Replacement Arthroplasty: Revel M

Barrois B, Gouin F, Ribinik P, Revel M, Rannou F, Anonymous00213. · Service de MPR, centre hospitalier de Gonesse, 25, rue Pierre-de-Theilley, BP 30071, 95503 Gonesse cedex, France. · Ann Readapt Med Phys. · Pubmed #17850912 No free full text.

Abstract: OBJECTIVES: To develop clinical practice guidelines concerning the interest of post-operative rehabilitation in a physical medicine and functional rehabilitation (PMR) ward after total hip arthroplasty (THA). METHOD: The SOFMER (French Physical Medicine and Rehabilitation Society) methodology, associating a systematic literature review, collection of everyday clinical practice, and external review by a multidisciplinary expert panel, was used. Main outcomes were impairment, disability, medico-economic implications and postoperative complications. RESULTS: Post-operative rehabilitation in a PMR ward after THA is recommended for frail patients because of their functional status, and/or associated co-morbidities, and/or post-operative complications. For patients in whom sustained rehabilitation is not necessary, but who cannot return home, a stay in a non-specific (non-PMR) post-operative center could be recommended. Post-operative rehabilitation in a PMR ward after THA could reduce the length of stay in a surgical ward and increase the functional status of patients. The total cost of the different modalities of post-operative rehabilitation after THA needs evaluation. CONCLUSION: This study suggests a value of rehabilitation in a PMR ward after THA, but good methodological quality studies are needed to evaluate the cost/benefit ratio of rehabilitation in a PMR ward after THA in the French health care system.

Postel JM, Thoumie P, Missaoui B, Biau D, Ribinik P, Revel M, Rannou F, Anonymous00070. · Clinique Arago, 95, boulevard Arago, 75014 Paris, France. · Ann Readapt Med Phys. · Pubmed #17412445 No free full text.

Abstract: OBJECTIVE: To develop clinical practice guidelines concerning the use of continuous passive motion (CPM) compared with intermittent mobilization after total knee arthroplasty (TKA). METHOD: We used the SOFMER (French Physical Medicine and Rehabilitation Society) methodology, combining systematic literature review and collection of everyday clinical practice concerning postoperative rehabilitation techniques and external review by a multidisciplinary expert panel, to develop the guidelines. RESULTS: The literature contains no evidence of the advantages of CPM over other techniques of mobilization, although CPM could be adjuvant therapy used to accelerate short-term recovery. However, in France, CPM remains widely used after TKA, both in orthopedic surgery units and in physical medicine and rehabilitation services. CONCLUSION: Good methodological quality studies are needed to assess different CPM modalities and compare them to alternative intermittent mobilization techniques, particularly those with therapy starting from a flexed position.

Froehlig P, Le Mouel S, Coudeyre E, Revel M, Rannou F. · Service de médecine physique et de réadaptation, CHRU de Strasbourg, hôpital de Hautepierre, avenue Molière, 67098 Strasbourg cedex, France. · Ann Readapt Med Phys. · Pubmed #18395285 No free full text.

Abstract: AIMS: To develop clinical practice guidelines for early mobilisation after total hip replacement (THR). METHOD: We used the French Society of Physical and Rehabilitation Medicine (Sofmer) methodology, which associates a systematic review of the literature, the collection of information regarding current clinical practice and external review by a multidisciplinary expert panel. RESULTS: Recommending early mobilisation after THR is not established by a review of the literature. A survey of French clinical practice allows for recommending early mobilisation in the context of complex hip issues. Trials with good methodology must be developed to evaluate the interest of early functional mobilisation corresponding to when patients first stand and take their first steps after surgery. These trials should focus mainly on the final pain, functional status, and reduction of handicap.

Paysant J, Jardin C, Biau D, Coudeyre E, Revel M, Rannou F. · Institut régional de médecine physique et de réadaptation, 75, boulevard Lobau, 54042 Nancy cedex, France. · Ann Readapt Med Phys. · Pubmed #18221816 No free full text.

