Postoperative Rehabilitation Process Research Articles

Effectiveness of Chinese Herbal Medicine in Postoperative Fatigue Syndrome Following Total Joint Arthroplasty or Hip Fracture Surgery: Evidence from Randomized Controlled Trials.

There is no high-quality, evidence-based protocol for the treatment of postoperative fatigue syndrome (POFS) after total joint arthroplasty (TJA) or fracture surgery with Chinese herbal medicine (CHM). The purpose of this study was to explore the efficacy of CHM in the treatment of POFS after TJA or hip fracture surgery (HFS). We searched six databases to obtain randomized controlled trials (RCTs) of CHM for the treatment of POFS after TJA or HFS. The retrieval time limit was from the establishment of each database to August, 2022. According to the Cochrane Handbook for Systematic Reviews version 5.1, we used RevMan 5.3 to evaluate the quality of the studies. Stata 14.0 software was used to merge and analyze the data. The weighted mean difference (WMD) was the effect estimate for statistical analysis. We also performed subgroup analyses according to different types of surgeries. A total of 11 RCTs were included in this study, comprising 430 cases in the CHM group and 432 cases in the control group (CG). The meta-analysis results showed that there was no significant difference in the Brief Profile of Mood States (BPOMS) score (WMD=0.08, 95% confidence interval (CI): -0.29 to 0.45, P=0.688), Christensen Fatigue scale (CHFS) score (WMD = 0.15, 95% CI: -0.09 to 0.39, P=0.214) or Identity-Consequence Fatigue Scale (ICFS) score (WMD=-0.40, 95% CI: -1.84 to 1.05, P=0.589) between the CHM group and the CG on the first postoperative day. The use of CHM significantly reduced the BPOMS score (WMD=-0.85 and WMD=-3.01, respectively), CHFS score (WMD=-1.01 and WMD= -1.45, respectively), and ICFS score (WMD=-3.51 and WMD=-5.26) on postoperative days 3 and 7. Compared with the CG, the CHM group had significantly increased serum transferrin and IgG levels on postoperative days 3 and 7. The subgroup analysis results suggested that the application of CHM in HFS patients improved fatigue symptoms on postoperative days 3 and 7, while the application of CHM to treat POFS in TJA patients had great inconsistency in the evaluation of different indicators. The application of CHM improved the fatigue status of POFS patients after TJA or HFS and increased the levels of transferrin and IgG in serum, which is conducive to promoting the postoperative rehabilitation process of patients. The subgroup analysis results showed that the application of CHM to intervene in POFS in HFS patients had obvious benefits.

Physiotherapy Rehabilitation for Accelerating the Recovery of Patient with Anterior Cruciate Ligament Total Reconstruction and Meniscal Repair: A Case Report

Background: The Anterior Cruciate Ligament (ACL) is a ligament that functions to limit the movement of the tibia toward the anterior and excessive rotation, while the meniscus serves as shock absorption, load transmission, and the stabilizer of the knee joint. About 22% to 86% meniscal tear incidences occurring along with ACL injuries is. The study aims to determine the role of physiotherapists in the postoperative rehabilitation process of patients of ACL Reconstruction (ACLR) and meniscal repair in preventing postoperative complications and functional abilities of patients. Case Report: The patient was a 35-year-old adult male who suffered a complete tear in the ACL and meniscus of the left knee. The patient underwent ACLR and meniscal repair with arthroscopic surgery 2 years after injury with Bone-Pattelar tendon-bone autograph. 2 weeks post-surgery the patient visited the physiotherapy polyclinic with medical conditions of difficulty in bending and straightening the knee, still feeling pain and thick in the knee area. Results: The physiotherapist program was conducted three times and it was a home program-based exercise. The physiotherapist program and outcomes used in the first phase focused on exercises to improve ROM (Goniometer), oedema management (Medline), pain reduction (Numerical Rating Scale), activation exercises, and surrounding muscle strength (Sphygmomanometer), and improve functional ability (Tegner Lysholm Knee Scale) as well as the provision of home programs Performed by regular monitoring of exercise intensity using isometric, isotonic, and isokinetic exercises, which were given according to the concept of progressive loading. Conclusion: This case study shows that surgery combined with a comprehensive physiotherapy program plan in ACLR and meniscal repair cases, as well as adding home-based exercise programs with intense monitoring, generate more effective results. Keywords: physiotherapy rehabilitation, anterior cruciate ligament total, meniscal repair Correspondence: Suryo Saputra Perdana. Physiotherapist Profession Education Department, Faculty of Health Sciences, Universitas Muhammadiyah Surakarta, Sukoharjo, Central Java, Indonesia. Email: suryo.saputra@ums.ac.id. Mobile: +6281298563988.

