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12NAUKI MEDYCZNE | МЕДИЦИНСКИЕ НАУКИ
A COMPARATIVE ANALYSIS BETWEEN THE RECOVERY RESULTS OF PATIENTS WITH HIP JOINT REPLACEMENT IN THE PERIOD OF FUNCTIONAL RECOVERY-UNTIL THE END OF THE FIRST YEAR AFTER SURGERY
Krastanova M. St.,
PhD, MD, Assistant professor Department of "Physical medicine, rehabilitation, ergotherapy and sport" Clinic of Physical and Rehabilitation Medicine University Hospital
Medical University - Pleven, Bulgaria Vacheva D. E., PhD, Assistant professor - kinesitherapist Department of "Physical medicine, rehabilitation, ergotherapy and sport" Clinic of Physical and Rehabilitation Medicine University Hospital
Medical University - Pleven, Bulgaria
ABSTRACT
Joint replacement is currently one of the most widespread surgery procedures in orthopedics and traumathology. Physical and rehabilitation medicine plays an important part for improving the speed and the degree of functional recovery for patients with hip joint arthtoplasty. Conducting proper and timely rehabilitation plays an important role for a more complete recovery and for prevention from complications. Endoprosthesis significant number of patients does not carry out adequate rehabilitation treatment after hospital discharge from the Department of Orthopedics and Traumatology. The reasons for this are mostly financial, social or domestic difficulties. The aim of this report is to make a comparative analysis between the recovery results of patients who conducted a comprehensive rehabilitation treatment, and a control group of patients who conducted only early physical therapy and occupational therapy in the hospitalization in the Department of Orthopedics and Traumatology in the period of functional recovery - until the end of the first year after surgery. Methods and materials: A total of 213 patients (147 female and 66 male aged 22 to 84) with Hip Joint Arthroplasty due to osteoarthrosis or femoral neck bone fracture participated in the study, divided into two groups, according to postoperative behavior. Rehabilitation program of the first observed therapy group includes: kinesitherapy; treatment with performed physical factors (low-frequency impulse magnetic field; interferential currents - quadrupole isoplanar interference; electrostimulation); occupational therapy - daily activities of life. Patients in the second contlol group have conducted kinesitherpy and occupapional therapy only in the early postoperative period in orthopedic clinic. We took the test for pain, self-rating test and the complex functional assessment test at the beginning and at the end of the observed period, and stored the results in an individual file for each patient. Results and discussion: Based on the results from the study, we can conclude that applying an annual complex rehabilitation program which includes kinesitherapy, performed physical factors and occupational therapy significantly speeds up and improves the recovery process, and ensures reaching optimal functional results for patients with endoprosthesis.
Key words: total hip arthroplasty, hip joint, rehabilitation
Introduction
Joint replacement of the hip joint is currently one of the most widespread surgery procedures in orthopedics and traumathology. Improvement of surgery methods and techniques and the introduction of new prosthesis materials have resulted in endoprosthesis becoming one of the most successful treatment methods in general [3, 3-14; 6, 148188]. Physical and rehabilitation medicine plays an important part for improving the speed and functional recovery degree for patients with hip joint arthtoplasty. Conducting proper and timely rehabilitation plays an important role for a more complete recovery and for prevention from complications [10, 400-480; 11,145-146]. A significant number of patients do not conduct an adequate rehabilitation treatment after discharge from the Department of Orthopedics and Traumatology. The reasons for this are most frequently financial and/or social.
The aim of this report is to make a comparative analysis of the results of the recovery of patients conducted annual comprehensive rehabilitation treatment (therapy group - TG) and control group(CG) patients conducted only early physical
therapy and occupational therapy in the hospitalization in the Department of Orthopedics and Traumatology in the period of functional recovery - until the end of the first year after surgery.
Methods and materials
213 patients (147 female and 66 male) aged between 22 and 84 with hip joint arthroplasty due to osteoarthritis or femoral neck fracture participated in the study. All of them had surgery at the Orthopedics and Traumatology Clinic at UMBAL "D-r G. Stranski", Pleven, between 2012 and 2015, divided into two groups, according to postoperative behavior:
TG includes 123 patients conducted a one-year comprehensive rehabilitation in the Department of Physical Medicine and Rehabilitation at University Hospital «Dr. D. Stransky» Pleven.
