Preoperative Rehabilitation Research Articles

Current Perspectives of the Australian Knee Society on Rehabilitation and Return to Sport After Anterior Cruciate Ligament Reconstruction

The importance of rehabilitation and evaluation prior to return to sport (RTS) in patients undergoing anterior cruciate ligament reconstruction has been reported. This study sought to investigate current perspectives of Australian orthopedic surgeons on rehabilitation and RTS evaluation. Survey. Members of the Australian Knee Society. A 14-question survey was disseminated to Australian Knee Society members (orthopedic surgeons) to investigate (1)preferred graft choice, (2)estimated retear rate, (3)importance of preoperative and postoperative rehabilitation, and (4)preferred timing of RTS and evaluation prior to RTS discharge. Of all 85 Australian Knee Society members contacted, 86% (n = 73) responded. Overall, 66 respondents (90.4%) preferentially used hamstring tendon autografts. All surgeons estimated their retear rate to be ≤15%, with 31 (42.5%) <5%. Twenty-eight surgeons (38.4%) reported no benefit in preoperative rehabilitation. The majority of surgeons (82.2%-94.5%) reported that postoperative rehabilitation was important within various periods throughout the postoperative timeline. Most surgeons did not permit RTS until ≥9 months (n = 56, 76.7%), with 17 (23.3%) allowing RTS between 6 and 9 months. The most highly reported considerations for RTS clearance were time (90.4%), functional capacity (90.4%), and strength (78.1%). Most commonly, knee strength and/or function was assessed via referral to a preferred rehabilitation specialist (50.7%) or with the surgeon at their practice (11.0%). This survey revealed variation in beliefs and practices surrounding rehabilitation and RTS evaluation. This is despite the current evidence demonstrating the benefit of preoperative and postoperative rehabilitation, as well as the emerging potential of RTS assessments consisting of strength and functional measures to reduce reinjury rates.

Neoadjuvant Chemoradiation Therapy is Associated with Adverse Outcomes in Patients Undergoing Pancreaticoduodenectomy for Pancreatic Cancer

The use of neoadjuvant chemoradiation therapy in patients with pancreatic adenocarcinoma is emerging as an acceptable therapy option. The effects of neoadjuvant therapy on 30 days' outcomes in patients with pancreatic cancer are not well defined in the literature. NSQIP (2009-2012) was used. Only patients with a diagnosis of pancreatic cancer and those who underwent a Whipple were included in the analysis. Patient who underwent neoadjuvant chemoradiation therapy were compared with those who did not receive therapy. Main outcome measures were as follows: complications, ≥2 units of blood transfusions, length of stay, readmission rates, return to the operating room, and 30-day mortality. A total of 1445 patients (395: neoadjuvant chemoradiation and 1050: no neoadjuvant therapy) were identified. The mean age was 67 ± 12 years, and 51 per cent of the patients were male. Neoadjuvant chemoradiation therapy was associated with increase in readmission rates (18% vs 12.2%, P 0.02), unanticipated return to the operating room (2.3% vs 1.1%, P 0.03) with no difference in mortality rates. Neoadjuvant chemoradiation therapy is associated with increase in inhospital complications. These differences in outcomes may be explained by the more advance stage of pancreatic cancer in these subsets of patients. Resource utilization and preoperative rehabilitation are of utmost significance to overcome this rise in complications associated with neoadjuvant chemoradiation therapy.

Preoperative Activities of Daily Living Dependency is Associated With Higher 30-Day Readmission Risk for Older Adults After Total Joint Arthroplasty.

