Multidisciplinary Intervention Before Joint Replacement Surgery May Improve Outcomes for People with Osteoarthritis and Metabolic Syndrome: A Cohort Study.

Background: Metabolic syndrome has been associated with poorer outcomes in the immediate postoperative period following joint replacement surgery for osteoarthritis. The aim of this study was to determine whether a multidisciplinary, preoperative intervention would minimize postoperative differences between people with and without metabolic syndrome who underwent joint replacement surgery for osteoarthritis. Method: A retrospective cohort study of older adults with multiple comorbidities (n = 230) attending a preoperative intervention service before lower limb joint replacement surgery. The intervention aimed to optimize the patient's health and functional reserve before surgery through weight loss, physical activity and medical management. Patient outcomes were adverse events, discharge destination and function. Health service outcomes were length of stay, hospital readmissions and emergency department presentations over a 2-year follow-up. Results: Two-thirds of participants (n = 151) had metabolic syndrome. There were no significant differences between those with and without metabolic syndrome in terms of discharge destination or adverse events during the acute hospital admission. There were no differences in function during rehabilitation but people with metabolic syndrome had significantly more adverse events (P = 0.037) during rehabilitation. In the 2 years following surgery, there were no differences in hospital readmission rates but people with metabolic syndrome had a higher observed frequency of potentially avoidable emergency department presentations (P = 0.066). Conclusions: Providing a preoperative intervention may help minimize differences between people with and without metabolic syndrome in the immediate postoperative period. However, having a diagnosis of metabolic syndrome may still adversely affect some long-term health service outcomes following joint replacement surgery.

The Clinical Effects of Manipulative Therapy in People with Chronic Obstructive Pulmonary Disease.

OBJECTIVES: This study aimed to determine the effects of manipulative therapies (MT), including spinal manipulation, and diaphragmatic release techniques on lung function, exercise capacity, symptoms, and health-related quality of life (HRQOL) in people with chronic obstructive pulmonary disease (COPD). DESIGN: Systematic review. PARTICIPANTS: People diagnosed with COPD. INTERVENTION: Randomized controlled trials of MT (either with or without pulmonary rehabilitation [PR]) compared to other treatments (soft tissue [ST] therapy or sham therapy) applied in people with COPD were identified following the search of seven databases. Two reviewers independently assessed study quality and extracted data. OUTCOME MEASURES: Lung function, exercise capacity, symptoms, and HRQOL. RESULTS: Four studies were included, with a total of 68 participants. The heterogeneity between treatments prevented meta-analysis. There was no beneficial effect on spirometry measures of lung function with MT. MT combined with PR improved exercise capacity by 48-49 m more than ST therapy plus PR. Less dyspnea was reported with MT and ST therapy compared to ST therapy alone (p = 0.01), but there was no effect on HRQOL, or symptoms of anxiety or depression. CONCLUSIONS: In people with COPD, MT (either with or without PR) improved functional exercise capacity, but had no effect on lung function, or HRQOL. Further research is required to determine the underlying mechanism of this treatment approach and its relationship to exercise capacity.