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Force-plate analyses of balance following a balance exercise program during acute post-operative phase in individuals with total hip and knee arthroplasty: A randomized clinical trial.

ABSTRACT: OBJECTIVES:Typical rehabilitation programs following total hip arthroplasty and total knee arthroplasty include joint range of motion and muscle-strengthening exercises. Balance and balance exercises following total hip arthroplasty and total knee arthroplasty have not received much attention. The purpose of this study was to determine whether an intervention of balance exercises added to a typical rehabilitation program positively affects patients' balance. METHODS:A total of 63 patients were provided with outpatient physical therapy at their home. Patients were randomly assigned to either typical (n?=?33) or balance (n?=?30) exercise group. The typical group completed seven typical surgery-specific joint range of motion and muscle-strengthening exercises, while the balance group completed the typical exercises plus three balance exercises. After 5?weeks of administering the rehabilitation program, patients' balance was assessed on a force plate using 95% ellipse area of the center of pressure amplitude. RESULTS:Patients in the balance group demonstrated significant reduction in the 95% ellipse area for the anterior and posterior lean standing conditions (p?

SUBMITTER: Jogi P

PROVIDER: S-EPMC5102164 | biostudies-literature | 2016

REPOSITORIES: biostudies-literature

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Force-plate analyses of balance following a balance exercise program during acute post-operative phase in individuals with total hip and knee arthroplasty: A randomized clinical trial.

Jogi Pankaj P Zecevic Aleksandra A Overend Tom J TJ Spaulding Sandi J SJ Kramer John F JF

SAGE open medicine 20161107

<h4>Objectives</h4>Typical rehabilitation programs following total hip arthroplasty and total knee arthroplasty include joint range of motion and muscle-strengthening exercises. Balance and balance exercises following total hip arthroplasty and total knee arthroplasty have not received much attention. The purpose of this study was to determine whether an intervention of balance exercises added to a typical rehabilitation program positively affects patients' balance.<h4>Methods</h4>A total of 63 ...[more]

PMID: 27867519

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Project description:ImportanceThe Hospital Readmissions Reduction Program (HRRP) is a Centers for Medicare and Medicaid Services policy that levies hospital reimbursement penalties based on excess readmissions of patients with 4 medical conditions and 3 surgical procedures. A greater understanding of factors associated with the 3 surgical reimbursement penalties is needed for clinicians in surgical practice.ObjectiveTo investigate the first year of HRRP readmission penalties applied to 2 surgical procedures-elective total hip arthroplasty (THA) and total knee arthroplasty (TKA)-in the context of hospital and patient characteristics.Design, setting, and participantsFiscal year 2015 HRRP penalization data from Hospital Compare were linked with the American Hospital Association Annual Survey and with the Healthcare Cost and Utilization Project State Inpatient Database for hospitals in the state of Florida. By using a case-control framework, those hospitals were separated based on HRRP penalty severity, as measured with the HRRP THA and TKA excess readmission ratio, and compared according to orthopedic volume as well as hospital-level and patient-level characteristics. The first year of HRRP readmission penalties applied to surgery in Florida Medicare subsection (d) hospitals was examined, identifying 60 663 Medicare patients who underwent elective THA or TKA in 143 Florida hospitals. The data analysis was conducted from February 2016 to January 2017.ExposuresAnnual hospital THA and TKA volume, other hospital-level characteristics, and patient factors used in HRRP risk adjustment.Main outcomes and measuresThe HRRP penalties with HRRP excess readmission ratios were measured, and their association with annual THA and TKA volume, a common measure of surgical quality, was evaluated. The HRRP penalties for surgical care according to hospital and readmitted patient characteristics were then examined.ResultsAmong 143 Florida hospitals, 2991 of 60 663 Medicare patients (4.9%) who underwent THA or TKA were readmitted within 30 days. Annual hospital arthroplasty volume seemed to follow an inverse association with both unadjusted readmission rates (r = -0.16, P = .06) and HRRP risk-adjusted readmission penalties (r = -0.12, P = .14), but these associations were not statistically significant. Other hospital characteristics and readmitted patient characteristics were similar across HRRP orthopedic penalty severity.Conclusions and relevanceThis study's findings suggest that higher-volume hospitals had less severe, but not significantly different, rates of readmission and HRRP penalties, without systematic differences across readmitted patients.

Project description:ImportanceSurgical team communication is a critical component of operative efficiency. The factors underlying optimal communication, including team turnover, role composition, and mutual familiarity, remain underinvestigated in the operating room.ObjectiveTo assess staff turnover, trainee involvement, and surgeon staff preferences in terms of intraoperative efficiency.Design, setting, and participantsRetrospective analysis of staff characteristics and operating times for all total joint arthroplasties was performed at a tertiary academic medical center by 5 surgeons from January 1 to December 31, 2018. Data were analyzed from May 1, 2021, to February 18, 2022. The study included cases with primary total hip arthroplasties (THAs) and primary total knee arthroplasties (TKAs) comprising all primary total joint arthroplasties performed over the 1-year study interval.ExposuresIntraoperative turnover among nonsurgical staff, presence of trainees, and presence of surgeon-preferred staff.Main outcomes and measuresIncision time, procedure time, and room time for each surgery. Multivariable regression analyses between operative duration, presence of surgeon-preferred staff, and turnover among nonsurgical personnel were conducted.ResultsA total of 641 cases, including 279 THAs (51% female; median age, 64 [IQR, 56.3-71.5] years) and 362 TKAs (66% [238] female; median age, 68 [IQR, 61.1-74.1] years) were considered. Turnover among circulating nurses was associated with a significant increase in operative duration in both THAs and TKAs, with estimated differences of 19.6 minutes (SE, 3.5; P < .001) of room time in THAs and 14.0 minutes (SE, 3.1; P < .001) of room time in TKAs. The presence of a preferred anesthesiologist or surgical technician was associated with significant decreases of 26.5 minutes (SE, 8.8; P = .003) of procedure time and 12.6 minutes (SE, 4.0; P = .002) of room time, respectively, in TKAs. The presence of a surgeon-preferred vendor was associated with a significant increase in operative duration in both THAs (26.3 minutes; SE, 7.3; P < .001) and TKAs (29.6 minutes; SE, 9.6; P = .002).Conclusions and relevanceThis study found that turnover among operative staff is associated with procedural inefficiency. In contrast, the presence of surgeon-preferred staff may facilitate intraoperative efficiency. Administrative or technologic support of perioperative communication and team continuity may help improve operative efficiency.

Dataset Information

Force-plate analyses of balance following a balance exercise program during acute post-operative phase in individuals with total hip and knee arthroplasty: A randomized clinical trial.

Publications

Force-plate analyses of balance following a balance exercise program during acute post-operative phase in individuals with total hip and knee arthroplasty: A randomized clinical trial.

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