With recent Medicare payment changes, older adults are increasingly likely to be discharged home instead of to extended care facilities after total joint arthroplasty (TJA), and may therefore be at increased risk for readmissions. Identifying risk factors for readmission could help re-align care pathways for vulnerable patients; recent research has suggested preoperative dependency in activities of daily living (ADL) may increase perioperative and postoperative surgical complications. However, the proportion of older surgical patients with ADL dependence before TJA, and the impact of ADL dependency on the frequency and timing of hospital readmissions is unknown. (1) What proportion of older adults discharged home after TJA have preoperative ADL dependency? (2) Is preoperative ADL dependency associated with increased risk of hospital readmissions at 30 days or 90 days for older adults discharged home after TJA? This was a retrospective cohort analysis of 6270 Medicare fee-for-service claims from 2012 from a 5% national Medicare sample for older adults (older than 65 years) receiving home health care after being discharged to the community after elective TJA. Medicare home health claims were used for two reasons: (1) the primary population of interest was older adults and (2) the accompanying patient-level assessment data included an assessment of prior dependency on four ADL tasks. Activities of daily living dependency was dichotomized as severe (requiring human assistance with all four assessed tasks) or partial/none (needing assistance with three or fewer ADLs); this cutoff has been used in prior research to evaluate readmission risk. Multivariable logistic regression models, clustered at the hospital level and adjusted for known readmission risk factors (such as comorbidity status or age), were used to model the odds of 30- and 90- day and readmission for patients with severe ADL dependence. Overall, 411 patients were hospitalized during the study period. Of all readmissions, 64% (262 of 411) occurred within the first 30 days, with a median (interquartile range [IQR]) time to readmission of 17 days (5 to 46). Severe ADL dependency before surgery was common for older home health recipients recovering from TJA, affecting 17% (1066 of 6270) of our sample population. After adjusting for clinical covariates, severe ADL dependency was not associated with readmissions at 90 days (adjusted odds ratio = 1.20 [95% CI 0.93 to 1.55]; p = 0.15). However, severe preoperative ADL dependency was associated with higher odds of readmission at 30 days (adjusted OR = 1.45 [95% CI 1.11 to 1.99]; p = 0.008). Severe preoperative ADL dependency is modestly associated with early but not late hospital readmission after TJA. This work demonstrates that it may important to apply a simple screening of ADL dependency preoperatively so that surgeons can guide changes in care planning for older adults undergoing TJA, which may include participation in preoperative rehabilitation (pre-habilitation) or more aggressive follow-up in the 30 days after surgery. Further research is needed to determine whether severe ADL dependence can be modified before surgery, and whether these changes in dependency can reduce readmission risk after TJA. Level III, therapeutic study.

A Qualitative Study of Preparation for Lumbar Spinal Stenosis Surgery: Perceptions of Patients and Physical Therapists.

To gain the perspectives of patients who underwent lumbar spinal stenosis (LSS) surgery and physical therapists who treat spine-related disorders regarding rehabilitation and other care prior to LSS surgery. Qualitative focus group study. Sixteen patients (4 female; average ± SD age, 64.3 ± 8.8 years; time since surgery, 9.9 ± 4.4 months) and 10 physical therapists (2 female; average ± SD age, 40.9 ± 6.6 years; time in practice, 17.2 ± 7.7 years) participated. Four groups were conducted: 2 with patients post LSS surgery and 2 with physical therapists who treat spine-related disorders. Participants were asked open-ended questions by a trained facilitator regarding their perceptions of preoperative LSS education and rehabilitation. Transcripts were coded and themes were identified. Analyses revealed 4 themes within the discussions: (1) desire for helpful information, (2) benefits of preoperative rehabilitation, (3) downfalls of preoperative rehabilitation, and (4) desire for coordinated care. Varying opinions on preoperative physical therapy between patients and physical therapists were discussed, revealing that similar numbers of participants held positive and negative perceptions of preoperative physical therapy. A desire for more thorough preoperative education and care was expressed by both groups. There is a clear need for standardized preoperative LSS care and education. This may decrease misunderstandings about LSS surgery and its treatments in the future as well as improve coordinated care between surgeons and physical therapists. J Orthop Sports Phys Ther 2020;50(4):198-205. Epub 30 Oct 2019. doi:10.2519/jospt.2020.8887.

P2.16-42 The Use of a Smartphone Application Improves Postoperative Outcomes in Patients Undergoing Lung Cancer Resection

For early stages of lung cancer, complete surgical resection with curative intent for patients who are surgical candidates remains the most effective treatment. However, thoracic surgery procedures are related to postoperative pulmonary complications which increase the morbidity and mortality. Preoperative pulmonary rehabilitation programs improve postoperative outcomes. This study aims to evaluate the role of a smartphone application to improve pulmonary rehabilitation in a group patients scheduled for lung cancer resection. A Smartphone application containing peri-operative medical advice (stop smoking, mouth health, early mobilization and pain control) and ten chest physical exercises (aerobic exercise, inspiratory muscle strength and secretion mobilization technique) was created. This prospective and no randomized study was developed between January 2017 and December 2018. All patients scheduled for surgery were asked to participate. A group of 68 patients used and interacted with the software before and after the surgery. The control group (114 patients) received classical information and education by the Department of Physical Medicine and Rehabilitation. Clinical-pathological variables, incidence of postoperative pulmonary complications, duration of chest drainage, length of hospital stay and 30 days mortality rate were recorded and analyzed. Postoperative pulmonary complications were developed 17.6% in the intervention group and 33.3% in the control group (P=0.02). The length of hospital stay was shorter in the intervention group (median 3±4.09d vs. 5±6.87d P=0.001). No differences were found in duration of chest drainage or 30 day mortality compared with control group. This new technological resource created by thoracic surgeons demonstrates that preoperative rehabilitation program and patient education improve postoperative outcomes in patients undergoing lung cancer resection, decreasing the incidence of postoperative pulmonary complications and length of hospital stay.

