The effect of a preoperative physical therapy education program on short-term outcomes of patients undergoing elective total hip arthroplasty: A controlled prospective clinical trial.

OBJECTIVE: The aim of this study was to determine the effect of a preoperative physical therapy education program on the shortterm outcomes of patients undergoing elective Total Hip Arthroplasty (THA). METHODS: A prospective, parallel-group controlled clinical trial was conducted from September 2016 to July 2018. Fifty patients who were scheduled for a first elective THA procedure were recruited and were equally allocated into one of two groups: intervention and control groups. While all patients received the routine preparation for the procedure, the intervention group underwent an additional structured physical therapy education session. Functional status was evaluated using The Oxford Hip Score (OHS) preoperatively and 6 weeks after the operation. Length of Hospital Stay (LOS) was recorded. State anxiety was measured by the state-anxiety portion of the Spielberger's State-Trait Anxiety Inventory questionnaire preoperatively and on the second postoperative day. Gait and balance abilities were assessed using Tinetti Performance-Oriented Mobility Assessment (POMA) test on the second postoperative day. Pain at rest and during weight-bearing was measured by a Numerical Rating Scale (NRS) on the postoperative second day. Satisfaction rates were evaluated by the NRS 6 weeks after the operation. RESULTS: Forty-seven patients completed the study. The intervention group consisted of 24 patients (10 males, 14 females; mean age = 64.29 ± 6.7 years), and the control group consisted of 23 patients (7 males, 16 females; mean age = 65.91 ± 10.19 years). The mean postoperative OHS was significantly higher in the intervention group than in the control group (39.04 ± 3.99 vs 28.04 ± 7.23, P < 0.001). Both groups increased their functional abilities 6 weeks postoperatively; however, the intervention group showed a greater increase than the control group (P = 0.001). No significant difference was found in the LOS between the control (2.83 ± 0.71) and intervention groups (2.71 ± 0.62) (P = 0.551). Patients in the intervention group exhibited lower rates of anxiety two days after the operation compared with the controls (17.75 ± 6.50 vs 27.70 ± 10.32, P < 0.001). The intervention group showed higher postoperative POMA scores compared to the control group (19.67 ± 3.89 vs 15.39 ± 5.85, P = 0.005). Although no significant difference was observed in resting pain between groups (P = 0.105), the intervention group reported a lower pain intensity while walking compared to the control group (5.04 ± 1.68 vs 6.39 ± 2.62, P = 0.041). While both groups reported high satisfaction rates 6 weeks postoperatively, patients in the intervention group were more satisfied than those in the control group (9.67 ± 0.91 vs 8.35 ± 1.82, P = 0.003). CONCLUSION: A structured interactive preoperative physical therapy education program for patients undergoing a THA may reduce anxiety, generate a faster recovery, reduce pain, and promote higher satisfaction. We recommend this program for routine use. LEVEL OF EVIDENCE: Level II, Therapeutic Study.

Survival benefit of coronary revascularization after myocardial perfusion SPECT: The role of ischemia.

BACKGROUND: Survival benefit of revascularization over medical therapy (MT) in patients with stable ischemic heart disease (SIHD) is uncertain. We evaluated the prognostic effects of revascularization in patients with SIHD undergoing single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI). METHODS: Of 47,894 patients, 7973 had ischemia ≥ 5% of the left ventricle. Of these, 1837 underwent early revascularization (≤ 60 days after SPECT-MPI). The rest were MT subgroup. Follow-up period was 4.04 ± 1.86 years. Statin therapy intensity and adherence were assessed. Outcomes were all-cause mortality, death + non-fatal myocardial infarction (MI), and MACE [major adverse cardiac event = death + MI + late revascularization (> 60 days after SPECT-MPI)]. RESULTS: Among patients with moderate-severe ischemia (≥ 10%), death rate was lower in early revascularization compared to MT subgroup (1.42%/year vs 3.12%/year, adjusted hazard ratio (HR) 0.67 (95% CI 0.50-0.90, P = .008). Death + MI and MACE rates were also lower, adjusted HR 0.69 (0.55-0.88, P = .003) and 0.80 (0.69-0.92, P = .003). Revascularization was beneficial in optimal statin therapy subgroup (death rate 1.04%/year vs 2.36%/year, adjusted HR 0.51 (0.30-0.86, P = .012). In mild ischemia (5%-9%), revascularization did not improve survival or MI-free survival, and was associated with higher MACE rate (8.86%/year vs 7.67%/year, adjusted HR 1.30 (1.12-1.52, P < .001). CONCLUSION: Compared to MT, revascularization was associated with reduced risk of death, death + MI, and MACE in patients with moderate-severe ischemia, incremental over optimal statin therapy. In mild ischemia, revascularization was associated with higher risk of MACE, driven by late revascularization, with no impact on death and death + MI.

