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Background The use of animals to augment traditional medical therapies was reported as early as the 9 th century but to our knowledge has not been studied in an orthopaedic patient population. The purpose of this study was to evaluate the role of animal-assisted therapy using therapy dogs in the postoperative recovery of patients after THA and TKA. Questions/purposes We asked: (1) Do therapy dogs have an effect on patients’ perception of pain after total joint arthroplasty as measured by the VAS? (3) Do therapy dogs have an effect on patients’ satisfaction with their hospital stay after total joint arthroplasty as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)? Methods A randomized controlled trial of 72 patients undergoing primary unilateral THA or TKA was conducted. Patients were randomized to a 15-minute visitation with a therapy dog before physical therapy or standard postoperative physical therapy regimens. Both groups had similar demographic characteristics. Reduction in pain was assessed using the VAS after each physical therapy session, beginning on postoperative Day 1 and continuing for three consecutive sessions. To ascertain patient satisfaction, the proportion of patients selecting top-category ratings in each subsection of the HCAHPS was compared. Results Patients in the treatment group had lower VAS scores after each physical therapy session with a final VAS score difference of 2.4 units (animal-assisted therapy VAS, 1.7; SD, 0.97 [95% CI, 1.4–2.0] versus control VAS, 4.1; SD, 0.97 [95% CI, 3.8–4.4], p < 0.001) after the third physical therapy session. Patients in the treatment group had a higher proportion of top-box HCAHPS scores in the following fields: nursing communication (33 of 36, 92% [95% CI, 78%–98%] versus 69%, 25 of 36 [95% CI, 52%–84%], p = 0.035; risk ratio, 1.3 [95% CI of risk ratio, 1.0–1.7]; risk difference, 23% [95% CI of risk difference, 5%–40%]), pain management (34 of 36, 94% [95% CI, 81%–99%], versus 26 of 36, 72% [95% CI, 55%–86%], p = 0.024; risk ratio, 1.3 [95% CI of risk ratio, 1.1–1.6]; risk difference, 18% [95% CI of risk difference, 5%–39%]). The overall hospital rating also was greater in the treatment group (0–10 scale) (9.6; SD, 0.7 [95% CI, 9.3–9.8] versus 8.6, SD, 0.9 [95% CI, 8.3–8.9], p < 0.001). Conclusions The use of therapy dogs has a positive effect on patients’ pain level and satisfaction with hospital stay after total joint replacement. Surgeons are encouraged to inquire about the status of volunteer-based animal-assisted therapy programs in their hospital as this may provide a means to improve the immediate postoperative recovery for a select group of patients having total joint arthroplasty. Level of Evidence Level II, randomized controlled study. See Instructions for Authors for a complete description of levels of evidence.

Background This study aimed to explore the impact of precision nursing intervention based on Damage Control Orthopedics (DCO) model on joint function and quality of life of elderly hip arthroplasty patients. Methods Elderly hip arthroplasty patients ( n  = 100) who underwent hip replacement surgery at our hospital from January 2023 to June 2024 were collected and randomly assigned into two groups, with 50 patients in each. The control group received conventional nursing intervention, while the observation group received precision nursing intervention based on the DCO model. The hip joint function (Harris), Self-rating Depression Scale (SDS), Self-rating Anxiety Scale (SAS), Pittsburgh Sleep Quality Index (PSQI), Barthel Index (BI), and SF-36 were employed to assess hip joint function, psychological status, sleep quality, daily living abilities, and quality of life before and after intervention in both groups. Complications in both groups were also recorded. Results Compared to pre-intervention, the hip joint function scores and BI scores in both groups significantly improved post-intervention, with the observation group scoring higher than the control group ( P  < 0.05). After the intervention, SAS, SDS, and PSQI scores decreased in both groups, with the observation group showing lower scores than the control group ( P  < 0.05). The quality of life scores in the observation group post-intervention were higher than those in the control group ( P  < 0.05). Conclusion Precision nursing intervention based on DCO model can significantly improve joint function and quality of life in elderly patients with hip arthroplasty.

