Intensive Postoperative Physiotherapy Research Articles

The Efficacy of Inpatient vs. Home-Based Physiotherapy Following Coronary Artery Bypass Grafting.

Background: Intensive post-operative physiotherapy after cardiac surgery helps to reduce the number of complications, accelerating convalescence and decreasing peri-operative mortality. Cardiac rehabilitation is aimed at regaining lost function and sustaining the effect of cardiac surgery. The aim of this study was to compare the efficacy of inpatient and home-based phase II physiotherapy following coronary artery bypass grafting, and inpatient phase II post-operative physiotherapy based on the analysis of the spirometry results. Methods: A prospective observational study included 104 adult patients of both sexes undergoing planned coronary artery bypass grafting and were randomized to one of the two groups—inpatients (InPhysio) and home-based (HomePhysio) at a 1:1 ratio. All patients had undergone spirometry testing prior to surgery (S1) and on the fifth day after the operation (S2), i.e., on the day of completion of the first phase (PI) of physiotherapy. Both the study group (InPhysio) and the control group (HomePhysio) performed the same set of exercises in the second phase (PII) of cardiac physiotherapy, either in the hospital or at home, respectively, according to the program obtained in the hospital. Both groups have undergone spirometry testing (S3) at 30 days after the operation. Results: The demographic and peri-operative data for both groups were comparable and showed no statistically significant differences. An analysis of gradients between the results of spirometry tests before surgery and at 30 days after the surgery showed a smaller decrease in forced vital capacity (FVC) in the study group than in the control group (p < 0.001). The results at five and 30 days after the surgery showed a greater increase in FVC in the study group than in the control group (680 mL vs. 450 mL, p = 0.009). There were no statistically significant differences in other parameters studied. Conclusions: The advantage of inpatient over home-based physiotherapy was evidenced by much smaller decreases in FVC between the initial and final tests, and greater increases between the fifth day after surgery and the final test. Our analysis showed greater efficacy of inpatient physiotherapy as compared with home-based exercises and raises concerns about patient adherence.

Combined Anterior and Posterior Lumbar Rhizotomy for Treatment of Mixed Dystonia and Spasticity in Children With Cerebral Palsy

BACKGROUND:Children with cerebral palsy (CP) can present with severe secondary dystonia with or without associated spasticity of their extremities.OBJECTIVE:To assess the outcomes of combined anterior and posterior lumbar rhizotomy for the treatment of mixed hypertonia in the lower extremities of children with CP.METHODS:Fifty children with CP were subjected to combined anterior and posterior lumbar rhizotomies in a prospective study. Clinical outcome measurements were recorded preoperatively and were evaluated at 2, 6, and 12 months postoperatively. The operative techniques were performed by laminotomy from L1-S1, and intraoperative monitoring was used in all cases. All patients underwent intensive postoperative physiotherapy programs.RESULTS:Changes in muscle tone, joint range of motion, and dystonia were significant (P = .000) at postoperative assessment visits.CONCLUSION:This study demonstrated the potential of combined anterior and posterior lumbar rhizotomies to improve activities of daily living in children with CP and with mixed spasticity and dystonia.ABBREVIATIONS:BAD, Barry-Albright Dystonia ScaleCAPR, combined anterior and posterior lumbar rhizotomyCP, cerebral palsyITB, intrathecal baclofenMAS, modified Ashworth ScaleROM, range of motionSDR, selective dorsal rhizotomy

Postoperative Respiratory Exercises Reduce the Risk of Developing Pulmonary Complications in Patients Undergoing Lobectomy

