The impact of the pandemic on functional outcomes for joint replacement patients: An observational study.

Elective surgeries, as joint replacement, were resumed after the first COVID-19 pandemic wave in 2020 and a phase of coexistence with the virus began. Surgery was organized in a new way that incorporated procedures aimed at reducing the risk of spreading the virus. The aim of this study is to describe the early functional results for patients undergoing hip and knee replacements at the time healthcare services were being reopened and to compare them with the same outcomes recorded in the prepandemic period. This is a controlled retrospective study. All patients consecutively admitted during 2020 and who underwent hip and knee replacement were enrolled in the study. Patient records from January to March 2020 constituted the prepandemic control group, while patient records from May to December 2020 constituted the study group. Functional recovery was described through the patient's ability to walk using antebrachial devices and to climb up and down 3 steps. The day after surgery on which these activities were first performed was also recorded. The prepandemic group consisted of 183 patients and the pandemic group of 280 patients. The mean age of patients was 66 years (±13.1), female was 44.9% and hip replacement was 66.5%. The number of patients who climbed stairs and the timing thereof was comparable for the 2 groups (68.5% vs 72.2%, respectively; P = .403). There was no significant difference in the incidence of patients able to walk with antebrachial device and incidence of pressure ulcers and major complications. Multivariate analysis confirmed that the incidence of stair climbing was not associated with the prepandemic or pandemic inclusion. During the reopening of orthopedic surgery activity, the reorganization and treatment pathway did not affect the functional outcome achieved by patients underwent joint replacement. Constant monitoring of the functional outcomes will be required so as to further increase the number of joint replacement surgeries.

What Factors Are Associated With the Recovery of Autonomy After a Hip Fracture? A Prospective, Multicentric Cohort Study.

OBJECTIVE: To identify the factors associated with recovering autonomy in activities of daily living (ADL) in patients who have had a hip fracture. DESIGN: A prospective cohort study. SETTING: The orthopedic and orthogeriatric departments of 2 regional hospitals. PARTICIPANTS: Patients (N=742) aged ≥65 years with a diagnosis of fragility hip fracture. MAIN OUTCOME MEASURES: The level of autonomy at 4 months was assessed using the ADL scale. RESULTS: The median score on the ADL scale at 4 months was 3 (interquartile range, 5). Half of the population was unable to recover their prefracture autonomy levels. The following were found to be risk factors: increasing age (B=.02, P<.001); an elevated number of comorbidities (B=.044, P=.005); a lower level of prefracture autonomy (B=.087, P<.001); more frequent use of an antidecubitus mattress (B=.211, P<.001); an increased number of days with disorientation (B=.002, P=.012); failure to recover deambulation (B=.199, P<.001); an increased number of days with diapers (B=.003, P<.001), with a urinary catheter (B=.03, P<.001), and with bed rails (B=.001, P=.014); and a nonintensive care pathway (B=.199, P=.014). CONCLUSIONS: Recovery of deambulation, treatment of disorientation and management of incontinence are modifiable factors significantly associated with the functional recovery of autonomy.

Measuring functional performance at discharge from hospital after total joint arthroplasty as a pre-requisite for planning early rehabilitation: a prognostic study.

BACKGROUND: The autonomy achieved by discharge after total knee and hip arthroplasty is important for planning early rehabilitation. PURPOSE: Describe functional performance using the Iowa Level of Assistance (ILOA) scale and investigate possible prognostic factors. METHODS: A prospective cohort study design was used. Autonomy at discharge was measured using the ILOA scale. Postoperative factors such as time to remove surgical drains, the length of hospitalization, preoperative physical therapy, and the number of physiotherapy treatments were collected. RESULTS: The sample was composed of 452 patients: 191 men (42.3%) and 261 women (57.7%). The mean ILOA score was 12.34 (SD = 5.4), representing a level of autonomy of 68.4%. Gait speed was the activity with the highest score and it ranged from 0.26 m/s to 0.32 m/s. Based on univariate and multivariate analysis, gender and age were the only significant variables to influence achieving autonomy at discharge. CONCLUSION: The rehabilitative program in its acute phase should be planned with particular attention paid to elderly women, unifying the physiotherapy protocol for total hip arthroplasty (THA) and total knee arthroplasty (TKA), reviewing the modalities of preoperative treatment sessions and with a specific training for the speed gait.

Rasch analysis of the Iowa Level of Assistance Scale in patients with total hip and knee arthroplasty.

The aim of this study was to carry out a psychometric analysis, using both Classical Test Theory and Rasch analysis (RA) methods, of the Iowa Level of Assistance Scale (ILAS) administered in patients with recent total hip arthroplasty (THA) or total knee arthroplasty, to examine its metric properties and provide insights for a refined version. A total of 203 patients who had undergone THA or total knee arthroplasty were assessed using the ILAS for assistance needed during functional activities (ILAS-funct) and need for assistive devices (ILAS-dev) before discharge from the orthopedic ward. The responses were psychometrically analyzed using the Classical Test Theory and RA. Cronbach's α was adequate only for group comparisons (ILAS-funct, 0.82; ILAS-dev, 0.79). The two domains (ILAS-funct and ILAS-dev) showed a good correlation. According to RA rating scale diagnostics, ILAS-funct showed two disordered response category thresholds: of the seven different response levels of 'assistance', only five were appreciably discernible. All five ILAS-funct items fitted the model and did not show either local dependence or differential item functioning across age groups or sex. ILAS-dev presented two unused response categories, which precluded Rasch calibration and subsequent analyses. ILAS-funct showed sound psychometric properties, but the rating system of ILAS-funct could be simplified, at least collapsing the response categories 5 (failed) and 6 (not tested). In ILAS-dev, the presence of unused response categories calls for a reconsideration of its scaling options and methods.