Expert Consensus for the Use of Outpatient Rehabilitation Visits After Total Knee Arthroplasty: A Delphi Study.

OBJECTIVE: There is no consensus for how to use rehabilitation visits after total knee arthroplasty (TKA). We sought to develop expert recommendations for outpatient rehabilitation visit usage after TKA. DESIGN: Delphi study. METHODS: First, we developed a broad list of preliminary visit usage recommendations, which were specific to patients' recovery status (ie, slow, typical, or fast recovery) and time since surgery. We then invited 49 TKA experts to participate on a Delphi panel. During round 1, we surveyed panelists regarding their level of agreement with each preliminary recommendation. We conducted additional Delphi rounds as needed to build consensus, which we defined using the RAND/UCLA method. We updated the survey each round based on panelist feedback and responses from the previous round. RESULTS: Thirty panelists agreed to participate, and 29 panelists completed 2 Delphi rounds. The panel reached consensus on recommendations related to visit frequency, visit timing, and the use of telerehabilitation. The panel recommended that outpatient rehabilitation should begin within 1 week after surgery at a frequency of 2 times per week for the first postoperative month regardless of recovery status. The panel recommended different visit frequencies depending on the patient's recovery status for postoperative months 2 to 3. The panel agreed that telerehabilitation can be recommended for most patients after TKA, but not for patients recovering slowly. CONCLUSION: We used the Delphi process to develop expert recommendations for the use of outpatient rehabilitation visits after TKA. We envision these recommendations could help patients decide how to use visits based on their own preferences. J Orthop Sports Phys Ther 2023;53(9):1-9. Epub: 10 July 2023. doi:10.2519/jospt.2023.11840.

Using a wearable camera to increase the accuracy of dietary analysis.

BACKGROUND: Food diaries are commonly used to assess individual dietary intake in both the general and sporting populations. Despite the widespread use of such diaries, evidence suggests that individuals' self-reported energy intake frequently and substantially underestimate true energy intake. PURPOSE: To examine the use of the Microsoft SenseCam wearable camera to help more accurately report dietary intake within various sporting populations. METHODS: In 2011, a total of 47 participants were recruited to take part in this study (17 trainee jockeys, 15 elite Gaelic footballers, and 15 healthy physically active university students). Participants wore a SenseCam for 1 day (from morning until night) while simultaneously keeping a 1-day food diary. Comparisons were made between the energy intake reported in the food diary alone and the food diary in conjunction with information gathered from the SenseCam. Data analysis was conducted in 2012. RESULTS: Mean total calorie intake using diary alone and diary and SenseCam were 2349±827.9 kcals vs 2631±893.4 kcal for the trainee jockeys; 2600±521.9 kcal vs 3191±770.2 kcal for the Gaelic footballers, and 2237±318.5 kcal vs 2487±404.6 kcal for the university students. This represented a difference of 10.7% (p≤0.001); 17.7% (p≤0.001); and 10.1% (p≤0.01) among measurement methods for trainee jockeys, Gaelic footballers, and university students, respectively. CONCLUSIONS: Results from this first-generation study suggest that a more accurate estimate of total energy intake is provided when combining the use of a conventional food diary and a SenseCam. Additional information on portion size, forgotten foods, leftovers, and brand names can be obtained by using this novel sensing technology in conjunction with the diary, with improved dietary assessment a potential outcome.