Is patient self-assessment of flexion after TKR able to identify risk of manipulation under anaesthesia?
Summary Background Patient self-assessment of postoperative knee flexion following knee replacement was introduced at our institution. This protocol had a dual objective: improve follow-up and act as an early indicator to identify patients at risk of requiring a manipulation under anaesthesia. The a...
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| Veröffentlicht in: | Orthopaedics & traumatology, surgery & research surgery & research, 2012-10, Vol.98 (6), p.672-676 |
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| description | Summary Background Patient self-assessment of postoperative knee flexion following knee replacement was introduced at our institution. This protocol had a dual objective: improve follow-up and act as an early indicator to identify patients at risk of requiring a manipulation under anaesthesia. The aim of our study was to audit the use of this patient self-assessment tool and evaluate whether these outcomes were being achieved. Materials and methods A prospective audit of patients admitted for total knee replacements under the care of one orthopaedic consultant between April and October 2009. Participants were asked to measure and record daily maximum knee flexion whilst sitting, from discharge through to six-week follow-up. Patients were advised to contact the arthroplasty team if flexion reduced by 10° or more for three consecutive days. Patient's documented knee flexion was compared to that measured on discharge and at six weeks postoperatively by clinicians. Results Seventy-nine participants (82 knees) were included with 61 participants (64 knees) returning data for analysis (78% compliance rate). Comparison of patient and clinician measurements showed a mean difference of +2° with limits of agreements from −12° to +15°. At a mean follow-up of six weeks maximum flexion (measured by clinician) was 99° (95%CI 97°, 102°) and 92% had a 90 °flexion or greater. During the audit period, six patients met the criteria to contact the arthroplasty team, however none of them followed this instruction. Discussion Patient self-assessment of knee flexion at home with a simple goniometer was accurate enough to be useful and 92% of patients reached 90° maximum flexion at six weeks. However this self-assessment method was not successful as an early indicator to identify patients at risk of requiring a manipulation under anaesthesia. Future studies into alternative identifiers are required. Level of evidence Level III. Investigating a diagnostic test. |
| doi_str_mv | 10.1016/j.otsr.2012.05.012 |
| format | Article |
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This protocol had a dual objective: improve follow-up and act as an early indicator to identify patients at risk of requiring a manipulation under anaesthesia. The aim of our study was to audit the use of this patient self-assessment tool and evaluate whether these outcomes were being achieved. Materials and methods A prospective audit of patients admitted for total knee replacements under the care of one orthopaedic consultant between April and October 2009. Participants were asked to measure and record daily maximum knee flexion whilst sitting, from discharge through to six-week follow-up. Patients were advised to contact the arthroplasty team if flexion reduced by 10° or more for three consecutive days. Patient's documented knee flexion was compared to that measured on discharge and at six weeks postoperatively by clinicians. Results Seventy-nine participants (82 knees) were included with 61 participants (64 knees) returning data for analysis (78% compliance rate). Comparison of patient and clinician measurements showed a mean difference of +2° with limits of agreements from −12° to +15°. At a mean follow-up of six weeks maximum flexion (measured by clinician) was 99° (95%CI 97°, 102°) and 92% had a 90 °flexion or greater. During the audit period, six patients met the criteria to contact the arthroplasty team, however none of them followed this instruction. Discussion Patient self-assessment of knee flexion at home with a simple goniometer was accurate enough to be useful and 92% of patients reached 90° maximum flexion at six weeks. However this self-assessment method was not successful as an early indicator to identify patients at risk of requiring a manipulation under anaesthesia. Future studies into alternative identifiers are required. Level of evidence Level III. Investigating a diagnostic test.