ObjectiveTo evaluate the effects of an intensive postoperative physiotherapy program focused on respiratory exercises in patients undergoing lobectomy by open thoracotomy. DesignQuasi-experimental study. SettingTertiary referral academic hospital. Participants208 patients undergoing lobectomy by open thoracotomy. InterventionsControl group patients (n=102) received standard medical/nursing care, and experimental group patients (n=106) added to the standard clinical pathway a daily physiotherapy program focused on respiratory exercises until discharge. OutcomesAnalyzed outcomes were the frequency of postoperative pulmonary complications (PPCs) more amenable to physiotherapy (pneumonia, atelectasis and respiratory insufficiency) and length of hospital stay (LOS). ResultsBoth groups were comparable regarding preoperative and surgical characteristics. Incidence of PPCs was 20.6% in control and 6.6% in experimental group (P=.003). Median (IQR) LOS in control group was 14 (7) days (Huber M estimator 14.21) and 12 (6) days (Huber M estimator 12.81) in experimental. Logistic regression model identified the evaluated physiotherapy program (P=.017; EXP [B] 95% CI 0.081–0.780) and % FEV1 (P=.042; EXP [B] 95% CI 0.941–0.999) as protective factors for the development of PPCs in patients undergoing lobectomy. ConclusionsImplementing a postoperative intensive physiotherapy program focused on respiratory exercises reduces the risk of PPCs and resultant LOS on patients undergoing lobectomy.

Los ejercicios respiratorios postoperatorios reducen el riesgo de complicaciones pulmonares en pacientes sometidos a lobectomía

ObjectiveTo evaluate the effects of an intensive postoperative physiotherapy program focused on respiratory exercises in patients undergoing lobectomy by open thoracotomy. DesignQuasi-experimental study. SettingTertiary referral academic hospital. Participants208 patients undergoing lobectomy by open thoracotomy. InterventionsControl group patients (n=102) received standard medical/nursing care, and experimental group patients (n=106) added to the standard clinical pathway a daily physiotherapy program focused on respiratory exercises until discharge. OutcomesAnalyzed outcomes were the frequency of postoperative pulmonary complications (PPCs) more amenable to physiotherapy (pneumonia, atelectasis and respiratory insufficiency) and length of hospital stay (LOS). ResultsBoth groups were comparable regarding preoperative and surgical characteristics. Incidence of PPCs was 20.6% in control and 6.6% in experimental group (P=.003). Median (IQR) LOS in control group was 14 (7) days (Huber M estimator 14.21) and 12 (6) days (Huber M estimator 12.81) in experimental. Logistic regression model identified the evaluated physiotherapy program (P=.017; EXP [B] 95% CI 0.081-0.780) and % FEV1 (P=.042; EXP [B] 95% CI 0.941-0.999) as protective factors for the development of PPCs in patients undergoing lobectomy. ConclusionsImplementing a postoperative intensive physiotherapy program focused on respiratory exercises reduces the risk of PPCs and resultant LOS on patients undergoing lobectomy.

Volar dislocation of four carpometacarpal joint: A rarest injury

This article reports a case of young male grieved with fracture dislocation of the four carpometacarpal (CMC) joints dislocation due to motor vehicle collision. Volar- radial deviation of the second and third CMC joints and volar- ulnar deviation of fourth and fifth CMC joints were observed. Patient was treated with closed reduction and fixed with 0.045 K wires. First wire was placed in third metacarpal and capitate and second wire was placed from fifth metacarpal base to the proximal row of carpals. Despite all effort complete reduction at fourth and fifth CMC joint was not achieved. Follow up radiographs at one month showed satisfactory reduction and patient is performing well till the last follow up. Intensive postoperative physiotherapy is vital to achieving a satisfactory outcome.

Management of Temporomandibular Joint Reankylosis in Syndromic Patients Corrected with Joint Prostheses: Surgical and Rehabilitation Protocols

Temporomandibular joint ankylosis (TMJA) is a severe disorder described as an intracapsular union of the disc-condyle complex to the temporal articular surface with bony fusion. The management of this disability is challenging and rarely based on surgical and rehabilitation protocols. We describe the treatment in two young adults affected by Goldenhar syndrome and Pierre Robin sequence with reankylosis after previous surgical treatments. There are three main surgical procedures for the treatment of TMJA: gap arthroplasty, interpositional arthroplasty, and joint reconstruction. Various authors have described reankylosis as a frequent event after treatment. Treatment failure could be associated with surgical errors and/or inadequate intensive postoperative physiotherapy. Surgical treatment should be individually tailored and adequate postoperative physiotherapy protocol is mandatory for success.