General anesthesia combined with bilateral 2-level erector spinae plane block may accelerate postoperative gastrointestinal function recovery and rehabilitation process in patients undergoing posterior lumbar surgery: A randomized controlled trial

BackgroundThis randomized controlled trial explored whether bilateral 2-level erector spinae plane block could accelerate postoperative gastrointestinal function and rehabilitation in patients undergoing posterior lumbar surgery. MethodsA total of 80 adult patients undergoing posterior lumbar surgery between March 2021 and August 2021 were randomized to either ultrasound-guided bilateral 2-level erector spinae plane block (group E) or not (group C). General anesthesia was routinely performed. The primary outcome was the time of the first flatus after surgery. We also recorded the first food and liquid intake, first off-bed activity, days of hospital stay, and postoperative complications. Postoperative visual analog scale score and opioid consumption were also recorded. A venous blood sample was taken to measure the serum concentration of lipopolysaccharides, c-reactive protein, tumor necrosis factor-alpha, interleukin-6, and blood glucose before induction of anesthesia, immediately after, and 24 and 48 hours after surgery. ResultsSeventy-seven patients, 39 in group C and 38 in group E, finished the trial. Patients in group E had a significantly shorter time to first flatus (16.2 ± 3.2 vs 19.7 ± 3.0 hours, P < .05), earlier liquid intake (1.7 ± 0.2 vs 1.9 ± 0.3 hours, P < .05), earlier food intake (1.9 ± 0.2 vs 2.1 ± 0.3 hours, P < .05), and first off-bed activity (27.9 ± 3.2 vs 31.4 ± 3.3 h, P < .05). Patients in group E had shorter postoperative hospital stay (4.6 [4.2–5.5] d vs 5.4 [4.5–6.3], P < .05). We found that patients in group E had less pain and total sufentanil consumption (129 [120–133] vs 138 [132–147] μg, P < .05) within 24 hours after surgery. At 24 hours after surgery, the serum concentrations of lipopolysaccharides, tumor necrosis factor-alpha, interleukin-6, and C-reactive protein in group E were significantly decreased compared to group C (P < .05). ConclusionBilateral 2-level erector spinae plane block can accelerate gastrointestinal function recovery and shorten the length of hospital stay in patients undergoing open posterior lumbar surgery. The potential mechanism may attribute to the opioids-sparing effects and anti-stress–related anti-inflammatory effects of bilateral 2-level erector spinae plane block.

Cerebral Cavernous Malformations Patient Perception Analysis via Social Media.

The rise of social media has allowed for individuals and patients to connect with each other and influence patient behavior. This study aimed to improve our understanding of the patients' experience with cerebral cavernous malformations (CCM) via social media. Instagram and Twitter were searched using terms of ("cavernoma," "cavernous malformations," "cavernous angioma," or "cav mal"). Public Instagram posts tagged with "#cavernoma" and "@cavernoma" identified 327 posts that directly included a patient's own experience. Twitter posts that included "#cavernoma" and "@cavernoma" were searched, yielding 75 after eliminating those that did not pertain to the patient's own experience. The posts and tweets were coded for relevant themes related to their experience with the disease. Overall, more patients are using Instagram (n = 327) over Twitter (n = 84) to share their personal experience with CCM with a trend for male patients to use Twitter more compared to females with a female predominance in Instagram. A total of 277 of 327 (84.7%) Instagram posts and 67 of 84 (89.3%) Twitter posts were made after the patient's surgery. The most common theme on Instagram was focused on the postoperative rehabilitation process and mobility support (52.0 and 24.5%, respectively). Other common themes present on Twitter and Instagram were recounting symptoms and complications and life satisfaction (26.0 and 24.2%, respectively). Cavernoma patients prior to surgery were more likely to discuss on Instagram their symptoms (p = 0.001), fear of bleeding (p < 0.001), and mental health (p = 0.014). Postoperatively, cavernoma patients were more likely to discuss disability than they were preoperatively (p = 0.001). Social media platforms offer a communication tool for patients with CCM patients to share their experience with other patients and the general public and portrays their personal experience with CCM. These platforms allow for physicians to better understand the patient experience following cavernoma surgery.