</description><identifier>ISSN: 1877-0568</identifier><identifier>EISSN: 1877-0568</identifier><identifier>DOI: 10.1016/j.otsr.2012.05.012</identifier><identifier>PMID: 22939105</identifier><language>eng</language><publisher>France: Elsevier Masson SAS</publisher><subject>Aged ; Anesthesia - methods ; Arthrofibrosis ; Arthroplasty, Replacement, Knee - methods ; Clinical audit ; Female ; Follow-Up Studies ; Humans ; Knee flexion ; Knee Prosthesis ; Male ; Manipulation under anaesthesia ; Orthopedics ; Osteoarthritis, Knee - physiopathology ; Osteoarthritis, Knee - surgery ; Patient self-assessment ; Postoperative Period ; Prospective Studies ; Prosthesis Design ; Range of Motion, Articular ; Risk identification tool ; Self-Assessment ; Surgery ; Total knee arthroplasty ; Treatment Outcome</subject><ispartof>Orthopaedics & traumatology, surgery & research, 2012-10, Vol.98 (6), p.672-676</ispartof><rights>Elsevier Masson SAS</rights><rights>2012 Elsevier Masson SAS</rights><rights>Copyright © 2012 Elsevier Masson SAS. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c406t-cf8d9885f752a64bcdc1bac6a30ae2f33b7775075f37c53899c828f7d276180a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1877056812001533$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22939105$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Maclean, C</creatorcontrib><creatorcontrib>Deakin, A.H</creatorcontrib><creatorcontrib>Picard, F</creatorcontrib><title>Is patient self-assessment of flexion after TKR able to identify risk of manipulation under anaesthesia?</title><title>Orthopaedics & traumatology, surgery & research</title><addtitle>Orthop Traumatol Surg Res</addtitle><description>Summary Background Patient self-assessment of postoperative knee flexion following knee replacement was introduced at our institution. This protocol had a dual objective: improve follow-up and act as an early indicator to identify patients at risk of requiring a manipulation under anaesthesia. The aim of our study was to audit the use of this patient self-assessment tool and evaluate whether these outcomes were being achieved. Materials and methods A prospective audit of patients admitted for total knee replacements under the care of one orthopaedic consultant between April and October 2009. Participants were asked to measure and record daily maximum knee flexion whilst sitting, from discharge through to six-week follow-up. Patients were advised to contact the arthroplasty team if flexion reduced by 10° or more for three consecutive days. Patient's documented knee flexion was compared to that measured on discharge and at six weeks postoperatively by clinicians. Results Seventy-nine participants (82 knees) were included with 61 participants (64 knees) returning data for analysis (78% compliance rate). Comparison of patient and clinician measurements showed a mean difference of +2° with limits of agreements from −12° to +15°. At a mean follow-up of six weeks maximum flexion (measured by clinician) was 99° (95%CI 97°, 102°) and 92% had a 90 °flexion or greater. During the audit period, six patients met the criteria to contact the arthroplasty team, however none of them followed this instruction. Discussion Patient self-assessment of knee flexion at home with a simple goniometer was accurate enough to be useful and 92% of patients reached 90° maximum flexion at six weeks. However this self-assessment method was not successful as an early indicator to identify patients at risk of requiring a manipulation under anaesthesia. Future studies into alternative identifiers are required. Level of evidence Level III. Investigating a diagnostic test.</description><subject>Aged</subject><subject>Anesthesia - methods</subject><subject>Arthrofibrosis</subject><subject>Arthroplasty, Replacement, Knee - methods</subject><subject>Clinical audit</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Knee flexion</subject><subject>Knee Prosthesis</subject><subject>Male</subject><subject>Manipulation under anaesthesia</subject><subject>Orthopedics</subject><subject>Osteoarthritis, Knee - physiopathology</subject><subject>Osteoarthritis, Knee - surgery</subject><subject>Patient self-assessment</subject><subject>Postoperative Period</subject><subject>Prospective Studies</subject><subject>Prosthesis Design</subject><subject>Range of Motion, Articular</subject><subject>Risk identification tool</subject><subject>Self-Assessment</subject><subject>Surgery</subject><subject>Total knee arthroplasty</subject><subject>Treatment Outcome</subject><issn>1877-0568</issn><issn>1877-0568</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kU1rFTEUhoMo9kP_gAuZpZsZ83EzyYAopWgtFgq1rkMmc0Jzm5lcc2ak99-b4VYpLlydBJ73DXkOIW8YbRhl7fttk2bMDaeMN1Q2ZTwjx0wrVVPZ6udPzkfkBHFLadsywV-SI8470TEqj8ndJVY7OweY5goh-toiAuK43pOvfISHkKbK-hlydfvtprJ9hGpOVRgKEvy-ygHvV3S0U9gtsXQVfpmGwtvJAs53gMF-ekVeeBsRXj_OU_Ljy-fb86_11fXF5fnZVe02tJ1r5_XQaS29kty2m94NjvXWtVZQC9wL0SulJFXSC-Wk0F3nNNdeDVy1TFMrTsm7Q-8up59Led6MAR3EaCdICxpGOyE3dKNUQfkBdTkhZvBml8No875AZjVstmY1bFbDhkpTRgm9fexf-hGGv5E_Sgvw4QBA-eWvANmgK3odDCGDm82Qwv_7P_4TdzFMwdl4D3vAbVryVPwZZrBkzPd1x-uKGaeUSSHEb2pvomM</recordid><startdate>20121001</startdate><enddate>20121001</enddate><creator>Maclean, C</creator><creator>Deakin, A.H</creator><creator>Picard, F</creator><general>Elsevier Masson SAS</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20121001</creationdate><title>Is patient self-assessment of flexion after TKR able to identify risk of manipulation under anaesthesia?