Critical appraisal on the impact of preoperative rehabilitation and outcomes after major abdominal and cardiothoracic surgery: A systematic review and meta-analysis

BackgroundThere has been increasing interest in the prehabilitation of patients undergoing major abdominal surgery to improve perioperative outcomes. This systematic review and meta-analysis aims to evaluate and compare the current literature on prehabilitation in major abdominal surgery and cardiothoracic surgery MethodsA systematic literature search was conducted for studies reporting prehabilitation in patients undergoing major abdominal and cardiothoracic surgery. Meta-analysis of postoperative outcomes (overall and major complications, pulmonary and cardiac complications, postoperative pneumonia, and length of hospital stay) was performed using random effects models. ResultsFive thousand nine hundred and twenty-one patients underwent prehabilitation in 61 studies, of which 35 studies (n = 3,402) were in major abdominal surgery and 26 studies were in cardiothoracic surgery (n = 2,519). Only 45 studies compared the impact of prehabilitation versus no prehabilitation on postoperative outcomes (abdominal, n = 26; cardiothoracic, n = 19). Quality of evidence for prehabilitation in major abdominal and cardiothoracic surgery appear equivalent. Patients receiving prehabilitation for major abdominal surgery have significantly lower rates of overall (n = 10, odds ratio: 0.61, confidence interval 95%: 0.43–0.86, P = .005), pulmonary (n = 15, odds ratio: 0.41, confidence interval 95%: 0.25–0.67, P < .001), and cardiac complications (n = 4, odds ratio: 0.46, confidence interval 95%: 0.22–0.96, P = .044). Sensitivity analysis including randomized controlled trials only did not alter the findings of this study. ConclusionPrehabilitation has the potential to improve surgical outcomes in patients undergoing major abdominal and cardiothoracic surgery. However, current evidence from randomized studies remains weak owing to variation in prehabilitation regimes, limiting the assessment of current postoperative outcomes.

Two-stage revision anterior cruciate ligament reconstruction

With the rising number of anterior cruciate ligament (ACL) reconstructions, revision ACL reconstructions are becoming increasingly common. A revision procedure may be performed to improved knee function, correct instability, and facilitate a return to normal activities. When performing a revision reconstruction, the surgeon decides between a single-stage or a two-stage revision. Two-stage revisions are rarely performed, but are particularly useful when addressing substantial tunnel-widening, active infection, and concomitant knee pathology (e.g., malalignment, other ligamentous injuries, meniscal or chondral lesions). Among these potential scenarios requiring a two-stage revision, tunnel-widening is the most common cause; the first stage involves graft removal, tunnel curettage, and bone grafting, followed by revision ACL reconstruction in the second stage. The purpose of this article is to review the preoperative planning, surgical considerations, rehabilitation, and outcomes of two-stage revision ACL reconstructions and summarize the recent literature outlining treatment results.

The Warrior Athlete Part 2-Return to Duty in the US Military: Advancing ACL Rehabilitation in the Tactical Athlete.

Rehabilitation following an anterior cruciate ligament reconstruction is a crucial component of the healing and recovery process and full return to duty/play in the tactical modern-day warfighter. The burden of anterior cruciate ligament injuries and subsequent loss of readiness in these military warfighters highlights one of the most significant gaps in musculoskeletal injury care today. Emphasis must be placed on early weight-bearing and range of motion (ROM), namely in this athlete population, to best facilitate a timely care and recovery process. Preoperative rehabilitation should commence immediately following the diagnosis of an anterior cruciate ligament tear, because one of the best predictors of postoperative ROM is preoperative ROM. Recent advances in rehabilitation technology such as Alter-G treadmills, inertial measurement units, and blood flow restriction therapy systems, have demonstrated success in the early rehabilitation of tactical athletes. Alter-G treadmills allow for early weight-bearing with reduced impact and progression in ROM following operative management, while inertial measurement units have been applied to tailoring rehabilitation protocols specifically to an athlete's unique functional deficits. When used in conjunction with a fined tune rehabilitation protocol, implemented by a well versed clinical team, these treatment techniques can greatly expedite the return to duty process and limit long-term complications.