Comparison of the diagnostic accuracies of very low stress-dose with standard-dose myocardial perfusion imaging: Automated quantification of one-day, stress-first SPECT using a CZT camera.

BACKGROUND: Previous studies have demonstrated accurate diagnosis of reduced dose myocardial perfusion imaging (MPI) using Cadmium-Zinc-Telluride (CZT) technology. We compared the diagnostic performances of very low stress-dose (<2 mSv) with standard-dose stress-first, quantitative MPI using a CZT camera. METHODS: Patients without known coronary artery- disease who underwent a stress-first Tc-99 m sestamibi CZT-MPI and invasive coronary angiography (ICA), and low-risk patients without ICA were included. A stress-rest standard-dose (10/30 mCi) MPI and a low-dose (5/15 mCi) MPI were compared. Normal limits for quantification were developed from 40 (20 males) low-risk patients, and total perfusion deficit (TPD) was derived. RESULTS: 208 patients who underwent MPI and ICA, and 76 low-risk patients were included. Of these, 128 had a standard-dose MPI and 156 had a low-dose MPI. Stress-doses in low-dose and standard-dose groups were 5.9 ± 1.2 vs 10.2 ± 0.5 mCi (1.7 ± 0.3 vs 3.0 ± 0.1 mSv), respectively, P < 0.001, and stress-rest effective radiation was 6.9 ± 1.1 vs 11.7 ± 0.4 mSv, respectively, P < 0.001. Sensitivity, specificity, and accuracy values in the low-dose and standard-dose groups were 86.1%, 76.6%, and 81.4%; and 90.6%, 78.1%, and 84.4%, respectively, P = ns. Using TPD prone, specificity values were 84.9% and 80.3%, respectively, P = ns. CONCLUSION: One-day stress-first MPI with 50% radiation reduction and a very low stress-dose (<2 mSv) using CZT technology and quantitative supine and prone analysis provided a high diagnostic value, similar to standard-dose MPI.

[Fast myocardial perfusion imaging of stress--first protocol using CZT-technology: a preliminary report of the correlation to invasive coronary angiography].

BACKGROUND: Myocardial perfusion imaging (MPI) is valuable for diagnosing coronary disease and assessing the risk of cardiac events. New technology based on semiconductors (Cadmium zinc telluride-CZT) enables reducing imaging time and improving image quality. METHODS: We retrospectively identified 57 patients who underwent MPI at Assuta using a CZT camera and invasive coronary angiography (ICA) within 60 days following nuclear testing without an intervening cardiac event, and without history of coronary disease. In addition, 25 patients with low pretest likelihood who did not undergo ICA were included in the study. All 82 patients underwent fast-acquisition, stress-first Tc-99m sestamibi MPI using very short imaging time (stress: 5:00 min., prone: 3:40 min. and rest: 2:00 min]. A low-dose stress injection (9-12 mCi, ≤ 3.5 mSv) and high rest-dose (25-32 mCi) with adjustment to patient weight were administered. Semi-quantitative visual analysis utilized a 17-segment model, 0-4 scale (0 = normal uptake, 4 = absent uptake). The summed stress score (SSS) representing stress perfusion abnormality was converted to a percentage of abnormal myocardium (SSS% = SSS/68*100). ICA served as a gold standard for the nuclear perfusion findings. RESULTS: The mean age was 60.1 ± 11 years and most subjects were men (58, 70.7%). Compared to low-risk patients, patients who underwent ICAwere older, and had a higher frequency of hypertension, diabetes mellitus and dyslipidemia. A low-dose stress-only test with low radiation exposure ≤ 3.5 mSv) was frequent among low-risk patients (18/25-72%). ROC analysis for identification of angiographic coronary disease by SSS% demonstrated area under curve of 0.923, 95% confidence interval 0.859-0.988, p < 0.001. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were: 91.4%, 81.2%, 78.3%, 97.2% and 86.6%, respectively. CONCLUSION: Fast, low-dose stress MPI using CZT technology enables semi-quantitative analysis with high diagnostic value for coronary disease.