Health care professionals use mobile apps to support patients' rehabilitation after total hip or knee arthroplasty. Understanding patient engagement in such mobile health interventions can help tailor these interventions to better support patients. This study aimed to investigate patient engagement in a mobile app-based arthroplasty rehabilitation program and to investigate the association between patient engagement and their characteristics. Data were extracted from a pool of 42 participants in the experimental arm of a randomized controlled trial that used a mobile app (WeChat [Tencent Holdings Limited])-based program to support patients' rehabilitation after total hip or knee arthroplasty. The primary outcomes were the number of days the participants accessed the program and completed recommended rehabilitation tasks. Secondary outcomes included data on the participants' posts on a discussion forum, messages sent by the participants, access to the program components, and reading and sharing the program content. Generalized linear models were used to analyze the association between patient engagement and personal characteristics. The participants reported in a rehabilitation diary accessing the program on a mean of 5.2 (SD 2) days per week and completing recommended rehabilitation tasks on a mean of 6.5 (SD 0.8) days per week. The majority (31/42, 74%) posted on the discussion forum, with a mean of 18.1 (SD 21.2) posts. Most participants (37/42, 88%) sent messages to health care professionals, with a mean of 14 (SD 15.9) messages. The program components were visited for a total of 525 times. The program content was read 898 times and shared 82 times in total. Generalized linear models showed that both primary outcomes, the number of days the participants accessed the program (B=6.46, 95% CI 1.98-15.35; χ =11.1, P=.001) and the number of days they completed rehabilitation tasks (B=2.65, 95% CI 0.45-5.48; χ =5.7, P=.02), were positively associated with having a high school education or above. In addition, the number of posts on the discussion forum was positively associated with living with family, having a high school education or above, undergoing total knee arthroplasty, having comorbidities, and the score of self-efficacy but was negatively associated with age. The number of messages sent by the participants was positively associated with having a high school education or above, having comorbidities, and the score of self-efficacy. Patient engagement in mobile arthroplasty rehabilitation is associated with their education level, cohabitation status, age, type of surgery, presence of comorbidities, and sense of self-efficacy. Program developers can consider these characteristics and use strategies, such as family involvement, in the design of mobile arthroplasty rehabilitation programs to enhance patient engagement in such interventions. Australian New Zealand Clinical Trials Registry ACTRN12621000867897; https://tinyurl.com/mtdw25fp.

Patients have multiple expectations of THA and TKA. We asked whether preoperative educational classes addressing recovery during the first year could modify patients’ expectations of their 12-month postoperative recovery. Participants were enrolled consecutively in two randomized, controlled trials, one for THA (177 patients) and one for TKA (143 patients). Control patients preoperatively received a standard THA or TKA class addressing recovery immediately after surgery. Intervention patients preoperatively received the standard class plus a joint-specific module addressing recovery during the first 12 months. Before and after the class, patients completed either a hip-specific or knee-specific validated expectations survey. The main outcome was the within-patient change in expectation scores (maximum increase, +100; maximum decrease, −100) before and after the class but preoperatively. Mean changes in hip scores were +3.3 ± 8 for intervention patients (range, −22–+32) and +4.9 ± 8 for control patients (range, −13–+29). Mean changes in knee scores were −3.4 ± 10 for intervention patients (range, −26–+33) and +2.4 ± 10 for control patients (range, −30–+30). Patients’ preoperative expectations of their recovery from THA or TKA can be modified by preoperative educational classes. Level of Evidence: Level I, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

This study aimed to investigate the effect of a video-assisted discharge education program on activities of daily living, functionality, and patient satisfaction following total hip replacement (THR) surgery. This study included 31 patients who were randomly divided into the physiotherapy group (n = 18), and the video-assisted discharge education (VADE) group (n = 13). Both groups received a physiotherapy program. The VADE group was also received the VADE program. Face-to-face instruction was used in all of the educational programs. There was a significant difference in favor of the VADE group in Harris Hip Score, Nottingham Extended Activities of Daily Living Scale’s movement score, Tampa Scale of Kinesiophobia, Patient Satisfaction Questionnaire ( p  < 0.05). There was a significant difference between groups on resting pain levels in the first week and on resting and activity pain levels in the third month in favor of the VADE group ( p  < 0.05). The results of this study demonstrated that VADE can be effective in improving patient satisfaction and functionality, reducing pain and kinesiophobia following THR.