Effects of stepped rehabilitation on postoperative rehabilitation process and pain in patients with lumbar spine fracture.

Effects of stepped rehabilitation on postoperative rehabilitation process and pain in patients with lumbar spine fracture.

Evaluation, Treatment, and Outcomes of Batter's Shoulder.

This article reviews the incidence of batter's shoulder, the relevant biomechanics that predispose the lead shoulder to a posterior instability event, the evaluation and workup of posterior labral injury, the surgical technique for arthroscopic posterior labral repair, the postoperative rehabilitation process, and the clinical outcomes and return to sport after treatment of batter's shoulder. New epidemiological studies have demonstrated the relatively low incidence of batter's shoulder at the professional baseball level with 85% of the injured players successfully returning to the sport with nonoperative management. However, recent studies have reinforced the limited historical literature that players requiring surgery are able to return to their prior sport at a high level. Batter's shoulder is a subtype of posterior glenohumeral instability caused by the significant forces experienced by the lead shoulder during the baseball swing. Although an uncommon injury, batter's shoulder is a source of significant time away from competition. In patients who do not improve with nonoperative management, arthroscopic posterior labral repair can reliably return players to sport. Future research studies should consider opportunities for injury prevention.

The Influence of Early Rehabilitation on Changes in the Range of Spinal and Thoracic Mobility in Patients after Thoracotomy Due to Lung Cancer Depending on Used Anaesthesia

Introduction: To the best of our knowledge, no reports are available on the relationship between the technique of anaesthesia and the effects of rehabilitation. Objective: The aim of the study is to assess the effectiveness of early rehabilitation on changes in range of spinal and thoracic mobility with different pain control after thoracotomy due to lung cancer. Material and methods: The study involved 100 patients following lung lobe resection by open anterolateral thoracotomy. After the operation, participants were assigned to 2 groups depending on the use of additional anaesthesia. All participants received standardised post-operative physiotherapy. The range of mobility of the spine and chest, the verbal rating scale (VRS) and visual analogue scale (VAS) were measured before and on the 1st, 3rd and 7th day after surgery. Results: In the study, an increase was shown in measurements for patients from both groups undergoing the rehabilitation programme after surgery. Mobility was highly significant in the study group. However, the mobility of the chest decreased in both groups, and in subsequent measurements following physiotherapy, its range improved, although it did not reach the baseline level even on the 7th day after the procedure. Consequently, 1 week after surgery, the decrease in spinal mobility among the group with standard anaesthesia was 1.3 cm greater than in the group with additional anaesthesia (-1.5 vs. -0.2 cm). Pain changes were greater in the control group. Conclusions: 1. It may be concluded that the mobility of the thoracic spine after the procedure in decreased both groups, to later significantly improve for subsequent measurements in favour of patients with additional analgesia. 2. Respiratory mechanics of the chest and the level of pain, both measured by the VRS and VAS, systematically decreased in subsequent measurements after surgery among both groups, however, greater respiratory mobility was noted in the group of patients with additional analgesia. 3. It was demonstrated that the patients from the study group achieved optimal measurement values in relation to the control group, which were measured several times after the procedure, demonstrating a shorter and effective post-operative rehabilitation process.

