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A Journal on Physical Medicine and Rehabilitation after Pathological Events

Official Journal of the Italian Society of Physical and Rehabilitation Medicine (SIMFER), European Society of Physical and Rehabilitation Medicine (ESPRM), European Union of Medical Specialists - Physical and Rehabilitation Medicine Section (UEMS-PRM), Mediterranean Forum of Physical and Rehabilitation Medicine (MFPRM), Hellenic Society of Physical and Rehabilitation Medicine (EEFIAP)
In association with International Society of Physical and Rehabilitation Medicine (ISPRM)
Indexed/Abstracted in: CINAHL, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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Europa Medicophysica 2003 March;39(1):45-57


language: English

The individual rehabilitation project in hip arthroplasty patients

Rucco V., Visentini A., Pellegrini E.

Rehabilitation Unit Ospedale di Spilimbergo (Pordenone), Italy


In ortho­paed­ic sur­gery, ­hip arthro­plas­ty is ­today ­one of ­the ­most fre­quent elec­tive (­and ­not emer­gen­cy) oper­a­tions. Recreation of ­the cor­rect ana­tom­i­cal rela­tion­ships ­that ­for ­years ­had ­been com­pro­mised by ­the arthrit­ic dis­ease is, how­ev­er, ­only ­the 1st ­step ­towards com­plete recov­ery of ­good func­tion­al­ity of ­the ­new ­joint. Such recov­ery is ­the ­result of a cor­rect ­approach to reha­bil­i­ta­tion, ­which ­must ­take ­into ­account ­the var­i­ous prob­lems emerg­ing ­after sur­gery ­and ­thus, ­even in cas­es of a sin­gle dis­abil­ity (as ­the out­come of ­hip replace­ment sur­gery) ­the com­mit­ment of ­the reha­bil­i­ta­tion ­team ­may be con­sid­er­able. This is par­tic­u­lar­ly ­true in ­recent ­years ­because, ­thanks to improve­ments in sur­gi­cal tech­niques, ­hip arthro­plas­ty is ­now ­also per­formed in ­patients suf­fer­ing ­from com­plex dis­abil­ities (­hemi-plegia, Parkinson’s dis­ease, ­etc.) or ­from oth­er med­i­cal con­di­tions (atri­al fib­ril­la­tion, his­to­ry of pul­mo­nary embo­lism, ­etc.). This ­review ­aims to deter­mine ­the prob­lems ­that ­are encoun­tered in for­mu­lat­ing an reha­bil­i­ta­tion pro­ject ­for ­hip arthro­plas­ty ­patients. Determination of ­the reha­bil­i­ta­tion diag­no­sis is ­the 1st ­step in defin­ing ­the indi­vid­u­al reha­bil­i­ta­tion pro­ject, ­and is ­very dif­fer­ent ­from ­the dis­ease diag­no­sis for­mu­lat­ed by spe­cial­ists in ­wards ­for ­acute ­patients. The reha­bil­i­ta­tion diag­no­sis ­must ­take sev­er­al fac­tors ­into ­account: ­some ­pre-exis­tent to sur­gery (­and ­for ­which ­the ­pre-sur­gi­cal eval­u­a­tion is impor­tant), oth­ers ­that ­are a ­direct con­se­quence of sur­gery, ­and oth­ers ­again ­that ­present as com­pli­ca­tions in ­the ­days, ­months or ­years sub­se­quent to sur­gery (­and ­that ­need care­ful mon­i­tor­ing by ­the reha­bil­i­ta­tion ­team). To for­mu­late a reha­bil­i­ta­tion prog­no­sis ­means to ­know in ­advance ­the theo­ret­i­cal improve­ment ­that is pos­sible ­for a dis­abil­ity (­and ­thus ­the out­come ­that theo­ret­i­cal­ly ­might be ­achieved in ­the ­patient oper­at­ed ­for ­hip replace­ment ­and ­the aver­age ­time ­required to ­achieve it) ­and to deter­mine ­the actu­al improve­ment ­that ­can be ­achieved in ­the ­patient in ques­tion (­and ­thus ­the out­come ­that ­the spe­cif­ic ­patient ­may actu­al­ly ­achieve). The ­real capa­bil­ity ­for improve­ment ­may be sig­nif­i­cant­ly ­reduced by ­the co-exis­tence of oth­er dis­abil­ities or dis­eas­es. Therapeutic-reha­bil­i­ta­tion-occu­pa­tion­al pro­grammes ­are tail­ored to ­the var­i­ous emerg­ing dis­abil­ities ­found, ­and in ­their ­turn ­are influ­enced by ­pre-exist­ing dis­abil­ities ­and med­i­cal prob­lems. For ­each pro­gramme ­the reha­bil­i­ta­tion ­team ­must ­agree on eval­u­a­tion modal­ities (to be ­applied ­before ­and ­after treat­ment), ­short-­term ­goals (approx­i­mate­ly 2 ­weeks), ­the ­tools to be ­used to ­reach ­these ­goals (phar­mac­o­log­i­cal, reha­bil­i­ta­tion, infil­tra­tion, ­etc.). Correct deter­mi­na­tion of ­the ­most suit­able reha­bil­i­ta­tion path­way ­enables a ­more ration­al ­use of ­the net­work of reha­bil­i­ta­tion struc­tures avail­able with­in ­the ­health ser­vice, ensur­ing at ­the ­same ­time max­i­mum pro­tec­tion ­for ­the ­patient. Determination of ­the reha­bil­i­ta­tion path­way ­depends on 3 ­basic param­e­ters: ­the med­i­cal require­ment (which is pro­por­tion­ate to ­the ­patient’s clin­i­cal-inter­nal-med­i­cine stabil­ity ­and to ­the ­degree of com­plex­ity of ­the dis­abil­ity), ­the ­care require­ment (­which is pro­por­tion­ate to ­the ­patient’s ­need ­for nurs­ing ­care) ­and ­the res­i­den­tial require­ment (pro­por­tion­al to ­the ­patient’s ­social ­needs). Furthermore, ­since ­the ­future of ­the ­total ­hip arthro­plas­ty ­patient ­will be sub­ject to numer­ous com­pli­ca­tions, ­the reha­bil­i­ta­tion ­team (phy­sia­trist, phys­io­ther­a­pist, ­nurse) ­must organ­ise peri­od­ic ­check-­ups, under­stand ­the var­i­ous prob­lems ­that ­exist, be prop­er­ly ­trained ­and ­work in ­close col­lab­o­ra­tion, in ­order to ­avoid ­late diag­nos­es ­and unsuit­able or ­indeed com­plete­ly use­less treat­ment. Lastly, it ­should ­not be for­got­ten ­that, in eval­u­at­ing ­the ­results of pros­thet­ic sur­gery, oth­er fac­tors ­that ­are ­not direct­ly ­linked to ­the sur­gery ­itself ­play a ­role: ­patient sat­is­fac­tion is ­increased if ­the oper­a­tion ­occurs ­after a ­long peri­od of dis­ease com­pared to ­patients oper­at­ed ­after a ­short peri­od of dis­ease. Furthermore, accep­tance of pos­sible ­side-­effects ­and con­se­quent irre­ver­sible dis­abil­ities of var­y­ing ­degrees of sever­ity is great­er in ­the for­mer ­group of ­patients.

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