Background The aim of the study was to improve physical activity (PA), well-being and clinical outcome after total knee and hip arthroplasty through tailored activity counselling during inpatient rehabilitation. Methods 65 patients (aged 70.4 ± 7.3 years, BMI 28.5 ± 4.3) starting inpatient rehabilitation after primary knee or hip arthroplasty due to osteoarthritis were recruited and pseudo-randomized into an intervention (IG) and a control group (CG). Twice a week, the IG was encouraged to increase their daily step count by 5%. PA, e. g. number of steps, step frequency, or active minutes, was measured by step activity monitoring. Well-being and clinical outcome were assessed using the SF-36, Oxford Knee/Hip Score and Global rating of Change. Procedures were conducted at the onset of inpatient rehabilitation, and repeated one and 6 months after inpatient rehabilitation. Results Data sets were obtained from 49 patients (IG: n  = 23, CG: n  = 26). Both groups significantly increased their number of daily steps from the 1 month to the 6 months follow up after rehabilitation: CG: 9019 (95%CI: 7812, 10,226), IG: 9280 (7972, 10,588) and CG: 10921 (9571, 12,271), IG: 11326 (9862, 12,791) respectively. Additionally, well-being and clinical outcome improved significantly in both groups. No significant differences in physical activity, clinical outcome and well-being were found between the groups. Conclusions PA counselling during inpatient rehabilitation does not improve PA, well-being and clinical outcome in patients with primary knee or hip arthroplasty in addition to the rehabilitation program. PA interventions may be more effective after the completion of the inpatient rehabilitation phase. Trial registration DRKS DRKS00012682 . Registered retrospectively on 03–07- 2017.

Background Virtual reality (VR) has shown promise as a nonpharmacological alternative to pharmaceutical pain relievers and anxiety medications in clinical trials by decreasing pain and anxiety in orthopedic surgeries. The aim of the study was to evaluate the impact of VR on these outcomes in individuals undergoing total hip arthroplasty (THA). Methods This randomized, controlled, open-label research included 50 participants planned for THA with spinal anesthesia (SA). Patients were allocated equally to group VR: patients were immersed in a peaceful natural environment with soft music preoperatively and intraoperatively, and group C did not receive VR. Results The STAI-S for anxiety and PSS-10 scores for stress were significantly lower in group VR before SA and immediately postoperatively ( P  < 0.05). Hemodynamics at 5 min, 30 min, and 60 min, pain scores at 4 h and 6 h, 24 h pethidine consumption, haloperidol dose, and cortisol level at 6 h postoperative were decrease in group VR in comparision to group C ( P  < 0.05). Time to first analgesia request and satisfaction level were higher in group VR in comparision to group C ( P  < 0.05). Conclusions VR can reduce perioperative anxiety, stress, pain, and opioid requirements, and improve satisfaction in THA patients. Trial registration The trial was registered https://clinicaltrials.gov/study/NCT06088069?id=NCT06088069&rank=1((ID:NCT06088069 , Principal investigator: (SAAD AHMED MOHARAM, Date of registration: 18-10-2023).

IntroductionWhile total hip replacement (THR) and total knee replacement (TKR) successfully reduce pain associated with chronic joint pathology, this infrequently translates into increased physical activity. This is a challenge given that over 50% of individuals who undergo these operations are physically inactive and have medical comorbidities such as hypertension, heart disease, diabetes and depression. The impact of these diseases can be reduced with physical activity. This trial aims to investigate the effectiveness of a behaviour change physiotherapy intervention to increase physical activity compared with usual rehabilitation after THR or TKR.Methods and analysisThe PEP-TALK trial is a multicentre, open-labelled, pragmatic randomised controlled trial. 260 adults who are scheduled to undergo a primary unilateral THR or TKR and are moderately inactive or inactive, with comorbidities, will be recruited across eight sites in England. They will be randomised post-surgery, prior to hospital discharge, to either six, 30 min weekly group-based exercise sessions (control), or the same six weekly, group-based, exercise sessions each preceded by a 30 min cognitive behaviour approach discussion group. Participants will be followed-up to 12 months by postal questionnaire. The primary outcome is the University of California, Los Angeles (UCLA) Physical Activity Score at 12 months. Secondary outcomes include: physical function, disability, health-related quality of life, kinesiophobia, perceived pain, self-efficacy and health resource utilisation.Ethics and disseminationResearch ethics committee approval was granted by the NRES Committee South Central (Oxford B - 18/SC/0423). Dissemination of results will be through peer-reviewed, scientific journals and conference presentations.Trial registration numberISRCTN29770908.