Poster 140: Shoulder Strengthening and Stabilization Systems – A Viable Option for Early Passive Range of Motion after Arthroscopic Rotator Cuff Repair

Objectives:Post-operative rehabilitation following arthroscopic rotator cuff repair (ARCR) is crucial for optimal outcomes. Early post-operative passive range of motion (PROM) is encouraged by some surgeons to minimize the development of adhesions and subsequent decreased range of motion. Existing literature comparing early and delayed PROM for small and medium size tears has demonstrated equivalent functional outcomes, with early PROM resulting in improved long-term active range of motion (AROM). The specific modality used for early PROM varies and may include manual home exercises, machine-assisted home exercises, or formal physical therapy (PT). In this study, we investigated Shoulder Strengthening and Stabilization Systems (SSS) (Advanced Integrated Motion; Elizur), a home-based machine monitored through telemedicine which allows for passive, active-assisted, and active motion in the early post-operative rehabilitation process. The benefit of SSS predominantly derives from the convenience of performing early PROM at home instead of attending in-person formal physical therapy. The objective of this study was to compare patient reported outcomes (PROs) and perioperative AROM after ARCR between patients who utilized SSS and those who underwent formal PT. We hypothesized that those who use SSS would have equivalent ROM and PROs compared to those who did not use SSS.Methods:A retrospective study comprised of patients undergoing RCR between 2018-2020 was conducted. Cohorts were defined by confirmation of SSS utilization via data provided by Elizur. SSS was started within several days following surgery in lieu of formal PT which started at 6 weeks. This was matched with a control group undergoing ARCR over the same time range, who initiated a formal PT protocol without the SSS machine when it was not available at our institution. The post-operative rehabilitation protocol consisted of PROM/pendulums beginning at 10 days, AROM at 6 weeks, and strengthening at 12 weeks. Data were collected from electronic medical records (EMR), entered into an institutional redcap database (UL1-TR-001857), and institutional review board approval was acquired. Patients undergoing concomitant labral repairs, capsular reconstruction procedures, revision ARCR, or with less than 3 months follow up were excluded. Primary outcome measure was subjective shoulder value (SSV) score. Secondary outcomes included American Shoulder and Elbow Surgeons Shoulder Score (ASES), visual analog scale (VAS), and AROM (forward flexion and external rotation). Baseline characteristics were analyzed with two sample t-tests and chi-square or Fisher’s exact test for continuous and categorical variables, respectively. A linear mixed model with fixed effects for cohort, time, and the cohort-time interaction was used to analyze PROs and AROM at various timepoints. Statistical significance was set at p < 0.05.Results:A total of 417 patients (243 SSS; 174 no SSS) with an average follow up of 5.5 months met inclusion criteria. SSS was used for an average of 36.2 days. Baseline characteristics including gender, BMI, nature of injury, time from injury to surgery, and preoperative PROs (SSV, ASES, and VAS) did not differ significantly between cohorts. The cohort without SSS was older at the time of surgery (61.3 years vs. 59.3 years, p=0.03). Linear mixed model analysis revealed no significant differences in AROM at any timepoint (table 1). There was no significant difference between cohorts with respect to SSV, ASES, and VAS at any timepoint (Table 2). Both cohorts had significant increases in each PRO over time, exceeding minimal clinically important difference (MCID) at 6 months post-operatively.Conclusions:The use of SSS demonstrated excellent ROM and patient reported outcomes equivalent to those who initiated formal PT in the early postoperative period. The convenience of a home-based therapy program monitored via telemedicine in lieu of formal PT during the first 6 post-operative weeks may be an attractive option for patients following ARCR. Future studies will elucidate whether there are potential cost saving implications.Table 1.Active Range of Motion Over TimeTable 2.Patient Reported Outcomes Over Time

Rapid Rehabilitation Program Can Promote the Recovery of Gastrointestinal Function, Speed Up the Postoperative Rehabilitation Process, and Reduce the Incidence of Complications in Patients Undergoing Radical Gastrectomy.

