Home- Based versus Hospital- Based Rehabilitation Program after Total Knee Replacement. Department of Nursing, Physiotherapy and Medicine, University of Almer. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objectives. To compare home- based rehabilitation with the standard hospital rehabilitation in terms of improving knee joint mobility and recovery of muscle strength and function in patients after a total knee replacement. Materials and Methods. A non- randomised controlled trial was conducted. Seventy- eight patients with a prosthetic knee were included in the study and allocated to either a home- based or hospital- based rehabilitation programme. Treatment included various exercises to restore strength and joint mobility and to improve patients’ functional capacity. Hyperglycemia Treatment What is cardiac rehabilitation and who should get it? Various organisations and national bodies have defined cardiac rehabilitation, which is encompassed by: “Cardiac rehabilitation (and secondary prevention) services are. The primary outcome of the trial was the treatment effectiveness measured by the Western Ontario and Mc. Master Universities Osteoarthritis Index (WOMAC). The groups did not significantly differ in the leg side (right/left) or clinical characteristics (). After the intervention, both groups showed significant improvements () from the baseline values in the level of pain (visual analogue scale), the range of flexion- extension motion and muscle strength, disability (Barthel and WOMAC indices), balance, and walking. This study reveals that the rehabilitation treatments offered either at home or in hospital settings are equally effective. Introduction. The success of total knee arthroplasty in reducing pain, restoring physical functions, and improving the quality of life of people with severe osteoarthritis of the knee is now well established . Pain relief and functional restoration, specifically the ability to achieve an adequate range of motion (ROM), including stair climbing and walking, are important goals of rehabilitation . Various authors have conducted systematic reviews . In Spain, patients are usually sent home 4 or 5 days after the replacement and called later on to receive outpatient rehabilitation at the hospital. However, in recent years this practice is being modified. Various alternatives are emerging for patients to receive physical therapy treatments, such as at public health centres or at patient’s home. In Spain, home- based rehabilitation support or rehabilitation in the home (RITH) has been a usual practice for many years (patients have had to hire physiotherapists privately to attend to them at home). However, the use of RITH as a welfare method of health departments in the public administration is relatively recent . Catalonia was the first community to offer RITH as a public service in 1. This was created to facilitate the treatment of patients who could not come to the hospital due to comorbidities or architectural barriers in their homes (i. In Andalusia (the Andalusian Health Service), a mobile rehabilitation and physical therapy team (rehabilitation physician, physiotherapist, and occupational therapist) started operating in 2. For patients to be discharged home, some health professionals consider personal/psychosocial factors such as patients’ goals and their social support . There is an increasing emphasis on achieving cost- effectiveness in care; and health systems are currently under strong economic pressure. Therefore, reducing the length of hospital stay has become a priority . Theoretical models and qualitative and quantitative studies all acknowledge the influence of the environment on functioning . When the activities of daily living (ADL) are carried out in the home setting, the situation is more meaningful to a patient than artificial simulations in a clinical setting . There is still conflicting evidence on the benefits of RITH versus outpatient hospital rehabilitation after a total joint replacement . Materials and Methods. This study was based on a nonrandomised controlled trial. After completing their postoperative period, 7. Traumatology Unit of the Torrec. The study was approved by the Human Research and Ethics Committee of the participating Health Service. All patients provided written informed consent in accordance with the Helsinki Declaration. The treatment condition (hospital/home) was selected by rehabilitation physician Dr. G., mainly on the basis of the need for assistance in ADL, the characteristics of patients’ homes (architectural barriers), and the availability (or lack) of social and family support, in accordance with the Rehabilitation Method Guidelines of the Regional Ministry of Primary Care in Andalusia . We assumed that a difference of more than 5. With an alpha of 0. Inclusion and Exclusion Criteria. The inclusion criteria were as follows: a total knee replacement operation, over 6. The following exclusion criteria were used: major postoperative complications (hemarthrosis, a fracture or infection of the operated knee joint and deep vein thrombosis), psychiatric diagnosis, concurrent physical therapy treatment at a different institution, and the existence of a terminal disease with a life expectancy of less than 6 months. Of the 7. 8 initially selected patients, 7. The final sample was comprised of 3. RITH) and 3. 