Orthopedic Management of the Hip and Pelvis - E-Book by Scott W. Cheatham & Morey J Kolber

Author:Scott W. Cheatham & Morey J Kolber [Cheatham, Scott W.]
Language: eng
Format: azw3
ISBN: 9780323294393
Publisher: Elsevier Health Sciences
Published: 2015-11-29T16:00:00+00:00

Preoperative Physical Therapy

The initiation of physical therapy as a preoperative intervention is often based on expectations of improved postoperative outcomes and a shorter length of stay. Many institutions consider preoperative physical therapy an integral component of a comprehensive care pathway model for patients undergoing joint replacement. The definition of what constitutes preoperative care may vary because one may assume that most patients scheduled for surgery have been recalcitrant to conservative measures, which often include some type of formal rehabilitation. Nevertheless, preoperative rehabilitation interventions (i.e., those performed within approximately 2 months of surgical admission) often include patient education about expectations, discussion of walking aids, precautions, postoperative care and recovery planning, and formal exercises to mitigate impairments. Although many facilities and surgeons have their own model of patient management, evidence does suggest that a few visits of preoperative physical therapy are associated with a significant reduction in postacute care services such as home health care, inpatient rehabilitation, and skilled nursing facility care.175 Interestingly, evidence for reduced cost was found after adjusting for comorbidities, demographics, and procedural variables. Moreover, the results pertaining to reduced postacute use are not dose dependent; thus, a cost shift to preoperative care is not anticipated.175 Other studies have suggested a reduced length of stay attributed to preoperative care.176 Furthermore, evidence indicates that preoperative physical therapy may improve function even in patients with the most complicated cases.177 The clinical interest in improving function and impairments resides in the association between preoperative variables (e.g., function and strength) and postoperative outcomes.178-180

Future studies are needed to determine whether a broadly recognized benefit indeed exists, such that one could state with certainty that withholding preoperative interventions is deleterious to the outcome following hip arthroplasty. Irrespective of the available levels of evidence, preoperative care appears innocuous in regard to side effects, and preliminary evidence does appear to exist on cost, length of stay, and physical function. The decision to incorporate preoperative physical therapy interventions should be individualized based on an individual patient's needs. More compelling evidence is needed to make a global recommendation about the benefit in regard to postoperative quality of life and impairments.181,182

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