Heart Rehabilitation in patients awaiting Open heart surgery targeting to prevent Complications and to improve Quality of life (Heart-ROCQ): study protocol for a prospective, randomised, open, blinded endpoint (PROBE) trial

IntroductionThe rising prevalence of modifiable risk factors (eg, obesity, hypertension and physical inactivity) is causing an increase in possible avoidable complications in patients undergoing cardiac surgery. This study aims to...

Preoperative rehabilitation for patients undergoing colorectal cancer surgery: a retrospective cohort study.

We investigated the impact of preoperative short-term rehabilitation on activities of daily living among patients with colorectal cancer. This retrospective cohort study utilized a hospital-based database containing Diagnosis Procedure Combination survey data from over 100 participating acute-care hospitals. We extracted data on consecutive inpatients hospitalized with stage 1 and 2 colorectal cancer. We compared characteristics and outcomes between patients who underwent short-term rehabilitation before surgery and those who did not. Primary outcomes measured were Barthel Index decline and number of complications during hospitalization. Among of included inpatients (male, 57%; older individuals aged over 65years, 79%; mean Barthel Index, 93.4), the number of patients who underwent preoperative rehabilitation was 760 (39.3%). Patients in the preoperative rehabilitation group were less likely to have a decline in the Barthel Index compared with the control group (5.9% vs 10.1%, P < 0.001) and after propensity score adjustment using inverse probability weighting (6.3% vs 9.8%, P = 0.024). The preoperative rehabilitation group had fewer complications during hospitalization compared with the control group (P < 0.001) and after inverse probability weighting (P = 0.001). Our study showed that preoperative short-term rehabilitation was associated with maintenance and improvement of activities of daily living and fewer complications among patients with stage 1 and 2 colorectal cancer.

Feasibility of conducting an active exercise prehabilitation program in patients awaiting spinal stenosis surgery: a randomized pilot study

Prehabilitation is defined as the process of augmenting functional capacity before surgery in preparation for the postoperative phase. This study intends to assess the feasibility of conducting a preoperative intervention program in patients with lumbar spinal stenosis and to report on the piloting of the proposed intervention. Patients were allocated to a 6-week supervised preoperative rehabilitation program or a control group. The intervention included supervised exercise sessions aimed to improve strength, muscular endurance, and spinal stabilization. Outcomes were measured at baseline, 6 weeks later and again 6 weeks, 3 months and 6 months after surgery. Sixty-five percent of admissible participants agreed to take part in the study, of which 5% dropped out before the end of the intervention period. Eighty-eight percent of potential training sessions were delivered without adverse event. Improvements were seen in favour of the experimental group at the preoperative assessment for active ranges of motion, leg pain intensity, lumbar extensor muscle endurance and walking capacities. Results show that slight modifications to the choice of outcome measures would increase feasibility of the main study. The absence of adverse events coupled with positive changes seen in dependant outcome measures warrant the conduct of a full-scale trial assessing the effectiveness of the intervention.

Superior 2-Year Functional Outcomes Among Young Female Athletes After ACL Reconstruction in 10 Return-to-Sport Training Sessions: Comparison of ACL-SPORTS Randomized Controlled Trial With Delaware-Oslo and MOON Cohorts.