Objective To explore the influence of rapid rehabilitation programs on gastrointestinal function, rehabilitation process, and complications of patients undergoing radical gastrectomy. Methods Of ninety-eight radical gastrectomy cases assessed for eligibility from January 2018 to July 2020, 43 patients who received routine perioperative nursing were assigned to the control group (CG), and 55 patients given a rapid rehabilitation program were assigned to the research group (RG). The recovery of gastrointestinal function, pain, nutritional status, complications, rehabilitation process, quality of life, and nursing satisfaction were compared. Results After nursing, in contrast to the CG, the RG showed significantly better recovery of gastrointestinal function (the first time to eat (t = 7.701, P < 0.01), the first time to anal exhaust (t = 9.342, P < 0.01), the first time to defecation (t = 2.061, P=0.040), and the recovery time to bowel sounds (t = 16.030, P < 0.01)), notably improved pain and nutritional status, and showed fewer complications (X2 = 9.385, P=0.002). Rapid rehabilitation protocol also showed shorter recovery time and higher quality of life and nursing satisfaction of patients versus the routine perioperative nursing (all P < 0.05). Conclusion The rapid rehabilitation program can accelerate the recovery of gastrointestinal function and postoperative rehabilitation and reduce the incidence of complications in patients undergoing radical gastrectomy.

Like I said, I would not have likely gotten up otherwise: patient experiences of using an Activity Board after abdominal cancer surgery

Purpose Most patients treated in a hospital setting are fully or partially immobilised. The Activity Board (Träningstavlan® Phystec) is a useful tool to enhance mobilisation after major abdominal cancer surgery. Knowledge of patient experiences of the mobilisation tool is crucial in implementing the Activity Board in health care. This study aimed to describe patient experiences of using the Activity Board after surgery for abdominal cancer. Materials and methods Semi-structured face-to-face interviews were conducted in 15 patients who underwent abdominal surgery due to colorectal, ovarian or urinary bladder cancer. All 15 patients (mean age 67.7 years, range 40–86) used the Activity Board postoperatively. The interviews were transcribed verbatim and analysed according to inductive content analysis. Results The overarching theme that emerged from the interviews was that “enabling participation facilitates empowerment over rehabilitation”. Three categories supported the theme: prerequisites for using the Activity Board, the value of using supportive behavioural techniques, and the possibility to influence the patients’ care. Conclusions These findings suggest that the Activity Board could be a viable tool that activates the person-centred postoperative rehabilitation process by cooperating with the medical team at the hospital ward. Implications for rehabilitation Patients who are in hospital due to cancer surgery are often immobilised, which increases the risk of complications. The Activity Board can stimulate the patients to participate in the rehabilitation process in a more active way. The Activity Board can be used to improve and clarify the person-centred approach in hospital settings.

Campaigning the innovation and practice of anesthesia and perioperative management for elderly patients in China

The aged population in China is rapidly increasing, but there is a relative lower anesthesia rate with surgical indication for elderly patients because of worry for higher morbidity and mortality. In past five years, Chinese anesthesiologists have made the tremendous efforts to change this situation in as follow aspects. Firstly, establishing the anesthesia and multidisciplinary evaluation system for elderly patients to improve preoperative functional status, and accelerating the postoperative rehabilitation process. Secondly, releasing the publications of perioperative experts consensus for elderly patients based on the high level clinical researches to highlight clinical practice in China. Thirdly, implementing online virtual MDT discussion of anesthesia and perioperative management for critical elderly patients to improve perioperative diagnosis and treatment level. Fourthly, making the innovation of clinical practice and management pathway to adopt to the ERAS' clinical requests for elderly patients, especially advanced aged patients.

Effect of a Care Bundle Combined with Continuous Positive Airway Pressure in the Postanesthesia Care Unit on Rapid Recovery after Pulmonary Tumor Resection.

