Reporting Functional Outcome After Knee Arthroplasty and Regional Anesthesia: A Methodological Primer.

Reporting Functional Outcome After Knee Arthroplasty and Regional Anesthesia: A Methodological Primer.

Reg Anesth Pain Med. 2013 July/August; 38(4): 340-349
Choi S, Trang A, McCartney CJ

The introduction of ultrasound guidance for regional anesthesia has resulted in an explosion of interest in its use for postoperative analgesia, particularly for orthopedic surgery. Regional anesthesia demonstrates unequivocal superiority compared with systemic opioids with respect to analgesia, reduced opioid consumption, increased patient satisfaction, and earlier achievement of discharge criteria. Improved acute postoperative analgesia can facilitate effective rehabilitation. Investigators are in the early stages of reporting the effects of regional anesthesia on functional outcome. Recent studies reporting functional outcomes have been plagued with sample sizes of inadequate power to generate meaningful results. Furthermore, the functional outcome measures are used inappropriately in terms of clinically meaningful difference, assessment intervals, and/or duration of follow-up. This report aims to address these issues by discussing functional outcomes used in the physiotherapy or orthopedic literature and their appropriate utilization, so that future research into the effects of regional anesthesia can be methodologically sound. Outcomes discussed include those that are physical-performance-based (ie, range of motion, quadriceps strength, Timed Up and Go test, 6-Minute Walk Test, Stair Time, and Self-paced Walk Test) and those that are self-reported (ie,Western Ontario and McMaster Universities Osteoarthritis Index, Knee Osteoarthritis Severity Score, Lower Extremity Function Scale). HubMed – rehab


Is progressive early digit mobilization intervention beneficial for patients with external fixation of distal radius fracture? A pilot randomized controlled trial.

Clin Rehabil. 2013 Jun 20;
Kuo LC, Yang TH, Hsu YY, Wu PT, Lin CL, Hsu HY, Jou IM

Objective:To investigate whether progressive early digit mobilization resulted in better outcomes for hand stiffness and related functional results, as well as the effects on the bone healing process.Design:Prospective, pilot randomized controlled trial.Setting:A university hospital in southern Taiwan.Participants:Twenty-two patients with distal radius fracture randomized into two groups: early digit mobilization or control.Interventions:The intervention group received 45 minutes per treatment session and three sessions per week until the external fixator was removed 6 weeks after fracture. The control group received usual home programmes. After removing fixators, both groups received regular rehabilitation programmes until 12 weeks after surgery.Main measures:Hand strength, dexterity and functional outcomes were obtained using a dynamometer, Purdue pegboard and self-report assessment, respectively, and X-rays of the distal radius were taken to reveal bone healing 1, 3, 6 and 12 weeks after surgery. A motion tracking system measured various kinematic parameters.Results:The recovery rates between the groups showed statistically significant differences in both thumb workspace (81.55% vs. 69.54%, P = 0.04) and finger workspace (89.22% vs. 59.97%, P = 0.03) 12 weeks after injury. However, no statistical differences were found in finger dexterity, strength and self-reported outcomes. The radiographic assessment showed no significant differences between the groups for radial inclination, radial height and volar tilt throughout the examinations.Conclusions:The findings suggest that early rehabilitative intervention for digits is applicable for distal radius fracture treatment, and does not produce additional bone deformities. HubMed – rehab


Comparative Cost-Effectiveness Analysis of Sacral Anterior Root Stimulation for Rehabilitation of Bladder Dysfunction in Spinal Cord Injured Patients.

Neurosurgery. 2013 Jun 19;
Bénard A, Verpillot E, Grandoulier AS, Perrouin-Verbe B, Chêne G, Vignes JR,

Urinary disorders account for 10% of deaths in patients with complete spinal cord injury. Sacral anterior root stimulation (SARS) may be a valuable therapeutic option to restore complete and voluntary micturition (CVM), but questions on its cost-effectiveness remain.To evaluate the cost-effectiveness of SARS to restore CVM in patients with complete spinal cord injury.We conducted a non-randomized, multicenter, parallel-group cohort study comparing SARS versus current medical treatments with catheterization or reflex micturition. CVM was assessed at 12 months (end of follow-up) by uro-dynamic examination. Medical and non medical costs were measured in the perspective of the French national health insurance. Linear regression models were used to estimate the incremental net benefit (INB=?E×?-?C; ?=willingness-to-pay) adjusted for potential confounders, and p(INB>0) (i.e: probability of SARS being cost-effective versus medical treatment) for different values of ?.25 patients were included in each group in 2005-2009. At inclusion, mean age was 41 years; 45 (90%) patients were male and 29 (59%) were paraplegic. At 12 months, 15 (60%) patients with SARS had a CVM versus 3 (12%) patients with medical treatment (p<0.001). The total mean cost was 42803&OV0556; and 8762&OV0556;, respectively (p<0.001). After adjustment for CVM and voiding methods at inclusion, p(INB>0) was 74% at ?=100000&OV0556;. This probability was 94% in a sensitivity analysis excluding 6 patients presenting a CVM at inclusion.Effectiveness and cost of SARS are much higher than for medical treatment. Our results inform decision-makers of the opportunity to reimburse SARS in this vulnerable population. HubMed – rehab


At the Sources of One’s Well-Being: Early Rehabilitation for Employees With Symptoms of Distress.

J Occup Environ Med. 2013 Jun 19;
Kuoppala J, Kekoni J

To examine the effects of a new multifaceted early rehabilitation program on employee well-being targeted on distressed employees in small-to-medium sized workplaces.Fifty-two employees (92% women; age: 34 to 66 years) participated in five biweekly sessions with one follow-up day at 6 months. Rehabilitation professionals specially trained for the mindfulness method covered topics from health, nutrition, sleep, physical activity to stress management. Employees were divided by their well-being level at baseline into “healthy” and “symptomatic” groups. Main outcomes were job, mental, and physical well-being.Well-being among the symptomatic employees reached that of the healthy ones at baseline. Also, the healthy participants benefited from the program to a small degree.The preliminary findings of this new program are promising although more research is needed on its effects and cost-effectiveness. HubMed – rehab


Adiponectin is a candidate biomarker of lower extremity bone density in men with chronic spinal cord injury.

J Bone Miner Res. 2013 Jun 20;
Doherty AL, Battaglino RA, Donovan J, Gagnon D, Lazzari AA, Garshick E, Zafonte R, Morse LR

Adipose tissue is a major regulator of bone metabolism and in the general population obesity has generally been associated with greater bone mineral density. However, bone-fat interactions are multi-factorial, and may involve pathways that influence both bone formation and resorption with competing effects on the skeleton. One such pathway involves adipocyte production of adipokines that regulate bone metabolism. In this study we determined the association between bone mineral density, walking status, and circulating adipokines (adiponectin and leptin) in 149 men with chronic spinal cord injury. Although adipokine levels did not vary significantly based on walking status, there was a significant inverse association between adiponectin and bone density in wheelchair users independent of body composition. We found no association between adiponectin and bone density in the walkers and no association between leptin and bone density in either group. These findings suggest that for subjects with chronic SCI, walking may mitigate the effect of adiponectin mediated bone loss. For wheelchair users, adipose-derived adiponectin may contribute to SCI-induced osteoporosis since the osteoprotective benefits of obesity appear to require mechanical loading during ambulation. HubMed – rehab