Background:Outcomes after anterior cruciate ligament reconstruction (ACLR) are not uniformly good and are worse among young female athletes. Developing better rehabilitation and return-to-sport training programs and evaluating their outcomes are essential.Purpose:(1) Test the effect of strength, agility, plyometric, and secondary prevention (SAPP) exercises with and without perturbation training (SAPP + PERT) on strength, hops, function, activity levels, and return-to-sport rates in young female athletes 1 and 2 years after ACLR and (2) compare 2-year functional outcomes and activity levels among young female athletes in the Anterior Cruciate Ligament Specialized Post-Operative Return-to-Sports (ACL-SPORTS) trial to homogeneous cohorts who completed criterion-based postoperative rehabilitation alone (Multicenter Orthopaedic Outcomes Network [MOON]) and in combination with extended preoperative rehabilitation (Delaware-Oslo).Study Design:Randomized controlled trial, Level of evidence, 1; and cohort study, Level of evidence, 3.Methods:A total of 40 level 1 and level 2 female athletes were enrolled after postoperative impairment resolution 3 to 9 months after primary ACLR. Participants were randomized to 10 SAPP or SAPP + PERT sessions and were tested 1 and 2 years after ACLR on quadriceps strength, hop tests, functional outcomes, and return-to-sport rates. Participants were then compared with homogeneous cohorts of young (<25 years) female athletes who completed criterion-based postoperative rehabilitation alone (MOON) and in combination with extended preoperative rehabilitation (Delaware-Oslo) on 2-year functional outcomes.Results:No significant or meaningful differences were found between SAPP and SAPP + PERT, so groups were collapsed for comparison with the other cohorts. At 2-year follow-up, ACL-SPORTS had the highest scores (P < .01) on the Marx activity rating scale (ACL-SPORTS, 13.5 ± 3.3; Delaware-Oslo, 12.5 ± 2.7; MOON, 10.6 ± 5.1); International Knee Documentation Committee Subjective Knee Evaluation Form (96 ± 7, 92 ± 9, and 84 ± 14, respectively); and Knee injury and Osteoarthritis Outcome Score (KOOS) subscales for Pain (98 ± 4, 94 ± 9, and 90 ± 10, respectively), Symptoms (94 ± 6, 90 ± 9, and 83 ± 14, respectively), Activities of Daily Living (100 ± 1, 99 ± 4, and 96 ± 7, respectively), Sports and Recreation (94 ± 8, 86 ± 15, and 82 ± 17, respectively), and Quality of Life (89 ± 14, 78 ± 18, and 76 ± 19, respectively). The Patient Acceptable Symptom State threshold on the KOOS–Sports and Recreation was achieved by 100% of the ACL-SPORTS cohort compared with 90% of Delaware-Oslo and 78% of MOON (P = .011).Conclusion:Although perturbation training provided no added benefit, 10 sessions of return-to-sport training, compared with criterion-based postoperative rehabilitation alone, yielded statistically significant and clinically meaningfully higher 2-year functional outcomes among young, high-level female athletes after ACLR.Registration:NCT01773317 (ClinicalTrials.gov identifier).

Priešoperacinė reabilitacija abdominalinėje onkologinėje chirurgijoje: naujas paciento paruošimo operacijai standartas?

Straipsnyje trumpai pristatoma nauja paciento paruošimo onkologinei pilvo organų operacijai strategija – priešoperacinė reabilitacija. Pirmieji klinikinių tyrimų rezultatai teikia vilčių, kad, taikant priešoperacinę reabilitaciją, susidedančią iš trijų komponentų: fizinių pratimų, mitybos nepakankamumo korekcijos ir psichologinio paciento paruošimo, galima pagerinti pacientų fizinę būklę, pooperacinę gyvenimo kokybę, net smarkiai sumažinti pooperacinių komplikacijų dažnį. Vis dėlto lieka neaišku, ar priešoperacinė reabilitacija yra tikslinga prieš visas operacijas, ar tik prieš tas operacijas, kurios yra ypač didelės apimties. Todėl, kol minėta metodika galės būti taikoma kasdienėje klinikinėje praktikoje, reikia naujų klinikinių tyrimų. Šie tyrimai turėtų atskleisti, prieš kokias operacijas paciento reabilitacija yra tikslingiausia, taip pat nustatyti, kokia konkreti priešoperacinės reabilitacijos metodika yra efektyviausia.

Superior 2-Year Functional Outcomes Among Young Female Athletes After ACL Reconstruction in Just 10 Post-Operative Return-to-Sport Training Sessions