CG includes 90 patients, doing kinezitherapy and occupational therapy only in the early postoperative period in Orthopedics and Traumatology Clinic.
The methods of the conducted rehabilitation program were developed at the clinic over 30 years ago and have been constantly improved and updated over the years. The purpose
of rehabilitation during the period of functional recovery varies with age - for younger patients, it is complete recovery exceeding pre-trauma level; patients of working age aim to return to professional activity, sports and an active social life; for older and disabled patients strive to achieve full independence at home. The complex rehabilitation program is proscribed by the assigned doctor - a specialist in physical and rehabilitation medicine, and is coordinated with the degree of recovery of the patients and their physical and functional capacity.
Patients in the therapy group (TG) conducted:
Kinesitherapy - based on what the patient learned during early and late rehabilitation and include: underwater shower massage - 10 min., 1 to 1,5 atmospheres with water temperature of 36-37° C; underwater gymnastics - 10 min.; analytical exercises and dosed walking with and without aids - 20-30 minutes; riding a stationary bike - up to 20 minutes with intermittent intensity. All sports associated with heavy physical activity are strictly prohibited, while moderate cycling, swimming and walking are allowed. When riding a stationary bike or bicycle, certain safety precautions are required [8, 598618; 15, 172-181]. Walking exercises take place over longer distances without aids, but not more than 2000 meters and on slope not higher than 10-15° [7, 16-19; 15, 172- 181 ]. The use of aids at this stage depends on several factors: the achieved muscle balance, the strength and endurance of the hip joint muscles, any accompanying diseases and the condition of the other joints of the lower limb. In the absence of contraindications, patients were advised to walk without aids [8, 598-618; 14, 643686]. Patients who have already mastered and gotten used to the elements of the rehabilitation program can slowly increase the number of repetitions of exercises, the duration of training and the intensity [7, 16-19].
Based on the subjective patient complaints and the objective state of the patients at this stage treatment, preformed physical factors include: low-frequency pulse magnetic field 20 min, 20 мин., 16000 A/m; Interference currents - 5 min. 90100 Hz, 10 min. 1-100 Hz (quadrupole isoplanar interference), electrostimulation (of the m. quadriceps femoris and the gluteal muscles) - 50 Hz, rectangular impulse with impulse length of 1 ms/19 ms pause; group modulation with group continuation of 100 ms, periods from 1000 to 2000 ms [5, 17-24; 12, 206-216; 13, 291-301].
- Occupational therapy covers recreational sports and professional and occupational activities [2, 193-220; 14, 643686]. Patients of working age should be oriented towards opportunities to return to work. Some professions such as teachers, doctors, accountants etc. allow patients to return to their former employment. In other professions, however, this is not possible and a career change is required. Jobs and activities associated with heavy physical work, prolonged standing or weight carrying are strictly forbidden [6, 68-72].
- Patients in the control group conducted: Kinesitherapy: includes positional therapy; isometric
exercises for the gluteal and thigh muscles; active exercises against resistance, exercises for the shoulder girdle, upper limbs and contralateral lower limb, gradual mobilization of prosthetic reconstructed hip joint, proprioceptive neuromuscular ease (PNME); verticalization in several stages; training with walking aids - two axillary crutches fnly in the period of early rehabilitation.
- Occupational therapy - daily life activities includes «clothing and footwear» with a «toilet and maintain personal hygiene.»
Results
For the purpose of our report, the following tests were made at the end of the first year after surgery: VAS for pain assessment (self-rating system based on points - 0 points means no pain, 20 points means severe pain), self-assessment test «Quality of life with prosthesis «(0 points shows an unsatisfactory condition, 10 points is satisfactory), and the complex functional assessment (CFA) test of the hip joint (it consists of a VAS test for pain, goniometry, manual muscle testing, a test of locomotion -depending on the presence or lack of a limp and walking aids, DAL test for personal hygiene, dressing, eating, household activities, transport). The results for each patient are stored in an individual patient file [1,156-159; 4, 1481-155; 9, 93-99].
Figure №1 reflects the comparative analysis of results of VAS for pain in both treatment groups, clearly shows a pronounced pain symptoms in patients CG.
Figure №2 presents the median results of the self-assessment test «Quality of life with hip joint arthroplasty». The majority of patients in TG were satisfied with their recovery at the end of the first year after surgery, and their self-assessment results were higher than those of patients in CG for the observed period.