Objective To study the effect of a care bundle combined with continuous positive airway pressure (CPAP) in the postanesthesia care unit (PACU) on rapid recovery after pulmonary tumor resection. Methods A total of 135 patients requiring anesthesia resuscitation after pulmonary tumor resection in our hospital from June 2020 to February 2021 were selected. They were randomly divided into three groups: the PACU experimental group, PACU control group, and operating room resuscitation (OR) group. Subsequently, their intraoperative clinical symptoms, parameters in monitoring postoperative respiratory status, and follow-up results were compared among the three groups. Results The PACU experimental group had the highest number of right lesions, while the OR group had the highest intraoperative blood transfusion volume, urine volume, intraoperative colloid volume, intrapulmonary shunt, and intraoperative physician handover rate (P < 0.05). Before surgery, serum potassium (K) in the PACU experimental group was significantly higher than that in the OR group but lower than that in the PACU control group (P < 0.01). During the time in the PACU, blood partial pressure of oxygen (PO2) and oxygen index (OI) levels in the PACU experimental group were significantly higher than those in the other groups (P < 0.01). After surgery, total PACU stay time, time from PACU to extubation, and stay after extubation were markedly reduced in the PACU experimental group (P < 0.05). The highest number of patients with drainage was found in the PACU experimental group, while the highest number of patients without drainage was found in the PACU control group. Conclusion A care bundle combined with CPAP in the PACU can improve the monitoring time of respiratory status and improve blood gas parameters, thus accelerating the postoperative rehabilitation process of patients undergoing pulmonary tumor resection.

Rehabilitation Process Issues and Functional Performance after Total Hip and Knee Replacement

(1) Background: to ensure satisfactory outcomes in patients who have undergone total hip or knee replacement, it is crucial to prioritize postoperative rehabilitation process and its management rather than the successful surgery alone. The goal of our study was to investigate the outcomes of rehabilitation process after the total hip or knee replacement, including local orthopedic follow-up, communication with local health authorities, patients’ satisfaction regarding rehabilitation, and their functional performance after the surgery. (2) Methods: the study included 523 patients who underwent total hip replacement, and 650 patients who underwent total knee replacement. All patients were surveyed via formalized phone interviews containing questions related to postoperative rehabilitation parameters and outcomes. (3) Results: in postsurgical period, nearly 70% of patients had regular local orthopedic follow-up. Lack of the latter at the local level was indicated by approximately 10% of patients, and the rest of the respondents note the practice of sporadic follow-up. Half of patients reported pains of various severity. Good physical activity (e.g., ability to walk unassisted within their residential district) was acknowledged by about a quarter of patients. Ability to walk unassisted was reported by just 54.5% of patients. (4) Conclusions: the disproportion between generally high patient satisfaction of rehabilitation management (>80%) and low feedback level on the part of local health authorities (9.4%) demonstrated lack of communication between the key parties involved in the rehabilitation process.

3D Laparoscopy-Assisted Operation to Adult Intussusceptions During Perioperative Period of Liver Transplantation: Case Report and Literature Review

Adult intussusception during the perioperative period is defined as an extremely rare condition, especially when it emerges within short intervals of laparotomy, which may be explained as an unphysiological peristaltic function of the bowel without any lead points. Accurate diagnosis and therapeutic schedule predict a satisfactory outcome. Here, we introduce the case of a 32-year-old man who had symptoms of abdominal pain, no gas emission, and defecation shortly after liver transplantation. Intussusception was definitely diagnosed by abdominal CT, and then reduction was operated successfully by three-dimensional laparoscopy-assisted operation. There were no other complaints, and no secondary lesions were detected during the postoperative rehabilitation process in the hospital and over a follow-up period of 6 months. Relevant literature has been summarized subsequently. A promising minimally invasive surgery along with minimal secondary trauma was presented by laparoscopy in this rare case, providing the potential remedy for perioperative intussusception in the adult.

Age-related language performance and device use in children with very early bilateral cochlear implantation