Objectives: Outcomes after anterior cruciate ligament reconstruction (ACLR) are not uniformly acceptable and are worse among young female athletes. Developing better rehabilitation and return-to-sport (RTS) training programs and evaluating their outcomes are essential. The purposes of this study were to: 1) Test the effect of strength, agility, plyometric, and secondary prevention (SAPP) exercises with and without perturbation training (SAPP+PERT) on strength, hops, functional outcomes, activity levels, and RTS rates in young female athletes 1 and 2 years after ACLR; and 2) Compare 2-year functional outcomes and activity levels among young female athletes in the ACL-SPORTS trial to homogeneous cohorts who completed criterion-based post-operative rehabilitation alone (MOON) and in combination with extended pre-operative rehabilitation (DE-Oslo). We hypothesized that SAPP+PERT would result in superior outcomes compared to SAPP alone; and female athletes who structured completed post-operative RTS training, compared to those who did not, would have higher functional outcomes. Methods: Aim 1 is a randomized control trial (NCT01773317) while aim 2 is a cohort study. For aim 1, we enrolled 39 female athletes, based on power calculations described previously. Athletes were enrolled 3-9 months after primary ACLR when they achieved impairment resolution. Participants were randomized to 10 SAPP or SAPP+PERT sessions (˜2x/week) and tested 1 and 2 years after ACLR on quadriceps strength, 4 hop tests, functional outcome measures, and RTS rates. We used 2x2 mixed-model ANOVA to test aim 1 (α = 0.05). Secondary to no group differences, we collapsed across SAPP and SAPP+PERT for aim 2. We applied inclusion/exclusion criteria and constrained sex (female) and age (13 to &lt; 25 years) to compare these athletes who received post-operative RTS training (ACL-SPORTS) to homogeneous subsets who completed criterion-based post-operative rehabilitation alone (MOON) and combined with extended pre-operative rehabilitation (DE-Oslo) on 2-yr outcomes: the International Knee Documentation Committee Subjective Knee Evaluation Form (IKDC), Knee Injury and Osteoarthritis Outcome Score (KOOS), and Marx Activity Rating Scale. We tested aim 2 using 3-way ANOVA and Chi-Square test of proportions to compare the proportion of individuals in each group who met the Patient Acceptable Symptom State (PASS) thresholds. Results: There were no significant or clinically meaningful differences between SAPP and SAPP+PERT; groups were collapsed for comparison to the other cohorts. ACL-SPORTS had the highest scores on every outcome (Table 1). A higher proportion of ACL-SPORTS achieved the PASS thresholds for the IKDC, KOOS Activities of Daily Living, and KOOS Sport and Recreation (Fig 1, p ≤ .01). Conclusion: Our 1st hypothesis, that the addition of perturbation training would result in superior clinical and functional outcomes, was not supported. Our 2nd hypothesis, that a structured RTS training program would improve outcomes over existing cohorts, was supported. Post-operative RTS training incorporating strengthening, agilities, and plyometrics but not necessarily perturbation training, may improve functional outcomes and activity levels among young female athletes after ACLR. We provide a prototype for RTS training that would be feasible to implement into group or non-clinical environments. Future RCTs should assess the comparative effectiveness of RTS training in various settings. [Table: see text][Figure: see text][Figure: see text][Figure: see text]

Effects of preoperative cardiac rehabilitation nursing intervention for patients with advanced valvular heart disease on cardiac function and quality of life

Objective To explore the feasibility and safety of preoperative cardiac rehabilitation (CR) nursing intervention in patients with severe valvular disease, and to evaluate the effect of preoperative exercise-mediated cardiac rehabilitation nursing on the clinical outcomes of patients after operation. Methods From January to December of 2017, 108 patients with advanced valvular heart disease (AVHD) admitted in Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School were selected based on the diagnostic standard for AVHD. The AVHD patients should not be younger than 18 years old, left ventricular ejection fraction (LVEF) less than 40%, and need repair of interventricular septal perforation, resection of ventricular aneurysm and radiofrequency ablation of surgical atrial fibrillation simultaneously. Random number method was used to divide the patients into control group and cardiac rehabilitation nursing intervention group (CR group) . Mitral and aortic valve lesions were the main types of valvular lesions in the two groups, and the principles of preoperative treatment were the same. Patients in the control group received routine nursing after admission. The patients in the observation group were evaluated by 6 minute walking test (6MWT) after admission. According to the distance of 6MWT, MOTO Med nursing intervention was carried out in gradeⅠ andⅡ. Frequency was once a day, 30 minutes each time, the first movement resistance was 1 kg, and was adjusted appropriately according to the individual situation. Exercise training and aerobic training were carried out for gradeⅢ andⅣ, with emphasis on lower limb muscles, abdominal muscles and ectopectoralis once a day for 20 minutes each time. Results There was no significant difference in hospital stay, ICU stay time and mechanical ventilation time between the two groups (P>0.05) . The LVEF value of CR group was significantly higher than that of control group at the early stage after operation[ (42.5±6.2) vs . (31.0±4.5) , P 0.05) . Conclusions Preoperative cardiac rehabilitation nursing intervention can effectively improve the cardiac function of patients with severe valvular disease early after operation, increase the early exercise tolerance of patients after operation, improve the early self-care ability of patients after operation, and help patients recover better and faster. Key words: Advanced valvular heart disease; Cardiac function; Quality of life; Preoperative cardiac rehabilitation nursing