Abstract: AIMS: To develop clinical practice guidelines for early mobilisation after total knee replacement (TKR). METHOD: We used the French Society of Physical and Rehabilitation Medicine (SOFMER) methodology, which associates a systematic review of the literature, collection of information regarding current clinical practice and external review by a multidisciplinary expert panel. RESULTS: A review of the literature and French clinical practice allow for recommending early mobilisation, at day 0, after TKR. This practice, with continuous passive motion, does not seem to increase the frequency of complications and seems to help with rapid recovery of the joint range of motion. Trials with good methodology must be developed to define the criteria for prescribing early mobilisation after TKR. These trials should focus mainly on joint range of motion but also on economical criteria (duration of hospitalisation, rehabilitation, physiotherapy, use of painkillers) and the satisfaction of the patient.

Genêt F, Mascard E, Coudeyre E, Revel M, Rannou F. · Service de médecine physique et de réadaptation, APHP, université Versailles-Saint-Quentin, groupe hospitalier Raymond-Poincaré, hôpital maritime de Berck, 92380 Garches, France. · Ann Readapt Med Phys. · Pubmed #17963973 No free full text.

Abstract: AIMS: To develop clinical practice guidelines for ambulatory physiotherapy for patients able to leave the surgery department directly for home just after total knee replacement (TKR). METHOD: We used the SOFMER (French Society of Physical and Rehabilitation Medicine) methodology, which associates a systematic revue of the literature, collection of information regarding current clinical practice and external review by a multidisciplinary expert panel. Main outcomes considered in the recommendations were impairment, disability, medico-economic implications and postoperative complications. RESULTS: The literature review did not allow for recommending systematic prescription of ambulatory physiotherapy for patients able to leave the surgery department directly for home just after TKR. However, this prescription could improve muscle strength and function but not mobility. When patients can return home directly after surgery, we recommend ambulatory physiotherapy as suggested by French clinical practice to increase function. CONCLUSION: Good methodological trials must be developed to define the criteria for prescribing ambulatory physiotherapy for patients able to return home just after total knee replacement (TKR) and to evaluate the content of the optimal program.

Coudeyre E, Lefevre-Colau MM, Griffon A, Camilleri A, Ribinik P, Revel M, Rannou F. · Centre de médecine physique et réadaptation Notre-Dame, BP 86, 4, avenue Joseph-Claussat, 63404 Chamalières cedex, France. · Ann Readapt Med Phys. · Pubmed #17498832 No free full text.

Abstract: OBJECTIVE: To develop clinical practice guidelines concerning predictive criteria for transfer of patients to a rehabilitation ward after hip and knee total arthroplasty. METHOD: The SOFMER (French Physical Medicine and Rehabilitation Society) methodology, associating a systematic literature review, collection of everyday clinical practice, and external review by a multidisciplinary expert panel, was used. RESULTS: From systematic literature review and collection of French professional practice, we cannot distinguish the patients undergoing THA and TKA who can transfer to a rehabilitation ward. For both types of patients, the main criteria determining transfer are demographic criteria such as older age or female sex; psychosocial and environmental criteria such as living alone, feeling unable to return home directly (pre-operative education could modify this criterion); and surgeon advice based on the pre and post-operative clinical and functional status. CONCLUSION: Studies with good methodological quality are urgently needed to evaluate the use of predictive tools such as the RAPT, separating THA and TKA, and using as parameters of assessment functional status and handicap reduction.

Coudeyre E, Jardin C, Givron P, Ribinik P, Revel M, Rannou F. · Centre de médecine physique et réadaptation Notre-Dame, 4, avenue Joseph-Claussat, BP 86, 63404 Chamalières cedex, France. · Ann Readapt Med Phys. · Pubmed #17343953 No free full text.

Abstract: OBJECTIVE: To develop clinical practice guidelines concerning preoperative rehabilitation for hip and knee total arthroplasty. METHOD: We used the SOFMER (French Physical Medicine and Rehabilitation Society) methodology, combining systematic literature review, collection of everyday clinical practice, and external review by a multidisciplinary expert panel, to develop the guidelines. