Feasibility of a Multimodal Prehabilitation Program before Elective Knee and Hip Arthroplasty in Older Adults

IF 4.2 2区医学 Q2 GERIATRICS & GERONTOLOGY

Journal of the American Medical Directors Association Pub Date : 2024-11-06 DOI:10.1016/j.jamda.2024.105345

Bastien Genet MD , Judith Cohen-Bittan MD , Michaël Nicolas PT , Dominique Bonnet-Zamponi MD, PhD , Charlotte Naline MD , Dehbia Ouafi-Hendel MD , Véronique François MD , Christopher Cabral MSc , Anaïs Cloppet MD , Claire Davy MSc , Jacques Boddaert MD, PhD , Lorène Zerah MD, PhD

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引用次数: 0

Abstract

Objectives

Hip osteoarthritis and knee osteoarthritis cause significant disability and pain in older adults, often leading to hip or knee replacement surgery. Prehabilitation programs have been established for these surgeries, but there are few programs for orthogeriatrics. We evaluated the feasibility of a new multimodal prehabilitation program (MPP) for older adults before hip or knee replacement due to arthrosis: the Prehabilitation for Os (PRE4OS) study.

Design

We conducted a multicenter feasibility study in the Greater Paris area.

Setting and Participants

Eligible adults were aged ≥75 years old awaiting hip or knee replacement with at least a 6-week delay before surgery and able to participate in the MPP follow-up. The MPP included weekly hospital sessions providing nutritional, psychological, functional, and cognitive support, along with weekly home sessions featuring physiotherapist visits.

Methods

The primary outcome was at least 80% of 1-day hospital (ODH) sessions performed by 80% of participants. Secondary outcomes included intervention achievement, quality of life, and nutritional and functional status changes. Participant's satisfaction was qualitatively assessed via structured phone interviews presurgery and at 30 days postsurgery.

Results

From September 2021 to September 2023, a total of 27 individuals participated in the PRE4OS study. The mean (SD) age was 83 (4.3) years, with 7 males (26%) and median baseline Activities of Daily Living score 5.5 (interquartile range 5.5–6.0). Surgeries were for insertion of hip prosthesis in 17 participants (63%) and knee prosthesis in 10 (37%). The primary outcome was achieved in 89% of participants, with comparable rates for hip and knee prostheses. In total, 60% of participants rated the MPP as “excellent” presurgery and 100% at 30 days postsurgery, expressing a willingness to recommend the protocol to a friend or family.

Conclusion and Implications

The MPP was feasible for individuals before hip or knee replacement and was well received. Further randomized trials are needed to assess its clinical impact.

查看原文本刊更多论文

老年人选择性膝关节和髋关节置换术前多模式预康复计划的可行性。

目的：髋关节骨关节炎和膝关节骨关节炎会给老年人带来严重的残疾和疼痛，通常会导致髋关节或膝关节置换手术。针对这些手术的术前康复计划已经建立，但针对老年骨科的计划却很少。我们评估了一项新的多模式康复计划（MPP）的可行性，该计划适用于因关节病而接受髋关节或膝关节置换术的老年人：设计：我们在大巴黎地区开展了一项多中心可行性研究：符合条件的成年人年龄≥75 岁，等待髋关节或膝关节置换术，手术前至少延迟 6 周，并能参加 MPP 随访。MPP包括每周一次的住院治疗，提供营养、心理、功能和认知支持，以及每周一次的物理治疗师上门服务：主要结果是 80% 的参与者至少完成了 80% 的 1 天住院（ODH）疗程。次要结果包括干预效果、生活质量以及营养和功能状况的变化。参与者的满意度通过术前和术后 30 天的结构化电话访谈进行定性评估：从 2021 年 9 月到 2023 年 9 月，共有 27 人参加了 PRE4OS 研究。平均（标清）年龄为 83（4.3）岁，男性 7 人（26%），基线日常生活活动能力评分中位数为 5.5（四分位间范围为 5.5-6.0）。17名参与者（63%）接受了髋关节假体植入手术，10名参与者（37%）接受了膝关节假体植入手术。89%的参与者达到了主要疗效，髋关节和膝关节假体植入率相当。总之，60%的参与者在手术前将MPP评为 "优秀"，100%的参与者在手术后30天将MPP评为 "优秀"，并表示愿意向朋友或家人推荐该方案：对于髋关节或膝关节置换术前的患者来说，MPP 是可行的，并且广受欢迎。需要进一步的随机试验来评估其临床影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the American Medical Directors Association 医学-老年医学

CiteScore

11.10

自引率

6.60%

发文量

472

审稿时长

44 days

期刊介绍： JAMDA, the official journal of AMDA - The Society for Post-Acute and Long-Term Care Medicine, is a leading peer-reviewed publication that offers practical information and research geared towards healthcare professionals in the post-acute and long-term care fields. It is also a valuable resource for policy-makers, organizational leaders, educators, and advocates. The journal provides essential information for various healthcare professionals such as medical directors, attending physicians, nurses, consultant pharmacists, geriatric psychiatrists, nurse practitioners, physician assistants, physical and occupational therapists, social workers, and others involved in providing, overseeing, and promoting quality