</title><author>Maclean, C ; Deakin, A.H ; Picard, F</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c406t-cf8d9885f752a64bcdc1bac6a30ae2f33b7775075f37c53899c828f7d276180a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Aged</topic><topic>Anesthesia - methods</topic><topic>Arthrofibrosis</topic><topic>Arthroplasty, Replacement, Knee - methods</topic><topic>Clinical audit</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Knee flexion</topic><topic>Knee Prosthesis</topic><topic>Male</topic><topic>Manipulation under anaesthesia</topic><topic>Orthopedics</topic><topic>Osteoarthritis, Knee - physiopathology</topic><topic>Osteoarthritis, Knee - surgery</topic><topic>Patient self-assessment</topic><topic>Postoperative Period</topic><topic>Prospective Studies</topic><topic>Prosthesis Design</topic><topic>Range of Motion, Articular</topic><topic>Risk identification tool</topic><topic>Self-Assessment</topic><topic>Surgery</topic><topic>Total knee arthroplasty</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Maclean, C</creatorcontrib><creatorcontrib>Deakin, A.H</creatorcontrib><creatorcontrib>Picard, F</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Orthopaedics & traumatology, surgery & research</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Maclean, C</au><au>Deakin, A.H</au><au>Picard, F</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Is patient self-assessment of flexion after TKR able to identify risk of manipulation under anaesthesia?</atitle><jtitle>Orthopaedics & traumatology, surgery & research</jtitle><addtitle>Orthop Traumatol Surg Res</addtitle><date>2012-10-01</date><risdate>2012</risdate><volume>98</volume><issue>6</issue><spage>672</spage><epage>676</epage><pages>672-676</pages><issn>1877-0568</issn><eissn>1877-0568</eissn><abstract>Summary Background Patient self-assessment of postoperative knee flexion following knee replacement was introduced at our institution. This protocol had a dual objective: improve follow-up and act as an early indicator to identify patients at risk of requiring a manipulation under anaesthesia. The aim of our study was to audit the use of this patient self-assessment tool and evaluate whether these outcomes were being achieved. Materials and methods A prospective audit of patients admitted for total knee replacements under the care of one orthopaedic consultant between April and October 2009. Participants were asked to measure and record daily maximum knee flexion whilst sitting, from discharge through to six-week follow-up. Patients were advised to contact the arthroplasty team if flexion reduced by 10° or more for three consecutive days. Patient's documented knee flexion was compared to that measured on discharge and at six weeks postoperatively by clinicians. Results Seventy-nine participants (82 knees) were included with 61 participants (64 knees) returning data for analysis (78% compliance rate). Comparison of patient and clinician measurements showed a mean difference of +2° with limits of agreements from −12° to +15°. At a mean follow-up of six weeks maximum flexion (measured by clinician) was 99° (95%CI 97°, 102°) and 92% had a 90 °flexion or greater. During the audit period, six patients met the criteria to contact the arthroplasty team, however none of them followed this instruction. Discussion Patient self-assessment of knee flexion at home with a simple goniometer was accurate enough to be useful and 92% of patients reached 90° maximum flexion at six weeks. However this self-assessment method was not successful as an early indicator to identify patients at risk of requiring a manipulation under anaesthesia. Future studies into alternative identifiers are required. Level of evidence Level III. Investigating a diagnostic test.</abstract><cop>France</cop><pub>Elsevier Masson SAS</pub><pmid>22939105</pmid><doi>10.1016/j.otsr.2012.05.012</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Anesthesia - methods Arthrofibrosis Arthroplasty, Replacement, Knee - methods Clinical audit Female Follow-Up Studies Humans Knee flexion Knee Prosthesis Male Manipulation under anaesthesia Orthopedics Osteoarthritis, Knee - physiopathology Osteoarthritis, Knee - surgery Patient self-assessment Postoperative Period Prospective Studies Prosthesis Design Range of Motion, Articular Risk identification tool Self-Assessment Surgery Total knee arthroplasty Treatment Outcome |
| title | Is patient self-assessment of flexion after TKR able to identify risk of manipulation under anaesthesia? |
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