ObjectivesPaediatric cochlear implantation within the first year of life results in better outcome in auditory and language skills. Beside individual, audiological and social factors, quantity and quality of daily cochlear implant (CI) use also seem to be an influencing factor. The purpose of this study was to evaluate children's early receptive and expressive language performance considering bilingual language development as well as quantity and quality of daily CI use and intraoperative objective measurements. MethodsThe retrospective analysis included data from 35 very early bilaterally cochlear-implanted children (age at CI M = 8.4 ± 1.5 months). Language performance was assessed by the German standardised test SETK-2 (age at testing M = 29.4 ± 4.0 months). The CI system-integrated data-logging was analysed with regard to daily CoilOn-time, CoilOff and exposure to classified listening scenes. Intraoperatively measured thresholds of evoked compound action potentials (T-ECAPs) were analysed to ensure CI functionality. ResultsThe cohort showed language performance within the normal range for word comprehension, sentence comprehension and word production, level of sentence production was reduced. Overall, bilingual children performed less well than monolingual children. Intraoperative T-ECAPs were recorded for the total cohort and no anomalies were detected. Children used their CI for about 8.7 ± 1.4 h per day, most of this time spent in a quiet environment (38%). Word production was significantly correlated with the daily duration of CI use (CoilOn-time) and with exposure to the listening environment Speech. No correlation was found between number of daily coil disconnections (CoilOff) and language performance. ConclusionVery early bilateral cochlear implantation may result in age-appropriate language skills already at the age of 2 years. Monolingualism seems to a better condition for early language development with CI than bilingualism. Especially for word production, the daily duration of CI use and exposure time in a speech-characterised environment seem to be additional positive factors. Monitoring the data-logs should be one important focus of professionals during the postoperative rehabilitation process to detect potential benefits and risks. These findings should be integrated into rehabilitative therapy and parent counselling.

Modified Unipolar Latissimus Transfer to Restore Elbow Flexion in Musculocutaneous Nerve Palsy

Modified Unipolar Latissimus Transfer to Restore Elbow Flexion in Musculocutaneous Nerve Palsy

Exploring Race Differences in Satisfaction With Rehabilitation Following Total Knee Arthroplasty: A Qualitative Study.

The purpose of this qualitative focus group study was to explore race differences in the rehabilitation experience and satisfaction with rehabilitation following total knee arthroplasty (TKA). We conducted a series of qualitative focus group discussions with groups of non-Hispanic White and non-Hispanic Black older adults who recently underwent TKA. We used grounded theory approach, which asks the researcher to develop theory from the data that are collected. Participants discussed barriers and facilitators to accessing rehabilitation after surgery, opinions regarding their physical therapists, the amount of postoperative physical therapy received, and overall satisfaction with the postoperative rehabilitation process. Thirty-six individuals participated in focus groups. Three major themes emerged: (i) Participants reported overall positive views of their post-TKA rehabilitation experience. They particularly enjoyed one-on-one care, the ability to participate in "prehabilitation," and often mentioned specific interventions they felt were most helpful in their recovery. (ii) Despite this, substantial barriers to accessing physical therapy exist. These include suboptimal pain management, copayments and other out-of-pocket costs, and transportation to visits. (iii) There were minor differences in the rehabilitation experiences between Black and White participants. Black participants reported longer paths toward surgery and occasional difficulty interacting with rehabilitation providers. Individuals undergoing TKA can largely expect positive rehabilitation experiences postoperatively. However, some barriers to postoperative physical therapy exist and may differ between Black and White patients. Physical therapists should increase their awareness of these barriers and work to minimize them whenever possible.

Functional deficits in post-operative adolescent idiopathic scoliosis

BACKGROUND: Little or no research currently exists investigating musculoskeletal strength, joint flexibility and cardiopulmonary capacity post-operative adolescent idiopathic scoliosis (AIS) patients. PURPOSE: To explore if AIS patients following spinal fusion surgery have deficiencies in strength, endurance joint flexibility and pulmonary capacity (&gt;12-month post-operative) compared to a matched sample of the general population. METHODS: This retrospective case control study; AIS group (n = 20) and control group (n = 20) matched for gender, age and anthropometrics. Participants underwent standardised tests to establish pulmonary capacity via spirometry, upper and lower limb strength via manual muscle testing, upper and lower limb endurance via press-up and wall squat tests and joint flexibility via manual goniometry. Within session reliability and reproducibility of variables were assessed. RESULTS: No significant differences between AIS and control cohorts were identified for mass (57.1±9.0 vs. 62.8±9.0kg), height (164.7±6.3 vs. 165.6±6.0cm) or BMI (21.2±4.0 vs. 22.9±2.7). Pulmonary and musculoskeletal deficiencies in the AIS cohort were identified, including significantly lower forced vital capacity (FVC; 2.6±0.5 vs. 3.3±0.5L, P &lt; 0.001) and forced expiratory volume in 1 second (FEV1, 2.8±0.6 vs. 3.3±0.5L, P &lt; 0.001); restrictions in shoulder flexion (P &lt; 0.01) and internal rotation (P &lt; 0.001) weaker bilateral pinch grip (P &lt; 0.01) and bilateral hip adductor strength (P &lt; 0.01). CONCLUSION: The results highlight that AIS patients still have major pulmonary and musculoskeletal impairments over a year after spinal fusion surgery. Clinicians should consider periodic assessment of pulmonary and musculoskeletal function with comparison to these age-matched reference values in order to improve the post-operative rehabilitation process.

