, is capable of removing tissue changes that are caused by lymphedema with satisfying cosmetic results.Other surgical procedures are so called “additive lymphologic surgical treatments”, such as dermatolipectomy and surgical resection of secondary lymphedema-lesions, like papillomatosis cutis, lymphcysts, lymphatic fistulas, which occur especially in lymphedema of the genitals. HubMed – rehab