全髋关节或膝关节置换术后的康复和术后物理治疗的应用。
Recovery and the use of postoperative physical therapy after total hip or knee replacement.
机构信息
Department of Orthopedics and Sports Medicine, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
Department of Orthopaedics, Rehabilitation and Physical Therapy Leiden, Leiden University Medical Center, Leiden, the Netherlands.
出版信息
BMC Musculoskelet Disord. 2022 Jul 13;23(1):666. doi: 10.1186/s12891-022-05429-z.
BACKGROUND
Total hip or knee arthroplasties (THA/TKA) show favorable long-term effects, yet the recovery process may take weeks to months. Physical therapy (PT) following discharge from hospital is an effective intervention to enhance this recovery process. To investigate the relation between recovery and postoperative PT usage, including the presence of comorbidities, 6 months after THA/TKA.
METHODS
Multicenter, observational study in primary THA/TKA patients who completed preoperative and 6 months postoperative assessments. The assessments included questions on PT use (yes/no and duration; long term use defined as ≥ 12 weeks), comorbidities (musculoskeletal, non-musculoskeletal, sensory comorbidities and frequency of comorbidities). Recovery was assessed with the HOOS/KOOS on all 5 subdomains. Logistic regression with long term PT as outcome was performed adjusted for confounding including an interaction term (comorbidity*HOOS/KOOS-subdomain).
RESULTS
In total, 1289 THA and 1333 TKA patients were included, of whom 95% received postoperative PT, 56% and 67% received postoperative PT ≥ 12 weeks respectively. In both THA and TKA group, less improvement on all HOOS/KOOS domain scores was associated with ≥ 12 weeks of postoperative PT (range Odds Ratios 0.97-0.99). In the THA group the impact of recovery was smaller in patient with comorbidities as non- musculoskeletal comorbidities modified all associations between recovery and postoperative PT duration (Odds Ratios range 1.01-1.05). Musculoskeletal comorbidities modified the associations between Function-in-Daily-Living-and Sport-and-recreation recovery and postoperative PT. Sensory comorbidities only had an effect on Sport-and-recreation recovery and postoperative PT. Also the frequency of comorbidities modified the relation between Function-in-Daily-Living, pain and symptoms recovery and postoperative PT. In the TKA group comorbidity did not modify the associations.
CONCLUSION
Worse recovery was associated with longer duration of postoperative PT suggesting that PT provision is in line with patients' needs. The impact of physical recovery on the use of long-term postoperative PT was smaller in THA patients with comorbidities.
TRIAL REGISTRATION
Registered in the Dutch Trial Registry on March 13, 2012. TRIAL ID NTR3348; registration number: P12.047. https://www.trialregister.nl/trial/3197 .
背景
全髋关节或全膝关节置换术（THA/TKA）具有良好的长期效果，但恢复过程可能需要数周或数月。出院后进行物理治疗（PT）是促进恢复过程的有效干预措施。本研究旨在 6 个月时，调查 THA/TKA 后与恢复相关的因素，包括术后 PT 使用情况（是否使用以及使用时长；使用时长定义为≥12 周）和并存疾病情况。
方法
本研究为多中心、观察性研究，纳入接受初次 THA/TKA 的患者，所有患者均完成术前和术后 6 个月的评估。评估内容包括 PT 使用情况（是/否和时长；使用时长定义为≥12 周）、并存疾病（肌肉骨骼、非肌肉骨骼、感觉并存疾病和并存疾病的频率）。使用 HOOS/KOOS 评估所有 5 个亚领域的恢复情况。使用逻辑回归分析以长期 PT 为结局，并进行混杂因素校正，包括交互项（并存疾病*HOOS/KOOS 亚领域）。
结果
共纳入 1289 例 THA 和 1333 例 TKA 患者，95%的患者接受术后 PT，56%和 67%的患者接受术后 PT≥12 周。在 THA 和 TKA 组中，术后 PT 时长≥12 周与所有 HOOS/KOOS 域评分的改善减少相关（OR 范围 0.97-0.99）。在 THA 组中，非肌肉骨骼并存疾病改变了恢复与术后 PT 时长之间的所有关联（OR 范围 1.01-1.05），从而降低了并存疾病对恢复的影响。肌肉骨骼并存疾病改变了功能恢复和运动与娱乐恢复与术后 PT 之间的关联。感觉并存疾病仅对运动与娱乐恢复和术后 PT 有影响。并存疾病的频率也改变了功能恢复、疼痛和症状恢复与术后 PT 的关系。在 TKA 组中，并存疾病并未改变关联。
结论
较差的恢复与术后 PT 时长较长有关，这表明 PT 提供符合患者的需求。THA 患者中并存疾病对物理恢复和长期术后 PT 使用的影响较小。
试验注册
于 2012 年 3 月 13 日在荷兰试验注册处注册。注册号：NTR3348；注册编号：P12.047。https://www.trialregister.nl/trial/3197。
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