Background Total hip arthroplasty (THA) is a common and effective surgical method for advanced hip arthritis. Rehabilitation exercises are important to improve joint function after THA and are usually conducted in a home-based program. Poor patient adherence limits improvements in pain and function, affecting quality of life. The increasing use of THA in the aging Chinese population underscores the need to develop strategies that maximize functional outcomes. The purpose of this pilot study is to develop and assess the feasibility of a self-efficacy-enhancing intervention (SEEI) to improve exercise adherence in patients undergoing THA. Methods This single-blinded, parallel, randomized control trial will recruit 150 patients after THA and randomly assign them to an intervention or control group using computer-generated block randomization. The control group will receive usual care using evidence-based guidelines. The intervention group will receive the 6-month SEEI comprising personalized exercise guidance and self-efficacy education delivered using one face-to-face education session and four telephone consultations, supplemented by written materials. Participants are encouraged to build confidence in their own abilities, set rehabilitation goals, and self-monitor their physical exercise. Results Assessments will be conducted at baseline and 1, 3, and 6 months postsurgery. The outcome indicators are exercise adherence, physical function, anxiety and depression, self-efficacy of rehabilitation, joint function, and quality of life. Conclusions This study will test a theory-based intervention program to improve self-efficacy in rehabilitation, which may significantly impact out-of-hospital rehabilitation. The results will provide evidence to inform the postoperative recovery of patients undergoing THA or similar procedures. Trial registration Chinese Clinical Trials Registry, ChiCTR2000029422 , registered on 31 January 2020

Background We hypothesised that psychological support would have a significant improvement on the mental and physical recovery of patients undergoing primary total hip or knee arthroplasty. Materials and methods 200 patients were consecutively alternately assigned (1:1) to receive routine care (control group) or, in addition, psychological support from a professional psychologist (experimental group). The psychological support was provided at the pre-operative visit, during the hospitalisation period and at the rehabilitation centre. Results Upon discharge, based on the ‘Hospital Anxiety and Depression Scale, a state of anxiety was observed in 12.8 % and 78.9 % of the patients in the experimental and in the control group, respectively ( p  < 0.0001). A state of depression was observed in 12.8 % and 73.7 % of the patients in the experimental and in the control group, respectively ( p  < 0.0001). With regard to the ‘Physical Component Scale’ of the SF-36 questionnaire, a similar temporal trend of values was observed in the two study groups, significantly increasing over time in both groups, taking into consideration both the joint population and the two hip and knee populations separately ( p  < 0.0001). With regard to the ‘Mental Component Scale’ of the SF-36 questionnaire, in both the joint population and the two hip and knee populations separately, an exact opposite temporal trend was observed in the experimental group compared to the control group ( p  < 0.0001), with generally higher scores in the experimental group ( p  < 0.0001). In patients with hip arthroplasty, the average time to reach the physiotherapy objective (i.e., the patient ability to walk 50 metres independently and to climb 10 steps) was 6.7 ± 1.8 days (range 4–12) in the experimental group and 7.9 ± 2.2 days (range 0–13) in the control group ( p  = 0.0015). Conclusions In summary, there was a lower incidence of anxiety and depression and better mental well-being in the group of patients who received the psychological support. Within the hip arthroplasty group, the patients who received the psychological support reached the physiotherapy objective 1.2 days earlier than the patients in the control group ( p  = 0.0015). Level of evidence Level 3, Non-randomized prospective controlled cohort.