Naylor Justine, Harmer Alison, Fransen Marlene, Crosbie Jack, Innes Lesley
Whitlam Joint Replacement Centre, Fairfield Hospital, Sydney, NSW, Australia.
Physiother Res Int. 2006 Mar;11(1):35-47. doi: 10.1002/pri.40.
BACKGROUND AND PURPOSE: Owing to a scarcity of clinical research, evidence-based clinical guidelines are not available to guide physiotherapy rehabilitation after total knee replacement surgery. This is despite the fact that, annually, over 20000 patients in Australia, over 300 000 patients in North America and 36 000 patients in the UK potentially require rehabilitation at this time to regain functional independence and to resume recreational and work-related physical activities. This survey of clinicians aimed to describe standard (usual) care after total knee replacement in Australia and to provide possible explanations for practice variance, if such variation exists. METHOD: A nationwide postal survey involving public and privately funded hospital physiotherapy departments was conducted. Purposive sampling was used to randomly select hospitals from the National Joint Replacement Registry. A series of closed and open-ended protocol-based questions were asked. RESULTS: A response rate of 65% (65/100) was obtained. Elements of consistency and diversity across the acute and post-acute phases were evident. Consistent findings included the provision of gait retraining and exercise prescription in the acute period, the requirement for independent ambulation as a criterion for discharge from acute care and the routine referral to ongoing outpatient or community-based physiotherapy. Less consistency was reported for the use of continuous passive motion and cryotherapy in the acute phase, the modes of ongoing rehabilitation, discharge from rehabilitation criteria and the tools for measuring outcomes. Both institutional and non-institutional factors appeared to explain the demonstrated practice variation. CONCLUSIONS: In order to propagate evidence-based practice guidelines and uniformity in care, well-designed clinical trials are required to identify cost-effective rehabilitation programmes after total knee replacement.
背景与目的:由于临床研究匮乏,目前尚无循证临床指南可用于指导全膝关节置换术后的物理治疗康复。尽管事实上,在澳大利亚每年有超过20000名患者、在北美有超过300000名患者以及在英国有36000名患者此时可能需要康复治疗以恢复功能独立并重新参与娱乐和与工作相关的体育活动。这项针对临床医生的调查旨在描述澳大利亚全膝关节置换术后的标准(常规)护理,并为实践差异(若存在)提供可能的解释。 方法:开展了一项涉及公立和私立医院理疗科的全国性邮寄调查。采用目的抽样法从国家关节置换登记处随机选取医院。提出了一系列基于封闭式和开放式方案的问题。 结果:获得了65%(65/100)的回复率。急性期和急性后期的一致性和多样性元素明显。一致的结果包括在急性期提供步态再训练和运动处方、将独立行走作为急性护理出院标准的要求以及常规转诊至持续的门诊或社区理疗。关于急性期连续被动运动和冷冻疗法的使用、持续康复的模式、康复出院标准以及测量结果的工具,报告的一致性较低。机构因素和非机构因素似乎都解释了所显示的实践差异。 结论:为了推广循证实践指南和护理的一致性,需要精心设计的临床试验来确定全膝关节置换术后具有成本效益的康复方案。
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