Early commencement of physical therapy in the acute phase following elective lower limb arthroplasty produces favorable outcomes

a systematic review and meta-analysis examining allied health service models

Research output: Contribution to journalReview ArticleResearchpeer-review

10 Citations (Scopus)

Abstract

Background Temporal and dose–response relationships between allied health (AH) and recovery in the acute phase following lower limb (LL) arthroplasty are unclear. This systematic review investigates whether early commencement, additional therapy and/or weekend AH affects length of stay (LOS) and patient outcomes in the acute phase following LL arthroplasty. Methods Electronic databases were searched in February 2015. Studies were included if they evaluated any of the following aspects of AH for adults following LL arthroplasty in the acute phase: Early compared to later therapy commencement; Additional therapy; or a 6- or 7-day service compared to a lesser service. Results Twenty-four studies met the inclusion criteria, of which 19 investigated effects of physical therapy (PT) alone. Earlier PT reduced LOS (WMD = −1.23 days; 95% CI, −2.16 to −0.30) and resulted in higher probability of discharge directly home (relative risk = 1.45; 95% CI, 1.26–1.67). Addition of weekend PT reduced LOS (WMD = −1.04 days; 95% CI, −1.66 to −0.41) and improved function (SMD = 0.37; 95% CI, 0.02–0.73). Increasing PT from once to twice daily did not affect LOS (WMD = −0.35 days; 95% CI, −0.96–0.26) or function (SMD = 0.31; 95% CI, −0.06–0.71). Discussion Early PT commencement and a weekend service may produce favorable outcomes following LL arthroplasty when baseline LOS is 4 days or more. Redistributing PT resources to commence as early as day of surgery regardless of weekday may accelerate postoperative recovery. Current, high quality research is needed to confirm these findings.

Original languageEnglish
Pages (from-to)1667-1681
Number of pages15
JournalOsteoarthritis and Cartilage
Volume24
Issue number10
DOIs
Publication statusPublished - 1 Oct 2016

Keywords

  • Allied health
  • Arthroplasty
  • Early commencement
  • Joint replacement
  • Length of stay
  • Physical therapy

Cite this

@article{4ade9eed90b34369b02144a5a8ca71d7,
title = "Early commencement of physical therapy in the acute phase following elective lower limb arthroplasty produces favorable outcomes: a systematic review and meta-analysis examining allied health service models",
abstract = "Background Temporal and dose–response relationships between allied health (AH) and recovery in the acute phase following lower limb (LL) arthroplasty are unclear. This systematic review investigates whether early commencement, additional therapy and/or weekend AH affects length of stay (LOS) and patient outcomes in the acute phase following LL arthroplasty. Methods Electronic databases were searched in February 2015. Studies were included if they evaluated any of the following aspects of AH for adults following LL arthroplasty in the acute phase: Early compared to later therapy commencement; Additional therapy; or a 6- or 7-day service compared to a lesser service. Results Twenty-four studies met the inclusion criteria, of which 19 investigated effects of physical therapy (PT) alone. Earlier PT reduced LOS (WMD = −1.23 days; 95{\%} CI, −2.16 to −0.30) and resulted in higher probability of discharge directly home (relative risk = 1.45; 95{\%} CI, 1.26–1.67). Addition of weekend PT reduced LOS (WMD = −1.04 days; 95{\%} CI, −1.66 to −0.41) and improved function (SMD = 0.37; 95{\%} CI, 0.02–0.73). Increasing PT from once to twice daily did not affect LOS (WMD = −0.35 days; 95{\%} CI, −0.96–0.26) or function (SMD = 0.31; 95{\%} CI, −0.06–0.71). Discussion Early PT commencement and a weekend service may produce favorable outcomes following LL arthroplasty when baseline LOS is 4 days or more. Redistributing PT resources to commence as early as day of surgery regardless of weekday may accelerate postoperative recovery. Current, high quality research is needed to confirm these findings.",
keywords = "Allied health, Arthroplasty, Early commencement, Joint replacement, Length of stay, Physical therapy",
author = "R. Haas and M. Sarkies and Bowles, {K. A.} and Lisa O'Brien and T. Haines",
year = "2016",
month = "10",
day = "1",
doi = "10.1016/j.joca.2016.05.005",
language = "English",
volume = "24",
pages = "1667--1681",
journal = "Osteoarthritis and Cartilage",
issn = "1063-4584",
publisher = "Elsevier",
number = "10",

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TY - JOUR

T1 - Early commencement of physical therapy in the acute phase following elective lower limb arthroplasty produces favorable outcomes

T2 - a systematic review and meta-analysis examining allied health service models

AU - Haas, R.

