The Effectiveness of Telerehabilitation for Functional Recovery After Orthopedic Surgery: A Systematic Review and Meta-Analysis.

Objective: The aim of this systematic review is to evaluate the effectiveness of physiotherapy treatment provided remotely via the Internet in the postoperative treatment of orthopedic patients and compare it with standard physiotherapy (face-to-face treatment or home-based treatment) in terms of motor performance, pain symptoms, and functional recovery. Methods: A systematic search of MEDLINE, Physiotherapy Evidence Database; EMBASE, SCOPUS, and CINHAL was conducted. Two independent reviewers performed study selection, data extraction, risk of bias (ROB) assessment using Cochrane ROB 2 tools, and summarize the results by Grading of Recommendations Assessment, Development, and Evaluation. Results: Eleven randomized controlled trial were selected. Pooled results showed improvement in motor performance in favor of the telerehabilitation group at 4-6 weeks (standardized mean difference -0.24, 95% confidence interval -0.45, -0.02, p = 0.03), and these differences were close to the minimum clinically important difference for Time Up and Go test. For pain and functional recovery, the results showed differences not statistically important. The certainty of evidence ranged from moderate to very low. Conclusion: For joint replacement patients, treatment conducted via telerehabilitation appears able to provide levels of motor performance better to that achieved through home-based treatment. In contrast, conclusive evidence that telerehabilitation is comparable to standard face-to-face treatment are not available.

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.

The tolerance of physiotherapy treatment in patients with COVID-19 and undergoing surgery for fragility hip fracture: An observational study.

ABSTRACT: The aim of the present work was to evaluate the tolerance of physiotherapy treatment implemented for patients with coronavirus disease (COVID-19) and undergoing hip surgeryCase-control study. During the period between March and May 2020, 9 patients were enrolled in the study with diagnosis of COVID-19 and hip fracture. In order to evaluate the tolerability of physiotherapy treatment a comparison group, involving 27 patients with a hip fracture but in the absence of suspicion of COVID-19 positivity, were put together. Blood saturation and heart rate, number of physiotherapy sessions, start of physiotherapy from surgery, number of healthcare providers, recovery of ambulation, execution of walking training and dyspnea measured by Borg scale were collected before and after each single physiotherapy session to describe the exercise tolerance of the patients.There are no significant differences between the two groups regarding basic characteristics. Average of Borg scale post treatment for COVID patients was 1.3 (DS = 1.3) compared to 0.6 (DS = 0.7) of non-COVID patients (P < .0005) but the breathing difficulty was light during the treatment, only 9% of COVID patients had a worsening superior of two points with Borg scale compared to 3% of non-COVID patients (P = .138). The incidence of walking recovery was 63% in the non-COVID patients group compared to 44.4% in the COVID group (P = .329).Physiotherapy treatment of patients with COVID-19 infection and undergoing surgery for hip fracture is well tolerated and should be encouraged and well monitored.

Postoperative function recovery in patients with endoprosthetic knee replacement for bone tumour: an observational study.

BACKGROUND: The objective of this study is to describe the rehabilitative pathway of patients undergoing endoprosthetic knee replacement surgery, build reference values ​​of the functional results achieved, and identify possible prognostic factors. METHODS: Prospective observational study. All patients undergoing resection and knee replacement surgery using a modular prosthesis following bone tumor resection were consecutively recruited over the last 2 years. The patients were followed for a period of 1 year, the result values ​​were collected at 3, 6 and 12 months. RESULTS: In total, 30 patients were enrolled. The median age was 19 years with 33% of patients being female. Median values recorded for knee flexion, quadriceps strength, Toronto Extremity Salvage Score, Time Up and Go and Six Minutes Walking Test showed an improvement of 16, 25, 18, 48 and 38% from 3 to 12 months, respectively. The level and width of the resection were correlated with the mobility of the knee and the strength of the quadriceps. CONCLUSION: Patients undergoing knee replacement for bone tumors were able to achieve satisfactory functional outcomes from the first postoperative year. A specific assessment of outcomes can be conducted to facilitate the management of patient expectations. A very wide resection and interventions of the proximal tibia are risk factors for a poorer functional outcome.