Interobserver variability of ventilatory anaerobic threshold in asymptomatic volunteers

Background: The ventilatory anaerobic threshold (VO2@AT) has been used in preoperative risk assessment and rehabilitation for many years. Our aim was to determine the interobserver variability of AT using cardiopulmonary exercise (CPET) data from a large epidemiological study (SHIP, Study of Health in Pomerania). Methods: VO2@AT was determined from CPET of 1,079 cross-sectional volunteers, according to American Heart Association guidelines. VO2@AT determinations were compared between two experienced physicians, between physicians and qualified medical assistants, and between physicians or medical assistants and software-based algorithms. For the first 522 data sets, the two physicians discussed discrepant readings to reach consensus; the remaining data sets were analyzed without consensus discussion. Results: VO2@AT was detectable in 1,056 data sets. The physicians recorded identical VO2@AT values in 319 out of 522 cases before consensus discussion (61.1%; intraclass correlation coefficient [ICC]: 0.90; 95% confidence interval [CI]: 0.88–0.92) and in 700 out of 1,056 cases overall (66.3%; ICC: 0.95; 95% CI: 0.95–0.96), with an interobserver difference of 0 ± 8% (95% limits of agreement [LOA]: ±161 mL/min). The interobserver difference was − 2 ± 18% (95% LOA: ±418 mL/min) between a physician and medical assistants, and − 19 ± 24% to − 22 ± 26% (95% LOAs: ±719–806 mL/min) between physicians or medical assistants and software-based algorithms. Conclusions: Experienced physicians show high agreement when determining AT in asymptomatic volunteers. However, agreement between physicians and qualified medical assistants is lower, and there is substantial deviation in AT determination between physicians or medical assistants and software-based algorithms. This must be considered when using AT as a decision tool.

Interobserver variability of ventilatory anaerobic threshold in asymptomatic volunteers

BackgroundThe ventilatory anaerobic threshold (VO2@AT) has been used in preoperative risk assessment and rehabilitation for many years. Our aim was to determine the interobserver variability of AT using cardiopulmonary exercise (CPET) data from a large epidemiological study (SHIP, Study of Health in Pomerania).MethodsVO2@AT was determined from CPET of 1,079 cross-sectional volunteers, according to American Heart Association guidelines. VO2@AT determinations were compared between two experienced physicians, between physicians and qualified medical assistants, and between physicians or medical assistants and software-based algorithms. For the first 522 data sets, the two physicians discussed discrepant readings to reach consensus; the remaining data sets were analyzed without consensus discussion.ResultsVO2@AT was detectable in 1,056 data sets. The physicians recorded identical VO2@AT values in 319 out of 522 cases before consensus discussion (61.1%; intraclass correlation coefficient [ICC]: 0.90; 95% confidence interval [CI]: 0.88–0.92) and in 700 out of 1,056 cases overall (66.3%; ICC: 0.95; 95% CI: 0.95–0.96), with an interobserver difference of 0 ± 8% (95% limits of agreement [LOA]: ±161 mL/min). The interobserver difference was − 2 ± 18% (95% LOA: ±418 mL/min) between a physician and medical assistants, and − 19 ± 24% to − 22 ± 26% (95% LOAs: ±719–806 mL/min) between physicians or medical assistants and software-based algorithms.ConclusionsExperienced physicians show high agreement when determining AT in asymptomatic volunteers. However, agreement between physicians and qualified medical assistants is lower, and there is substantial deviation in AT determination between physicians or medical assistants and software-based algorithms. This must be considered when using AT as a decision tool.

Rehabilitation nursing of a patient with pleural giant solitary fibroma with Doege-Potter syndrome

Objective To summarize the clinical rehabilitation nursing practice of a patient with pleural giant solitary fibroma with Dege-Port syndrome. Methods A preoperative and postoperative rehabilitation nursing of a patient with low pulmonary function pleural giant solitary fibroma and non-islet cell hypoglycemia was analyzed and summarized. Results After psychological, hypoglycemia, and pulmonary rehabilitation, the patient was tolerant to surgery and recovered well after surgery. He was discharged from hospital on the 13th day after surgery. Conclusions For patients with difficult diagnosis, long-term pleural giant solitary fibroma with hypoglycemia and low lung function, psychological nursing, hypoglycemia symptomatic treatment, pulmonary rehabilitation to improve lung function, close observation and prevention of serious complications in patients It plays a vital role in the course of the disease and rehabilitation. Key words: Solitary fibrous tumor; Rehabilitation nursing; Doege-Potter syndrome