Fracture Dislocation of Carpometacarpal Joints: A Missed Injury

Fracture dislocation of the carpometacarpal joints on the ulnar side of the hand is an uncommon injury. These are high-energy injuries seen in motorcyclists and boxers. The mechanism of injury involves violent, forceful dorsiflexion of the wrist combined with longitudinal impact on the closed hand. This article reports a case of fracture of the base of the middle finger with dislocation of the ring and little finger carpometacarpal joints. On first examination, a diagnosis of isolated, minimally-displaced, middle-metacarpal base fracture was made and deemed suitable for nonoperative management. The hand was splinted in a plaster-of-Paris slab. Later, a true lateral radiograph showed the exact nature of the injury. The fracture was successfully treated with closed reduction under general anesthesia and transfixation using Kirschner wires. Functional results were excellent with return to work at 10 weeks and excellent grip strength at 14 weeks. This injury may be missed in an acute setting in a busy accident and emergency unit. Swelling around the wrist with shortening of the knuckle should alert the clinician towards the possibility of such an injury. On routine anteroposterior view, overlap of joint surfaces, loss of parallelism, and asymmetry at the carpometacarpal joints should raise suspicion of the possibility of a subtle carpometacarpal injury. This article highlights the importance of a high index of suspicion, a true lateral radiograph, and careful evaluation of radiographs in diagnosing these injuries. Intensive postoperative physiotherapy is vital to achieving a satisfactory outcome.

Korrekturosteotomie der fehlverheilten Monteggia-Verletzung mit einem Fixateur externe

Definite reduction of the dislocated radial head to prevent further damage and loss of function in case of a neglected radial head dislocation following Monteggia lesion. Three different operation methods are demonstrated.A correction must be striven for in any fresh injury. The indication has to be made according to the complaints in chronic dislocations. A correction is very difficult and not always successful.In principle, none.In principle, the surgical technique depends on the underlying disease and the kind of deformity, as well as on the instruments and implants available. There are different techniques: exclusive angulation osteotomy of the ulna (short interval after injury < 3 months), angulation osteotomy and additional lengthening of the ulna (mostly > 3 months after injury); an open procedure is seldom necessary and should be avoided.Depending of the child's age, the technique used and the implant chosen (external fixator, plate), a cast-free treatment should be striven for (better function).The results depend on the surgeon's experience, the accuracy of planning, and the technique chosen. An intensive postoperative physiotherapy is mandatory, frequently with initial application of CPM (continuous passive motion). Loss of correction and residual malalignments are well known and not rare. They occur mostly in instances of insufficient stability and centralization of the radial head, respectively. There are no evident numbers but this is confirmed by clinical experience.

Neue Aspekte zum Thema Kniegelenksarthrolysen

Recently we observed a change of problems with patients suffering from impaired movement of the knee joint. Among 24 arthrolysis performed in 16 male and 7 female patients from 1983 to 1987, ligamentous injuries had preceded in 13 cases. Extension deficits of more than 10 degrees were the leading problem in 10 cases, flexion deficits in 5 cases, combined deficits in 8 cases. Combined intra- and extraarticular procedures were necessary in most operations. Posteromedial capsular dissection was successfully performed in 12 cases to improve extension. 23 results were evaluated with an average interval of 39 months after operation. Improvement of motion averaged to 62%. Careful preoperative evaluation, systematic operative technique and intensive postoperative physiotherapy are of equal importance to obtain satisfying results with knee joint arthrolysis.

