Factors associated with pressure ulcer onset after knee replacement.

OBJECTIVE: The aim of this study was to find the rate of pressure ulcers (PUs) in patients with knee replacements and identify predictive factors. The ability of the Braden scale to predict the onset of PUs was also investigated. METHOD: A retrospective prognostic cohort study was carried out involving all consecutive patients undergoing knee replacement surgery. The data were collected from patient records. The variables collected were grouped into two categories: those connected to the patient's own characteristics; and those linked to the care methods used. RESULTS: The total number of patients included in the study was 565. Of these, 2.3% had developed a PU: 0.5% at the heel and 1.8% at the sacrum. Multivariate analysis showed that the variables actually correlated to the outcome were age (p=0.074; odds ratio (OR)=1.08), body mass index (BMI, p=0.037; OR=1.13) and Braden scale (p=0.029; OR=0.72). A combination of these three parameters showed better predictivity of PUs (area under the curve (AUC) 84%). CONCLUSION: Age, BMI and preoperative Braden score were shown to be independent predictive factors of the onset of PUs in patients with knee replacements. The combined use of all three variables increased the ability to identify the patients at most risk of developing a PU. DECLARATION OF INTEREST: The study was financed by the Professional Nurse Register of Bologna as winner of a competition for research projects in the province of Bologna. The authors declare no conflicts of interest.

At discharge gait speed and independence of patients provides a challenges for rehabilitation after total joint arthroplasty: an observational study.

BACKGROUND: The level of functioning in people discharged from hospital after hip arthroplasty is very heterogeneous and prognostic factors are not fully understood. The aim of this study was to determine the mean level of autonomy achieved by such patients at discharge from hospital using the Iowa Level of Assistence (ILOA) scale as a measurement tool and to investigate the possible predictive factors of this autonomy. METHODS: It was conducted a prospective cohort study including hip arthroplasty patients treated consecutively in 2012. Hip arthroplasty patients following fractures, revision surgery and partial replacement were excluded, as well as patients with concomitant neurologic or rheumatologic diseases or postoperative complications that did not allow to continue the rehabilitation program, and patients with a hospitalization of more than 7 days. During the last 24 h of hospital stay the physiotherapist filled in the ILOA scale and collected all data (age, gender, number of physiotherapy treatments, length of hospitalization). Statistical analysis (univariate and multivariate analysis) was performed between the variables collected and the ILOA Score. RESULTS: The sample was composed of 167 patients. The mean score of the ILOA was 16.6 (±6.5) and gait speed had the poorest outcome 0.19 m/s - 0.43 m/s. Multivariate analysis showed that older women are most at risk of not achieving good levels of autonomy. CONCLUSIONS: In hip arthroplasty patients at discharge from hospital gait speed is severely impaired. The challenge for rehabilitation should be to recover walking ability and efficiency starting from the early post-operative period. Gender- and age-tailored rehabilitation programs should be considered by placing particular attention on elderly women.

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.