Harper Carl M, Dong Yan, Thornhill Thomas S, Wright John, Ready John, Brick Gregory W, Dyer George
Department of Orthopaedic Surgery, Harvard Medical School, 55 Fruit Street, White Building 535, Boston, MA, 02114, USA,
Clin Orthop Relat Res. 2015 Jan;473(1):372-9. doi: 10.1007/s11999-014-3931-0. Epub 2014 Sep 9.
The use of animals to augment traditional medical therapies was reported as early as the 9th century but to our knowledge has not been studied in an orthopaedic patient population. The purpose of this study was to evaluate the role of animal-assisted therapy using therapy dogs in the postoperative recovery of patients after THA and TKA.
QUESTIONS/PURPOSES: We asked: (1) Do therapy dogs have an effect on patients' perception of pain after total joint arthroplasty as measured by the VAS? (3) Do therapy dogs have an effect on patients' satisfaction with their hospital stay after total joint arthroplasty as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)?
A randomized controlled trial of 72 patients undergoing primary unilateral THA or TKA was conducted. Patients were randomized to a 15-minute visitation with a therapy dog before physical therapy or standard postoperative physical therapy regimens. Both groups had similar demographic characteristics. Reduction in pain was assessed using the VAS after each physical therapy session, beginning on postoperative Day 1 and continuing for three consecutive sessions. To ascertain patient satisfaction, the proportion of patients selecting top-category ratings in each subsection of the HCAHPS was compared.
Patients in the treatment group had lower VAS scores after each physical therapy session with a final VAS score difference of 2.4 units (animal-assisted therapy VAS, 1.7; SD, 0.97 [95% CI, 1.4-2.0] versus control VAS, 4.1; SD, 0.97 [95% CI, 3.8-4.4], p<0.001) after the third physical therapy session. Patients in the treatment group had a higher proportion of top-box HCAHPS scores in the following fields: nursing communication (33 of 36, 92% [95% CI, 78%-98%] versus 69%, 25 of 36 [95% CI, 52%-84%], p=0.035; risk ratio, 1.3 [95% CI of risk ratio, 1.0-1.7]; risk difference, 23% [95% CI of risk difference, 5%-40%]), pain management (34 of 36, 94% [95% CI, 81%-99%], versus 26 of 36, 72% [95% CI, 55%-86%], p=0.024; risk ratio, 1.3 [95% CI of risk ratio, 1.1-1.6]; risk difference, 18% [95% CI of risk difference, 5%-39%]). The overall hospital rating also was greater in the treatment group (0-10 scale) (9.6; SD, 0.7 [95% CI, 9.3-9.8] versus 8.6, SD, 0.9 [95% CI, 8.3-8.9], p<0.001).
The use of therapy dogs has a positive effect on patients' pain level and satisfaction with hospital stay after total joint replacement. Surgeons are encouraged to inquire about the status of volunteer-based animal-assisted therapy programs in their hospital as this may provide a means to improve the immediate postoperative recovery for a select group of patients having total joint arthroplasty.
Level II, randomized controlled study. See Instructions for Authors for a complete description of levels of evidence.
早在9世纪就有关于利用动物辅助传统医学治疗的报道，但据我们所知，尚未在骨科患者群体中进行过研究。本研究的目的是评估治疗犬辅助疗法在全髋关节置换术（THA）和全膝关节置换术（TKA）患者术后恢复中的作用。
问题/目的：我们提出以下问题：（1）治疗犬对全关节置换术后患者的疼痛感知（通过视觉模拟评分法[VAS]测量）是否有影响？（3）治疗犬对全关节置换术后患者对住院治疗的满意度（通过医疗服务提供者和系统消费者评估[HCAHPS]测量）是否有影响？
对72例行初次单侧THA或TKA的患者进行了一项随机对照试验。患者被随机分为两组，一组在物理治疗前接受15分钟的治疗犬探视，另一组接受标准的术后物理治疗方案。两组患者的人口统计学特征相似。从术后第1天开始，在每次物理治疗后使用VAS评估疼痛减轻情况，并连续评估三次。为确定患者满意度，比较了HCAHPS各子部分中选择最高等级评分的患者比例。
治疗组患者在每次物理治疗后的VAS评分较低，第三次物理治疗后最终VAS评分差异为2.4分（动物辅助治疗VAS评分为1.7分；标准差，0.97[95%可信区间，1.4 - 2.0]，对照组VAS评分为4.1分；标准差，0.97[95%可信区间，3.8 - 4.4]，p<0.001）。治疗组患者在以下方面的HCAHPS最高等级评分比例更高：护理沟通（36例中的33例，92%[9