□ therapy group
□ control group
/ У У
6,12
2,75
л / Г
Fig. №1 Results of VAS for pain in both treatment groups
□ therapy group
□ control group
10 8 6
Л л
f- 9,34 'У-7
7,28
Fig. №2 Results of the self-assessment test «Quality of life with hip joint arthroplasty» in both treatment groups
Figure №3 shows the median results of the test for CFA (below 40 points - «satisfactory» condition, 41-70 points -«good» condition, 70-85 points - «very good» condition, more than 85 points - «excellent 'functional recovery) at the end
of the first year of the operation - maximum 100 points. The results show a significant improvement in functional recovery of rehabilitated patients compared to patients in the CG.
□ therapy group
□ control group
100 80 60 40 20
л //-7
86,12 Л X
71,23
Fig. №3 Results of the test for CFA in both treatment groups
Implications
1. The applied one-year comprehensive rehabilitation program significantly improves and speeds up the functional recovery of patients after Hip joint replacement. It is positively rated by patients, does not cause accidents, complications and side effects.
2. The fact that patients rate their functional recovery positively after complex rehabilitation and are satisfied with it at the end of the first year proves the benefits of the treatment and its positive effects on the self-sufficiency, psychological condition and lack of depressive states compared to patients who conducted only early rehabilitation in the Orthopedics and Traumatology Clinic.
3. The good results of the CFA test for the first group of patients in the observed period, the formation of a peak and the shift of the Wilcoxon curve to the right reflect significantly improved functional status of rehabilitated patients compared to the ones in the control group.
Conclusions
Based on the results of the study we can conclude that conducting a comprehensive rehabilitation program including
kinesitherapy, preformed physical factors and occupational therapy significantly accelerates the recovery of patients with hip joint arthroplasty and provides optimal functional results. Patients who received a one-year comprehensive rehabilitation therapy reported much higher satisfaction with the achieved results compared to patients without rehabilitation.
References
1. Velkova D. Health and social problems of the elderly people living alone in the villages. Disertation. Pleven, 2000; 156-159 [In Bulgarian].
2. Ilieva E. Occupational Therapy in endoprosthesis. In the textbook Occupational Therapy, part II, edited by Prof. Topuzov. Sofia: „Simel", 2008; 193-220 [In Bulgarian].
3. Jotov A., Rusimov V. Current Aspects in Hip and Knee Joint Replacement. Physical medicine, rehabilitation, Health. 2013; (2): 3-14 [In Bulgarian].
4. Kinov P. et al. Validation of a questionnaire for self-assessment of patient the function of hip with arthroplasty. Ortop and Traumatology, 2003; (39): 1481-1559 [In Bulgarian].
5. Milanova H, Troev T. Превенция и рехабилиат-
4
2
0
0
цмfl, Current strategies for physical therapy and rehabilitation after fracture of the distal radius (magnetic therapy, interference current, laser therapy) (overview). Prevention and rehabiliattsiya, vol. V, 2011; (2): 17-24 [In Bulgarian].
6. Tivchev P., Kinov P. et al. Arthroplasthy of the Hip Joint. Sofia, BG Kniga. 2014; 68-72, 148-188 [In Bulgarian].
7. Troev T, Milanova H, Mavrova R. Our experience in kinesitherapy after knee endoprosthesis. Medicine and sports, vol. VII, 2011; (4): 16-19.
8. Brander V, Srulberg SD. Rehabllitation after hip- and knee-joint replacement: an experience- and evidence-based approach <0 care, Am J Phys Med Rehab, 2006; 85 (suppl. II): 598-618.
9. Cook C, Hegedus E. Orthopedic physical examination tests: an evidence-based approach , Upper Saddle River. N). Pearson Prentice Hall, 2008; 93-99.
10. Donatelli R, Wooden MJ. Orthopaedic physical therapy, fourth edition, by Churchill Livingnone, an imprinl of Elsevier Inc., 2010; 400-480.
11. Dreinhöfer et al. (eds.). EUROHIP: Health Technology Assessment of Hip Arthroplasty in Europe, EFORT Appropriateness of Total Hip Replacement K. Dreinhöfer Department of Orthopedics, Ulm, 2011; 55-63; 145-146.
