Rehabilitation implications during the development of the Norwich Enhanced Recovery Programme (NERP) for patients following total knee and total hip arthroplasty

Smith, Toby; McCabe, Candida; Lister, Sarah A.; Christie, SP; Cross, Jane

doi:10.1016/j.otsr.2012.03.005

Cited by 52 publications

(50 citation statements)

References 13 publications

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“…3,5 The Norwich ERP was successful in reducing LOS following total knee and total hip replacement, and included preoperative physiotherapy education sessions for rehabilitation. 6 Preoperative education reduced LOS after either total knee or total hip arthroplasty by one day using one-to-one individualised preoperative teaching, either by phone or in person. 5 However, this programme would certainly be time consuming and expensive to achieve in the current economic era.…”

Section: Preoperative Interventions Preoperative Educationmentioning

confidence: 99%

“…Physiotherapy starts mostly on postoperative day 0. 6,34 A randomised controlled study comparing two different rehabilitation programmes (mobilising patients on day 0 or on day 1) has shown that the mobilisation of patients on day 0 in addition to other fast track modalities reduces LOS significantly. 34 Early postoperative mobilisation was found to be a significant risk factor affecting LOS following TKR in patients over 75 years.…”

Section: Postoperative Interventions Physiotherapymentioning

confidence: 99%

“…The Norwich ERP showed that mobilisation on day 0 significantly reduces LOS and produces better pain scores. 6 …”

Section: Postoperative Interventions Physiotherapymentioning

confidence: 99%

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An evidence-based review of enhanced recovery interventions in knee replacement surgery

Ibrahim

Alazzawi

Nizam

et al. 2013

annals

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Introduction Total knee replacement (TKR) is a very common surgical procedure. Improved pain management techniques, surgical practices and the introduction of novel interventions have enhanced the patient’s postoperative experience after TKR. Safe, efficient pathways are needed to address the increasing need for knee arthroplasty in the UK. Enhanced recovery programmes can help to reduce hospital stays following knee replacements while maintaining patient safety and satisfaction. This review outlines common evidence-based pre, intra and postoperative interventions in use in enhanced recovery protocols following TKR. Methods A thorough literature search of the electronic healthcare databases (MEDLINE®, Embase™ and the Cochrane Library) was conducted to identify articles and studies concerned with enhanced recovery and fast track pathways for TKR. Results A literature review revealed several non-operative and operative interventions that are effective in enhanced recovery following TKR including preoperative patient education, pre-emptive and local infiltration analgesia, preoperative nutrition, neuromuscular electrical stimulation, pulsed electromagnetic fields, perioperative rehabilitation, modern wound dressings, different standard surgical techniques, minimally invasive surgery and computer assisted surgery. Conclusions Enhanced recovery programmes require a multidisciplinary team of dedicated professionals, principally involving preoperative education, multimodal pain control and accelerated rehabilitation; this will be boosted if combined with minimally invasive surgery. The current economic climate and restricted healthcare budget further necessitate brief hospitalisation while minimising costs. These non-operative interventions are the way forward to achieve such requirements.

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Section: Preoperative Interventions Preoperative Educationmentioning

confidence: 99%

Section: Postoperative Interventions Physiotherapymentioning

confidence: 99%

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An evidence-based review of enhanced recovery interventions in knee replacement surgery

Ibrahim

Alazzawi

Nizam

et al. 2013

annals

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“…Rollators are four-wheeled walkers commonly used in clinical practice in many patient groups (Gupta et al, 2006;Chee et al, 2013;Eggermont et al, 2006;Smith et al, 2012). The specific aims of rollator use vary depending on the patient diagnosis.…”

Section: Introductionmentioning

confidence: 99%

Walking with a four wheeled walker (rollator) significantly reduces EMG lower-limb muscle activity in healthy subjects

Suica

Romkes

Tal

et al. 2016

Journal of Bodywork and Movement Therapies

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“…Early physical therapy (PT) is important to improve functional recovery following total joint replacement (TJR) surgery [1][2][3][4][5][6][7][8]. Adequate analgesia is essential for patients to participate in PT after TJR.…”

Section: Introductionmentioning

confidence: 99%

Peripheral nerve blocks and postoperative physical therapy: a single-institution survey of physical therapists’ preferences and opinions

McClain

Porter

Arnold

et al. 2017

Rom J Anaesth Intensive Care

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Background and Aims: Our aim was to ascertain the opinions and preferences of physical therapists with regard to use of peripheral nerve blocks and their impact on the recovery of patients undergoing total joint replacement.Methods: We conducted an anonymous 24-question survey of 20 full-time inpatient physical therapists at a single tertiary care medical center.Results: One respondent indicated they never work with patients who have undergone total joint replacement surgery. Nineteen questionnaires were included in the final analysis. Questions omitted by respondents or with write-in answers were not included in the analysis. A majority of respondents (15 [ of respondents would prefer that their patients receive periarticular infiltration or no block at all after total knee arthroplasty or total hip arthroplasty, respectively. All respondents (19 [100%]) answered that they thought lower extremity nerve blocks increased a patient's risk of falling after surgery.Conclusions: According to the physical therapists we surveyed, nerve blocks impede patient recovery and increase the risk of falls, despite their positive impact on pain control. When considering surgery for themselves, therapists indicated they would not want a nerve block.

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Rehabilitation implications during the development of the Norwich Enhanced Recovery Programme (NERP) for patients following total knee and total hip arthroplasty

Cited by 52 publications

References 13 publications

An evidence-based review of enhanced recovery interventions in knee replacement surgery

An evidence-based review of enhanced recovery interventions in knee replacement surgery

Walking with a four wheeled walker (rollator) significantly reduces EMG lower-limb muscle activity in healthy subjects

Peripheral nerve blocks and postoperative physical therapy: a single-institution survey of physical therapists’ preferences and opinions

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