Nancy Walsh writing for MedPage Today on November 21, 2011 discusses that Rheumatoid arthritis patients don’t expect as much functional relief from total knee replacement surgery, and those lower expectations may explain the effort that they put into rehabilitation efforts, researchers said here.
Using the Hospital for Special Surgery Expectations Survey, researchers from the New York hospital reported that osteoarthritis patients had a score of 79.8 (out of 100) compared with a score of 73.7 for rheumatoid arthritis patients — a more than 6 point difference that is considered clinically meaningful (P=0.03).
Lower expectations could prevent patients from optimizing recovery, said Lisa Mandl, MD, of the Hospital for Special Surgery, New York. Mandl reported her findings at the annual meeting of the American College of Rheumatology.
“When people say they are satisfied, a lot of it is not just related to actual objective measures. It had to do with their expectations preoperatively,” Mandl stated in a press release. She explained that prior to surgery a patient might have expressed hope that after the procedure they could easily walk to the bathroom.
When they accomplish that, she suggested, they are satisfied and may not try to do even more “because that is all they expected. They kind of give up after that. They might not be optimizing their postoperative physical therapy.”
Mandl and colleagues in a retrospective study identified 64 rheumatoid arthritis patients undergoing total knee replacement and compared their expectations with 124 matched osteoarthritis patients also undergoing knee replacement surgery.
Overall, the rheumatoid arthritis patients had lower expectations than osteoarthritis patients, especially when it cane to being able to perform activities of daily living (P<0.0026) and the ability to interact with others such as being able to play with small children (P<0.0026).
“If rheumatoid arthritis patients are healthy enough to have surgery, they should really expect good outcomes,” Mandl stated. “It would be a real shame if these patients could have significantly improved function, but for some reason they don’t attain it, perhaps connected to their expectations.”
Mandl and her co-researchers noted that, although rheumatoid arthritis patients don’t fare as well as their osteoarthritis counterparts as far as physical improvement following surgery is concerned, they feel better about how well they did, suggesting lower expectations.
Co-author of the paper, Susan Goodman, MD, attending rheumatologist at the hospital, stated in the release, “What we can do as doctors is ensure that we educate our patients properly. In the past our rheumatoid arthritis patients didn’t do as well as other patients and those expectations were realistic, but I think times are changing. Doctors should explain to rheumatoid arthritis patients that they should expect good outcomes.”
The study cohort was predominantly women — 87%. The average age of the patients was 65 years and the average Lower Extremity Activity Score was 8.7, which corresponds to being able to walk around the house and for several blocks without assistance. There was no difference in living status or education.
The LegTutor will help maintain the patients current strength after knee replacement surgery.
The LegTutor™ system has been developed to allow for functional rehabilitation of the lower extremity. The system consists of an ergonomic wearable leg brace and dedicated rehabilitation software. The LegTutor™ system allows for a range of biomechanical evaluation including speed, passive and active range of motion and motion analysis of the lower extremity. Quantitative biomechanical data allow for objective evaluation and rehabilitation treatment follow up. The LegTutor™, which includes the HandTutor, ArmTutor and 3DTutor, rehabilitation concept is based on performing controlled exercise rehabilitation practice at a patient customized level with real time accurate feedback on the patient’s performance. The exercises are designed in the form of challenging games that are suitable for a wide variety of neurological and orthopedic injury and disease.
The games challenge the patient to perform the exercise task to their best ability and to continue exercise practice.
The LegTutor™ allows for isolated and a combination of knee and three directional hip treatment. The system provides detailed exercise performance instructions and precise feedback on the patients exercise performance. Controlled exercise of multi joints within the normal movement pattern prevents the development of undesired and compensatory joint movement and ensures better performance of functional tasks.
The LegTutor™ system is used by many leading rehabilitation centers worldwide and has full FDA and CE certification. See www.HandTutor.com for more information. .
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