Evaluation of Safety and Efficacy of ReHub in Patients Who Underwent Primary Total Knee Arthroplasty: Study Protocol for a Randomized Controlled Trial.

BACKGROUND: Total Knee Arthroplasty (TKA) is an intervention that can significantly improve the quality of life of patients with advanced knee osteoarthritis. Early start of rehabilitation and its continuation at home once the patient is discharged are key factors for the success of the process.This study aims to assess the effectiveness of a home-based telerehabilitation solution (ReHub) on improving functional capacity and clinical outcomes for patients who underwent TKA. METHODS/DESIGN: The study is a randomized, open-label with blinded outcome assessor, parallel assignment clinical trial with a sample size of 52 patients that is conducted according to the SPIRIT recommendations. After the TKA intervention, the patients are randomly allocated to the control group or the experimental group with a 1:1 ratio. Both groups follow a Fast Track recovery protocol which includes discharge after 2-3 days from surgery, a daily plan of 5 exercises for autonomous rehabilitation and domiciliary visits by a physiotherapist starting approximately 2 weeks after surgery. The experimental group uses the sensor-based telerehabilitation system ReHub to perform the exercises. The primary outcome measure is the range of motion of the knee. Secondary outcomes include physical performance, quality of life, pain intensity, muscle strength, treatment adherence and satisfaction with the ReHub system. The outcomes assessment is performed at hospital discharge (baseline), at stitch removal (2 weeks after baseline) and 2 weeks after stitch removal (4 weeks after baseline).The study conforms to the guidelines of the Declaration of Helsinki and was approved by the hospital's ethics committee. DISCUSSION: The study will address an important gap in the evidence base by reporting the effectiveness of an affordable and low-cost home-based telerehabilitation solution in patients who underwent TKA. ETHICS AND DISSEMINATION: The study was approved by the hospital's ethics committee ("Comité Ético de Investigación Clínica del HCB", reg. HCB/2019/0571). The trial was registred at ClinicalTrials.gov (NCT04155957). The results of this study will be published in peer-reviewed journals as well as national and international conferences. TRIAL REGISTRATION: NCT04155957 (ClinicalTrials.gov). HIGHLIGHTS: Assessing a home-based telerehabilitation solution effectiveness in knee surgery.In situations such as the CoVid-19 pandemic, it is a resolutive intervention method.Telerehabilitation is an alternative to conventional face-to-face physical therapy.This system is far less demanding in terms of human resources.Range of motion assessment is the primary outcome measure.

Results of a fast-track knee arthroplasty according to the experience of a multidisciplinary team.

INTRODUCTION: Fast-Track is a multidisciplinary system that has changed the perception of total knee arthroplasty surgery. It's based on the education of the patient, an increased autonomy, adequate pain control and early mobilization. In the bibliography, there are no articles that refer to the evolution of the protocol once established, and most of them are comparatives with the previously existing conventional system. For this reason, the objective of our work is to study the evolution of the clinical results obtained through a Fast-Track system according to the experience acquired by the multidisciplinary team in this protocol. MATERIAL AND METHODS: It's a prospective observational study. We have analyzed the results obtained in our center from its implementation in 2013 (n = 65) to the end of the study in 2016 (n = 60). We evaluated the pain at 24 and 48 h after surgery, the time until the first ambulation, the range of flexion and extension at discharge, and length of hospital stay. RESULTS: The results obtained at the beginning of the implantation of the Fast-Track protocol in our center and the present ones do not present statistically significant differences. Mean pain at 24 h was 1,65/10 in 2013 and 1,5/10 in 2016, and at 48 h 1,61/10 and 1,58/10 respectively. Most of the patients in both years scored a pain below 4/10 at 24 h and 48 h. Mean time of the first ambulation was 260 min in 2013 and 254 min in 2016 (most of the patients started walking in ≤5 h). Mean flexion at discharge was 90,3° in 2013 and 87,92° in 2016 (most of the patients presented a flexion between 80 and 100°). Mean extension at discharge was 6,95° in 2013 and 8,1° in 2016 (most of the patients presented an extension between 0 and 10°). Mean length of stay was 2,46 days in 2013 and 2,43 days in 2016 (most of the patients had a stay of fewer than 4 days). CONCLUSIONS: When applying the Fast-Track protocol by a multidisciplinary team in primary knee prosthetic surgery, the clinical results obtained are independent of the experience of this team in the protocol. So, from our experience, we can affirm that the protocol has enough solidity since its beginning and it maintains similar results despite the years of execution.

[Portable elastomeric infusion system applied to patients with knee prosthesis]. / Elastoméirco portátil. Aplicado a pacientes intervenidos de prótesis de rodilla.

An LV infuser consists of an infusion pump which can administer medicines via various methods: intravenous, epidural, subdural, o subcutaneous. Its usefulness is based on the administration of medicines such as oncological drugs and/or analgesic by means of a continuous infusion.

Sistema de infusion elastomérico portátil. Aplicado a pacientes intervenidos de prótesis de rodilla / Portable elastomeric infusion system

El infusor LV (ILV) consiste en una bomba de infusión que puede administrar medicamentos por vía intravenosa, epidural, subdural o cualquier vía raquídea, y subcutánea. Su finalidad se basa en la administración de medicamentos tales como drogas oncológicas y/o analgésicas por medio de infusión continua

An LV infuser consists of an infusion pump which can administer medicines via various methods: intravenous, epidural, subdural, o subcutaneous. Its usefulness is based on the administration of medicines such as oncological drugs and/or analgesic by means of a continuous infusion

Entorno clínico de la enfermera hospitalaria / The Clinical Environment of Hospital Nursing

Este artículo presenta un estudio piloto en el que se explora la posibilidad de utilizar el instrumento validado en los EE.UU. para identificar los atributos de "mejor servicio" en un entorno clínico de enfermería en hospitales españoles. En este estudio piloto sólo se ha incluido un hospital español. En los EE.UU. hemos analizado un número superior de hospitales, en los que las observaciones se compararon con las que se presentan en este artículo (Aiken et al, 2000; Havens y Aiken, 1999). Las observaciones del hospital universitario de Barcelona indican que un estudio más comprensivo de los hospitales españoles podría ser muy revelador y útil para la futura potenciación de la práctica profesional de la enfermería en España. Entre los países, la reestructuración de la plantilla hospitalaria y el rediseño del trabajo en el ámbito hospitalario parecen ser generalizados y destacadamente similares (Sochalski y Aiken, 1999; Sochalski et al, 1998).Las observaciones de este estudio piloto indican que los hospitales españoles y estadounidenses están implementando variaciones en la organización del trabajo de enfermería. Nosotros sugerimos que las observaciones obtenidas a partir de un programa de investigación de larga evolución en los EE.UU. podrían tener implicaciones para la organización de la enfermería hospitalaria en el ámbito internacional; a saber: que se obtienen mejores resultados referentes a pacientes y profesionales de enfermería cuando éstos son autónomos para aplicar sus conocimientos en la toma de decisiones en el cuidado de los pacientes, para controlar el ámbito de atención al paciente, incluida la movilización de los recursos necesarios, y cuando establecen buenas relaciones con los médicos. Se dispone de evidencias empíricas de acuerdo con las cuales esta organización del trabajo de enfermería produce mejores resultados sobre pacientes y plantilla. Por tanto, el modelo del hospital magnético es un planteamiento innovador que puede tener una aplicación global como estrategia para potenciar tanto la calidad de la atención al paciente como el ámbito de la práctica clínica de la enfermería. (AU)