9 patients in the control group (Figure 1). Outcome Measures. All subjects were assessed by an external physiotherapist who did not participate in the patients’ treatment (R. L.), on the 5th postoperative day. The assessment included basic demographic data (age, sex), the knee affected (right/left), the presence of comorbidities (diabetes, obesity (body mass index . High WOMAC scores indicate poorer function and more severe pain and stiffness levels. The descriptors range from 0 (no problems with pain, functional activities, and stiffness) to 4 (extreme pain, difficulty, and stiffness). We also measured participants’ joint- specific pain using a 0–1. VAS). The patients rated the highest intensity of pain experienced in their operated knee in the previous 2. The following measurements were also taken: passive knee ROM measured with a goniometer (expressed in degrees), flexion assessed while sitting and extension assessed while in supine position . This latter was assessed through gait and balance observation using the 2. Tinetti test . L.) assessed the same baseline variables, as well as the duration of hospital stay (in days), the number of rehabilitation sessions received by each patient, the complications detected, and the readmission cases during the rehabilitation period. Intervention. On the second day of the postoperative period and after having had an X- ray, all the patients (experimental and control groups) received prophylactic antibiotics and prophylaxis against deep vein thrombosis. The patients started physical therapy at the Traumatology Unit, according to the previously established and standardized care guidelines for a total joint replacement. This included health education for patients and families as well as the following: postural treatment; passive kinesiotherapy for the lower limb and cryotherapy for one hour thrice a day (once after passive mobilisation); muscle strengthening exercises (isometric exercises for quadriceps) and stretching of quadriceps and hamstrings; active flexion- extension exercises for the knee and ankle with no resistance; flexion- extension while sitting; isotonic exercises; and facilitation of position changes from lying to sitting, sitting to standing (transfer from bed to chair). Depending on their progress, this training on transfers was gradually carried out and the patients started walking with a walker between the third and the fourth days of the postoperative period. They were provided with instructions on exercises (passive, active- assisted and active flexion- extension bed and chair exercises and gait training, beginning with assisted walking), which they were recommended to perform daily after discharge. The participants assigned to RITH were referred to their respective community health centre and included in an early intervention program that ensured that each patient was assessed at home by a rehabilitation physician approximately 7. The principal aim of the RITH program was to improve patients’ quality of life and functional capacity by improving strength, increasing joint mobility, improving endurance, and motivating the patients to carry out a regular exercise program. The patients assigned to RITH spent an average of 2. SD 7. 5. 3) per treatment session with a physiotherapist. The functional exercises included transfers, gait training, and stair climbing . Muscle work was intensified daily and increased as the patients progressively adapted to ADL. In the case of the control group, the hospital rehabilitation appointment was made before the patient was discharged (the average delay in starting outpatient physical therapy treatment at the hospital was 1. In the hospital, a supervised exercise program was developed by physiotherapists and it included various exercises to restore strength and joint mobility, such as walking without crutches, further joint mobility exercises, and strengthening exercises (isometric and dynamic) without external loads . Data Analysis. The results were analysed using the SPSS software Version 1. Windows (SPSS Inc., Chicago, IL, USA). After conducting descriptive analysis of the variables (means and standard deviations), we performed baseline comparisons of the two treatment groups to determine whether they were equivalent on the measured variables. Next, within- group comparisons of pre- and postintervention scores were performed using - tests, and between- group comparisons of change scores on all outcome measures were performed using - tests, with a confidence interval of 9. Results. The mean age of the patients was 7. SD = 6. 5. 2 years), and approximately two- thirds were women (7. The groups did not differ significantly in the leg side (right/left) or in clinical characteristics. Pulmonary Impairment After Tuberculosis* . Estimated incidence, prevalence and TB mortality, 2. Available at: http: //www. Accessed May 2. 1, 2. WB Saunders. County information project: Tarrant County profile. Available at: http: //www. FIPS=4. 84. 39. Accessed May 4, 2. Texas administrative code title 2. Available at: http: //info. View. TAC? tac. Accessed May 2. Tuberculosis control programs. Available at: http: //www. Accessed August 1. Available at: http: //www. A=7. 63 & Q=4. Accessed May 2. 1, 2. Geneva, Switzerland: . Louis, ME, Mukadi, YB, et al Pulmonary tuberculosis in HIV- infected patients in Zaire: a controlled trial of treatment for either 6 or 1. N Engl J Med. 19. Tuberculosis- related deaths within a well- functioning DOTS control program. Accessed February 1, 2.
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