Massive cutback in orthopaedic healthcare services due to the COVID-19 pandemic.

PURPOSE: Due to the lack of evidence, it was the aim of the study to investigate current possible cutbacks in orthopaedic healthcare due to the coronavirus disease 2019 pandemic (COVID-19). METHODS: An online survey was performed of orthopaedic surgeons in the German-speaking Arthroscopy Society (Gesellschaft für Arthroskopie und Gelenkchirurgie, AGA). The survey consisted of 20 questions concerning four topics: four questions addressed the origin and surgical experience of the participant, 12 questions dealt with potential cutbacks in orthopaedic healthcare and 4 questions addressed the influence of the pandemic on the particular surgeon. RESULTS: Of 4234 contacted orthopaedic surgeons, 1399 responded. Regarding arthroscopic procedures between 10 and 30% of the participants stated that these were still being performed-with actual percentages depending on the specific joint and procedure. Only 6.2% of the participants stated that elective total joint arthroplasty was still being performed at their centre. In addition, physical rehabilitation and surgeons' postoperative follow-ups were severely affected. CONCLUSION: Orthopaedic healthcare services in Austria, Germany, and Switzerland are suffering a drastic cutback due to COVID-19. A drastic reduction in arthroscopic procedures like rotator cuff repair and cruciate ligament reconstruction and an almost total shutdown of elective total joint arthroplasty were reported. Long-term consequences cannot be predicted yet. The described disruption in orthopaedic healthcare services has to be viewed as historic. LEVEL OF EVIDENCE: V.

Reduced Requests for Medical Rehabilitation Because of the SARS-CoV-2 Pandemic: A Difference-in-Differences Analysis.

OBJECTIVE: To examine the extent to which medical rehabilitation requests decreased because of the pandemic in Germany. DESIGN: Data were retrieved from the German Pension Insurance, which is the main provider for rehabilitation of working-age people in Germany. Our data represented all medical rehabilitation requests in 2019 and 2020. These requests have to be approved to use a rehabilitation program. We used a difference-in-differences model to determine the reduction in rehabilitation requests attributable to the pandemic. SETTING: General community. PARTICIPANTS: We included 1,621,840 rehabilitation requests from working-age people across Germany in 2019 and 1,391,642 rehabilitation requests in 2020 (N=3,013,482). INTERVENTION: Medical rehabilitation in inpatient or outpatient facilities. MAIN OUTCOME MEASURES: Number of medical rehabilitation requests. RESULTS: The number of medical rehabilitation requests decreased by 14.5% because of the pandemic (incidence rate ratio, 0.855; 95% confidence interval, 0.851-0.859). The decline in requests was more pronounced among women and in Western Germany than among men and in Eastern Germany. The reduction in requests affected non-postacute rehabilitations more clearly than postacute rehabilitation services. After the pandemic declaration by the German Bundestag in March 2020, the reduction in requests was initially strongly associated with the regional incidence of infection. This association weakened in the following months. CONCLUSIONS: The reduction in requests will have a significant effect on the number of completed rehabilitation services. For many people with chronic diseases, failure to provide medical rehabilitation increases the risk of disease progression.

Don't stop walking: the in-home rehabilitation program for peripheral artery disease patients during the COVID-19 pandemic.

We studied the outcomes of peripheral artery disease (PAD) patients enrolled in a structured in-home walking program right before the lockdown due to the SARS-CoV-2 epidemic emergency, to determine whether this intervention ensured the maintenance of mobility even in the case of movement restrictions.We selectively studied 83 patients (age 72 ± 11, males n = 65) enrolled in the program within 9-month before the lockdown. The usual intervention was based on two daily 8-min sessions of slow intermittent in-home walking prescribed in circa-monthly hospital visits. During the lockdown, the program was updated by phone. Six-minute (6MWD) and pain-free walking distance (PFWD) were measured pre- and post-lockdown as well as body weight (BW), blood pressure (BP), and ankle-brachial index (ABI). Sixty-six patients were measured 117 ± 23 days after their previous visit. A safe, pain-free execution of the prescribed sessions was reported (median distance: 74 km). Overall, the 6MWD was stable, while PFWD improved (p < 0.001). The improvement was not related to age/gender, comorbidities, type of home but to the time of enrollment before lockdown. The new-entry subjects (≤ 3 months; n = 35) obtained significant improvements post-lockdown for 6MWD and PFWD, while those previously enrolled (> 3 months; n = 31) were stable. Decreased BW with stable BP and ABI values were also recorded, with better outcomes for new-entry subjects. In PAD patients, a structured walking program performed inside home and purposely guided by phone was adhered to by patients and favored mobility and risk factor control during the COVID-19 pandemic, regardless of walking ability, type of home and external conditions.