Incentive spirometry decreases respiratory complications following major abdominal surgery

Pulmonary complications are the leading cause of morbidity and mortality following major abdominal surgery. Chest physiotherapy aims to decrease the likelihood of these complications and hasten recovery. Exercises aimed at maximising inspiratory effort are the most beneficial for the patients. The incentive spirometer is a handheld device that patients use to achieve effective inspiration. In a nonrandomised pilot study of 263 patients we have found that the addition of the incentive spirometer, as part of an intensive post-operative physiotherapy programme, decreased the occurrence of pulmonary complications (6 vs 17%, p = 0.01) and length of stay on the surgical high dependency unit (3.1 vs 4 days p = 0.03). The two groups were comparable when age, sex, smoking history, the need for emergency surgery and post-operative analgesia were compared.

Surgical Treatment of Maisonneuve Fractures

Closed or open reduction and internal fixation of Maisonneuve fracture with the goal to restore form and function of ankle joint. Prevention of posttraumatic osteoarthritis. Proximal fibular fractures associated with rupture of the distal tibiofibular syndesmosis, the interosseous membrane, and the deltoid ligament; sometimes associated with fracture of the medial malleolus and the posterior rim of the tibia. Poor skin and soft-tissue conditions. Poor general health. Open or closed reduction and repositioning of lateral malleolus into fibular incisure of the tibia. Internal fixation with one or two temporarily inserted syndesmosis screws. Suture of syndesmosis. Treatment of associated injuries. Split below-knee cast. After wound healing closed below-knee cast for 6 weeks and walking with crutches and partial weight bearing. Removal of syndesmosis screw(s) 6–8 weeks postoperatively. Once ligamentous stability has been ascertained, increasing mobilization and weight bearing. An exact diagnosis, meticulous reduction and internal fixation as well as intensive postoperative physiotherapy will guarantee a satisfactory functional result.

Effects of early intensive postoperative physiotherapy on limb function after tibial plateau leveling osteotomy in dogs with deficiency of the cranial cruciate ligament

Effects of early intensive postoperative physiotherapy on limb function after tibial plateau leveling osteotomy in dogs with deficiency of the cranial cruciate ligament

Effects of early intensive postoperative physiotherapy on limb function after tibial plateau leveling osteotomy in dogs with deficiency of the cranial cruciate ligament

To determine effects of early intensive postoperative physiotherapy on limb function in dogs after tibial plateau leveling osteotomy (TPLO) for deficiency of the cranial cruciate ligament (CCL). 8 adult dogs with CCL deficiency. After TPLO, dogs underwent a physiotherapy program 3 times/wk (physiotherapy group; n = 4) or a walking program (home-exercise group; 4). All dogs were evaluated before surgery, 1 and 10 days after surgery, and 3 and 6 weeks after surgery. Thigh circumference (TC), stifle joint flexion and extension range of motion (ROM), lameness, and weight-bearing scores were recorded. Before surgery, CCL-deficient limbs had significantly reduced TC and reduced flexion and extension ROMs, compared with values for the contralateral control limb. Six weeks after TPLO, the physiotherapy group had significantly larger TC than the home-exercise group, with the difference no longer evident between the affected and nonaffected limbs. Extension and flexion ROMs were significantly greater in the physiotherapy group, compared with values for the home-exercise group, 3 and 6 weeks after surgery. Six weeks after surgery, the difference in flexion and extension ROMs was no longer evident between the affected and nonaffected limbs in the physiotherapy group. Both groups had improvements for lameness and weight-bearing scores over time, but no difference was found between the 2 groups. After TPLO in CCL-deficient dogs, early physiotherapy intervention should be considered as part of the postoperative management to prevent muscle atrophy, build muscle mass and strength, and increase stifle joint flexion and extension ROMs.