New Exercise Monitoring and Management Technologies in Post-Operative Orthopaedic Rehabilitation

Appropriate application of exercise protocols during post-operative orthopedic rehabilitation is of great importance for the improvement of the patient's clinical condition. With the introduction of telerehabilitation services in recent years, it is possible for clinicians to monitor and manage the exercise protocols of their patients in a more practical, cost-effective and time-saving manner. Telerehabilitation is used in post-operative period for many pathological conditions, especially total knee arthroplasty, and its effectiveness is investigated by randomized controlled studies. In this review, exercise monitoring and management technologies in post-operative orthopedic rehabilitation process are discussed. Differences, similarities, advantages and disadvantages of these applications compared to conventional methods will be examined.

Does size of the cochlear nerve affect postoperative auditory performance in pediatric cochlear implant patients with normal cochlear nerves?

IntroductionCochlear implantation is an effective treatment method for severe to profound hearing loss. Many factors that may influence cochlear implantation success have been explained in previous studies. Apart from those, minor differences in size of normal cochlear nerves may affect postoperative performance. ObjectiveTo investigate whether the minor differences in cochlear nerve size in normal cochlear nerves affect postoperative cochlear implant performance. Methods30 pediatric prelingually deaf patients who were treated with cochlear implantation were included in this study. From the reconstructed parasagittal magnetic resonance images, the diameter and cross-sectional area of the cochlear nerve on the ipsilateral and contralateral side were measured. Auditory evaluations were performed 1, 3, 6 and 12 months following the first fitting. All the analysis was performed by using EARS®, evaluation of auditory responses to speech tool. Correlation between cochlear nerve diameter, cross-sectional area and postoperative auditory perception was analyzed to determine whether variation in cochlear nerve size contributes to postoperative auditory performance. ResultsThe mean diameter of the cochlear nerve on the ipsilateral side was 718.4 μm (504.5 − 904.3 μm) and mean cross sectional area was 0.015 cm2 (0.012 − 0.018 cm2). On the contralateral side the mean cochlear nerve diameter was 714.4 μm (502.6 − 951.4 μm) and mean cross sectional area was 0.014 cm2 (0.011 − 0.019 cm2). The correlation between the diameter and cross-sectional area of the ipsilateral and contralateral cochlear nerve revealed no significance. Mean score at first month monosyllable-trochee-polysyllable test, MTP1, was 0.17 (0.08 − 0.33), at 6th month with 6 words test, 6th month MTP6 was 0.72 (0.39 − 1.0), at 6th month with 12 words, 6th month MTP 12 was 0.46 (0.17 − 0.75) and at 12th month with 12 words, 12th month MTP12 was 0.73 (0.25 − 1.0). There was no correlation between the monosyllable-trochee-polysyllable test, values at any time with the diameter of the ipsilateral cochlear nerve. However, the first month MTP, 6th month MTP6 and 12th month MTP12 correlated with the cross-sectional area of the ipsilateral cochlear nerve. ConclusionMeasuring the cross sectional area of the normal- appearing cochlear nerve may give important prognostic knowledge on cochlear implant outcomes. In patients with a larger cross sectional area the auditory performance was better and faster. Although normal appearing, slight differences on cross sectional area of the cochlear nerve may affect performance. Measuring the size of the cochlear nerve on parasagittal magnetic resonance images may provide beneficial information on the postoperative rehabilitation process.