Outcome of intensive rehabilitation following single-event multilevel surgery for crouch gait in children with cerebral palsy

BackgroundCrouch gait is one of the most common gait patterns in ambulatory children with cerebral palsy (CP) and is contributed by several factors. The literature reports wide variations in surgical practice and rehabilitation programs following single-event multilevel surgeries.ObjectiveTo evaluate the outcome of rehabilitation after single-event multilevel orthopedic surgery for crouch gait in children with CP.Patients and methodsA total of 20 children with bilateral spastic CP and walked with a crouch gait, with gross motor function classification system levels II, III, and IV, were subjected to single-event multilevel surgery. Ten (20 limbs) patients were men and eight (14 limbs) were women. Their age ranged from 5.5 to 19 years. To assess the outcome of our rehabilitation program, we used clinical couch examination parameters, functional mobility scale, and instrumented three-dimensional gait analysis. Rehabilitation program included preoperative and postoperative rehabilitation at 1-year postoperatively.ResultsHighly statistically significant improvements in clinical parameters, which include hip abduction, femoral anteversion, fixed flexion deformity, popliteal angle, and extension lag, were demonstrated (P<0.01), whereas tibial torsion showed a statistically significant improvement (P<0.05). Functional mobility scale at 5, 50, and 500m improved in 10 (55.6%) cases, 13 (72.2%) cases, and 11 (61.1%) cases, respectively. Instrumented gait laboratory parameters, namely, stride length, crouch angle at initial stance, and peak knee flexion in mid-swing, showed improvement but did not reach statistical significance.ConclusionThe rehabilitation program we offered improves clinical and functional mobility of children with CP with crouch gait. Thus, it is viewed as an important contributor to the overall outcome together with multilevel orthopedic surgery.

Preoperative rehabilitation care in total hip joint replacement by rapid recovery approach in Slovakia

Relevance of research: Hip fractures and arthrosis are currently one of the serious illnesses presenting as a serious health problem faced by the aging population. The health problem is not just the wound itself or arthrotic changes accompanied by severe pains and difficulties to get up and walk on the affected lower limb, but also the risk of inadequate healing after surgery. Also, significant disability and reduced ADL performance may continue despite the immense advances in surgical techniques, nursing care and rehabilitation. Nowadays, which is primarily aimed at reducing the cost of health care, it is necessary to ensure that this reduction in costs is not at the expense of the quality of health care and future medical success. In general, physiotherapy for total hip joint replacement is considered to be a routine matter that deals mainly with mobility training, increased muscular strength, and basic day-to-day activities such as bed-to-chair transition, standing and walking. In addition to these attributes, physiotherapists also need the patient's own experiences and psychological responses such as anxiety and fear. Goal and methods of research: The aim of the thesis is to point out the importance of preoperative preparation of the patient for total replacement of the hip joint and its impact on the reduction of recovery after surgery. As a method, a case study of the 33 year patient indicated for total hip replacement was selected. The patient underwent a comprehensive preoperative three-month preoperative treatment (from the moment of indication to surgery to performance itself) and subsequent post-operative rehabilitation treatment of three and a half months. Results: A comprehensive rehabilitation program was developed taking into account the patient's health and Rapid recovery recommendations in preoperative and postoperative care. During the preparatory phase of the operation, the patient was modified by motor stereotype walking, strengthened lower limb muscles, especially musculus quadratus femoris and pelvis stabilizers. Lower limb circumference values increased by 2 cm, hip muscle strength increased from grade 3 to grade 4 of the Janda muscle tests, and shortened muscles iliopsos were released on the affected side. Taking into account the operational complications and subsequent comprehensive care according to Rapid Recovery recommendations, the stay in the hospital was reduced from 12 days to 5 and the patient returned to normal working life from 6 months to 4 months. Conclusion: Rapid recovery program requires the development of a new culture not only in normal orthopedic outpatient clinics but also in hospitals. In the past, and nowadays in some regions of the world, slow recovery with extended acute hospitalization for several weeks has been thought to be the best way for patients to recover and achieve a good result after complete replacement of either the hip or knee joint. The results of total hip joint surgery studies showed a significant reduction in hospital stay without increasing the remission rate. Subsequently, patient satisfaction increased, accompanied by a reduction in health care costs and a faster return to normal daily life.