12. Facci LM, Nowotny JP, Tormem F, Trevisani VF. Effects of transcutaneous electrical nerve stimulation (TENS) and interferential currents (IFC) in patients with nonspecific chronic low back pain: randomized clinical trial. Sao Paulo Med J, 2011; 129(4): 206-216.
13. Fuentes CJ, Armijo-Olivo S, Magee DJ, Gross DP. A preliminary investigation into the effects of active interferential current therapy and placebo on pressure pain sensitivity: a random crossover placebo controlled study. Physiotherapy, 2011; 97(4): 291-301.
14. Kisner C, PT, MS Therapeutic Exercise F. A. Davis Company 1915 Arch Street Philadelphia, PA. 2007; 191-03; 643-686.
15. Maxey L. Rehabilitation for the postsurgical orthopedic patient Library of Congress Cataloging in Publication Data, 2001; 172-187.
МЕТОДИКА КОМПЛЕКСНОЙ ОЦЕНКИ СОСТОЯНИЯ ЗДОРОВЬЯ НАСЕЛЕНИЯ
НА РЕГИОНАЛЬНОМ УРОВНЕ
Борис Василий Николаевич,
главный врач,
Новоград-Волынское горрайТМО, Украина
METHOD OF COMPREHENSIVE ASSESSMENT OF PUBLIC HEALTH AT THE REGIONAL LEVEL
Borys V.N., chief physician, Novograd-Volynsky Territorial Medical Association, Ukraine
МЕТОДИКА КОМПЛЕКСНОI ОЦ1НКИ СТАНУ ЗДОРОВ'Я НАСЕЛЕННЯ НА РЕГЮНАЛЬНОМУ Р1ВН1
Борис Василь Миколайович, Головний лкар, Новоград-Волинське мкьрайТМО, Украгна
АННОТАЦИЯ
Проведена комплексная ретроспективная рейтинговая оценка состояния здоровья населения отдельных регионов на примере Житомирской области с использованием основных индикаторов, которые рекомендованы Всемирной организацией здравоохранения (ВОЗ). На основании рекомендаций ВОЗ определены 20 основных индикаторов для характеристики и сравнения состояния здоровья населения, актуальных для Украины, и их весовые коэффициенты. Проведено определение и учет влияния каждого из индикаторов на суммарную интегральную оценку региона с учетом изменения показателей во времени (коэффициента динамики), агрегация полученных данных и окончательное вычисление обобщающего статистического показателя. Примененная нами методика комплексной оценки состояния здоровья населения на региональном уровне, апробированная на примере Житомирской области, объективно отражает существующие региональные различия. В результате исследования произведена рейтинговая оценка состояния здоровья населения отдельных регионов, получена существенная информационная база для изучения причин негативных тенденций, формирования и принятия соответствующих мер медицинского обеспечения с целью улучшения состояния здоровья населения.
АНОТАЦ1Я
Проведено комплексну ретроспективну рейтингову оцшку стану здоров'я населення окремихрегюшв на прикладiЖи-томирськог областi з використанням основних iндикаторiв, ят рекомендован Всесвтньою оргашзацкю охорони здоров'я (ВООЗ). На пiдставi рекомендацш ВООЗ визначеш 20 основних iндикаторiв для характеристики та порiвняння стану здоров'я населення, актуальних для Украгни, та гх ваговi коефщкнти. Проведено визначення i врахування впливу кожного з iндикаторiв на сумарну ттегральну оцнку регюну з урахуванням змши показнитв у чаа (коефцкнта ди-намти), агрегащя отриманих даних i остаточне обчислення узагальнюючого статистичного показника. Застосована нами методика комплексног оцнки стану здоров'я населення на регюнальному рiвнi, апробована на прикладi Житомир-ськог области об'ективно вiдображаe iснуючi регюнальш вiдмiнностi. У результатi до^дження проведена рейтингова оцшка стану здоров'я населення окремих регюшв, отримана суттева тформацшна база для вивчення причин негатив-них тенденцт, формування та прийняття вiдповiдних заходiв медичного забезпечення з метою полшшення стану здоров'я населення.
ABSTRACT
To conducted the comprehensive retrospective rating health status of individual regions on the example of Zhytomyr region with using the main indicators recommended by WHO. It was identified 20 key indicators to characterize and compare the health