AU - Sarkies, M.

AU - Bowles, K. A.

AU - O'Brien, Lisa

AU - Haines, T.

PY - 2016/10/1

Y1 - 2016/10/1

N2 - Background Temporal and dose–response relationships between allied health (AH) and recovery in the acute phase following lower limb (LL) arthroplasty are unclear. This systematic review investigates whether early commencement, additional therapy and/or weekend AH affects length of stay (LOS) and patient outcomes in the acute phase following LL arthroplasty. Methods Electronic databases were searched in February 2015. Studies were included if they evaluated any of the following aspects of AH for adults following LL arthroplasty in the acute phase: Early compared to later therapy commencement; Additional therapy; or a 6- or 7-day service compared to a lesser service. Results Twenty-four studies met the inclusion criteria, of which 19 investigated effects of physical therapy (PT) alone. Earlier PT reduced LOS (WMD = −1.23 days; 95% CI, −2.16 to −0.30) and resulted in higher probability of discharge directly home (relative risk = 1.45; 95% CI, 1.26–1.67). Addition of weekend PT reduced LOS (WMD = −1.04 days; 95% CI, −1.66 to −0.41) and improved function (SMD = 0.37; 95% CI, 0.02–0.73). Increasing PT from once to twice daily did not affect LOS (WMD = −0.35 days; 95% CI, −0.96–0.26) or function (SMD = 0.31; 95% CI, −0.06–0.71). Discussion Early PT commencement and a weekend service may produce favorable outcomes following LL arthroplasty when baseline LOS is 4 days or more. Redistributing PT resources to commence as early as day of surgery regardless of weekday may accelerate postoperative recovery. Current, high quality research is needed to confirm these findings.

AB - Background Temporal and dose–response relationships between allied health (AH) and recovery in the acute phase following lower limb (LL) arthroplasty are unclear. This systematic review investigates whether early commencement, additional therapy and/or weekend AH affects length of stay (LOS) and patient outcomes in the acute phase following LL arthroplasty. Methods Electronic databases were searched in February 2015. Studies were included if they evaluated any of the following aspects of AH for adults following LL arthroplasty in the acute phase: Early compared to later therapy commencement; Additional therapy; or a 6- or 7-day service compared to a lesser service. Results Twenty-four studies met the inclusion criteria, of which 19 investigated effects of physical therapy (PT) alone. Earlier PT reduced LOS (WMD = −1.23 days; 95% CI, −2.16 to −0.30) and resulted in higher probability of discharge directly home (relative risk = 1.45; 95% CI, 1.26–1.67). Addition of weekend PT reduced LOS (WMD = −1.04 days; 95% CI, −1.66 to −0.41) and improved function (SMD = 0.37; 95% CI, 0.02–0.73). Increasing PT from once to twice daily did not affect LOS (WMD = −0.35 days; 95% CI, −0.96–0.26) or function (SMD = 0.31; 95% CI, −0.06–0.71). Discussion Early PT commencement and a weekend service may produce favorable outcomes following LL arthroplasty when baseline LOS is 4 days or more. Redistributing PT resources to commence as early as day of surgery regardless of weekday may accelerate postoperative recovery. Current, high quality research is needed to confirm these findings.

KW - Allied health

KW - Arthroplasty

KW - Early commencement

KW - Joint replacement

KW - Length of stay

KW - Physical therapy

UR - http://www.scopus.com/inward/record.url?scp=84990946651&partnerID=8YFLogxK

U2 - 10.1016/j.joca.2016.05.005

DO - 10.1016/j.joca.2016.05.005

M3 - Review Article

VL - 24

SP - 1667

EP - 1681

JO - Osteoarthritis and Cartilage

JF - Osteoarthritis and Cartilage

SN - 1063-4584

IS - 10

ER -