Treatment of knee flexion contracture in patients with chronic juvenile arthritis: A case report

Knee flexion contractures are common after-effects of juvenile arthritis. Treatment is usually conservative and may include physical therapy and kinesitherapy. Surgical treatment, particularly of the soft parts, indicated for contractures resistant to conservative treatment, helps to correct the deformity, maintain movements, and relieves pain. Intensive postoperative physiotherapy is of special importance. A 23-year-old female patient with chronic juvenile arthritis since the age of one was admitted for treatment of flexion contractures in both knees, muscle hypotrophy, loss of strength and gait disability. The patient underwent arthroscopic synovectomy. The operation was first performed on the right and after 3 mouths on the left knee. The preoperative range of motion in the right knee was 30 degrees - 70 degrees and in the left 40 degrees - 80 degrees. The patient underwent intensive physical therapy to reduce postoperative swelling of knees and firstly passive and then active kinesitherapy. Nine months after the first surgery and six months after the second, the range of motion in the right knee was 0 degrees - 100 degrees and in the left 0 degrees - 105 degrees. The strength of tested muscles was increased and gait was improved. Management and rehabilitation of patients with chronic juvenile arthritis include maintenance or improvement in position and function of joints that is achieved with synovectomy. The results depend on combined interdisciplinary rehabilitation, well-experienced staff and pre- and post-operative physiotherapy as well as kinesitherapy. Arthroscopic synovectomy has many advantages and we believe that it was a better solution than open capsulosynovectomy in this patient with chronic juvenile arthritis of the knee.

Does pre-operative physiotherapy improve outcomes from lower limb joint replacement surgery? A systematic review

A systematic review of randomised controlled trials was performed to evaluate the effectiveness of pre-operative physiotherapy programmes on outcome following lower limb joint replacement surgery. A search of relevant key terms was used to find suitable trials, with five papers meeting the inclusion criteria for the review. The methodological quality of the trials was rated using the PEDro scale. Estimates of the size of treatment effects were calculated for each outcome in each trial, with 95% confidence intervals calculated where sufficient data were provided. Of the three trials pertaining to total knee replacement, only very small mean differences were found between control and intervention groups for all of the outcome measures. Where confidence intervals could be calculated, these showed no clinically important differences between the groups. Two papers (one study) pertaining to total hip replacements found significant improvements in WOMAC scores, hip strength and range of movement, walking distance, cadence, and gait velocity for the intervention group, compared to a control group. Estimates of treatment effect sizes for these outcomes were larger than for the total knee replacement studies, with confidence intervals showing potentially clinically important differences between group means. However, as the intervention group also received an additional intensive post-operative physiotherapy program, these results cannot be attributed solely to the pre-operative program. This systematic review shows that pre-operative physiotherapy programmes are not effective in improving outcome after total knee replacement but their effect on outcome from total hip replacement cannot be adequately determined.

Seromuscular spiral cuff perineal colostomy: an alternative to abdominal wall colostomy after abdominoperineal excision for rectal cancer.

Seromuscular spiral cuff perineal colostomy may be an alternative to abdominal wall colostomy after abdomino-perineal excision. We present our initial experience with the procedure in 13 patients operated upon between March 1993 and December 1997. Patients undergoing abdomino-perineal excision for rectal cancer, under 65 years of age, without severe concomitant disease, and strongly motivated to comply with an intensive postoperative physiotherapy were selected. The neosphincter procedure comprised a pull-through of a sufficient length of well-vascularized colon, 12 cm of which was then cleared of fat. In this segment, the seromuscular layer was separated from the mucosa, cut into a longitudinal sheet and wrapped in spirals around the colon at its perineal insertion. One patient died from pulmonary embolism. A second patient suffered from ischemic necrosis of the distal colon and lost his neosphincter. Minor complications included one stenosis, corrected by surgery, and one iatrogenic lesion on rectoscopy at another institution. No patients experienced local recurrence, while four patients presented distant metastases. Initially, all patients suffered from incontinence. After 6 months, 6 of 11 evaluable patients showed total and 5 showed partial continence.