Four weeks of inpatient comprehensive prosthetic rehabilitation achieves contrasting results in different groups of prosthetic users.

BACKGROUND: This study explored how inpatient exercise rehabilitation affected prosthetic mobility, function, and ambulation in persons with lower limb loss. METHODS: In this explorative prospective nonrandomized intervention study, experienced (EXP-INT, n = 20) and new prosthetic users (NEW-INT, n = 18) completed a 4-week rehabilitation intervention. A control group of experienced prosthetic users (n = 19) received no intervention. Tests were performed at baseline (pretest) and after 4 weeks (posttest). A step-monitoring device recorded ambulatory activity. RESULTS: For the primary outcome measure, Prosthetic Limb Users Survey of Mobility, the between-group analysis revealed significant differences (χ2 = 10.91, df = 2, p < 0.01). Within-group Prosthetic Limb Users Survey of Mobility T-scores improved by 8.1% for the EXP-INT (p < 0.01) and 15.1% for NEW-INT (p < 0.01). Significant between-group differences were observed for the Amputee Mobility Predictor, L-test, 2-minute walk test, and 10-meter walk test. Within-group analysis demonstrated nonsignificant changes for the EXP-INT except for Prosthetic Limb Users Survey of Mobility, while the NEW-INT improved by 24.1% (p < 0.001), 34.0% (p < 0.01), 46.5% (p < 0.05), and 31.0% (p < 0.01), respectively. The number of steps during the last 7 d of rehabilitation showed significant differences between the groups (χ2 = 13.99, df = 2, p < 0.001). The NEW-INT improved by 138% (p < 0.05) compared with the first 7 d of rehabilitation, while the EXP-INT had nonsignificant changes. CONCLUSIONS: A 4-week rehabilitation intervention substantially increased prosthetic mobility, function, and ambulation activity for new prosthetic users but less so for experienced users. The results of the NEW-INT at discharge signify a considerable functional improvement.

Mobilisation and physiotherapy intervention following hip fracture: snapshot survey across six countries from the Fragility Fracture Network Physiotherapy Group.

PURPOSE: Hip fracture guidelines recommend early mobilisation, multidisciplinary care, physiotherapy and fall prevention interventions. This study documents mobilisation practices and physiotherapy interventions provided post-hip fracture in six countries. MATERIALS AND METHODS: Physiotherapists from orthopaedic wards in Denmark, Australia, Spain, Brazil, Norway and Ireland provided information regarding mobilisation and physiotherapy for 10 consecutive hip fracture patients (>60 years), between 2014 and 2018. RESULTS: Physiotherapists (n = 107) entered data on 426 patients. Two-thirds of patients (283, 66%) attempted standing 0-1 days after surgery (range: 0% of patients in Spain to 92% in Norway). Fewer patients (199, 47%) attempted walking on day 0-1 (range: 0% Spain/Brazil to 69% Norway). Physiotherapy to mobilise every weekday was provided to 356 patients (84%, range: 60% Ireland to 100% Spain). On weekends, physiotherapy to mobilise was limited (175, 40%, range: 0% Spain to 81% Brazil) but 298 patients (70%) mobilised with non-physiotherapy staff (range: 0% Spain to 96% Denmark/Ireland). Physiotherapy treatments included mobility, gait training, and range-of-motion exercises. Referral to fall prevention interventions was low (93, 22%, range: 0% Spain to 76% Ireland). CONCLUSION: Stronger compliance with guideline recommendations on early mobilising, weekend mobilising and referral to fall prevention interventions post hip-fracture is needed in some countries.Implications for rehabilitation This study provides a snapshot of mobilisation and physiotherapy practice for hip fracture patients in six countries. The results suggest a need to improve systems and approaches in some countries to enhance compliance with recommendations specifically relating to: • early attempts at standing and walking post-surgery. • opportunities to mobilise on weekends (with physiotherapist and/or other staff). • broader range of multidisciplinary care e.g., geriatric review, occupational therapy and nutrition advice. • use of standardised tests by physiotherapists post-surgery. • referral to fall prevention interventions.

Full-thickness cartilage lesion do not affect knee function in patients with ACL injury.

There is debate in the literature regarding the impact of full-thickness cartilage lesion on knee function in patients with ACL injury. The hypothesis of the current study is that a full-thickness cartilage lesion at the time of ACL reconstruction does not influence knee function as measured by the Knee injury and Osteoarthritis Outcome Score (KOOS) in patients with ACL injury. Of the 4,849 primary ACL surgery cases in the Norwegian National Knee Ligament Registry as of 12 December 2007, 30 patients met the following inclusion criteria: a full-thickness cartilage lesion (International Cartilage Repair Society [ICRS] grades 3 and 4), age less than 40 years, no associated pathology or meniscus injury, and less than 1 year between knee injury and ACL reconstruction. Each of the 30 patients in this study group was matched with two control participants without cartilage lesions. Preoperatively, the patients completed the KOOS, and the surgeon recorded the location and size of the cartilage lesion and graded the cartilage injury according to ICRS standards. There were no significant differences between the case and control groups for any of the five subscales of the KOOS. A cartilage lesion was located in the medial compartment in 67% of the cases, in the lateral compartment in 20% of the cases, and in the patellofemoral joint in 13% of the cases. In conclusion, the combination of a full-thickness cartilage lesion and an ACL rupture did not result in inferior knee function at the time of the ACL reconstruction as measured by the KOOS.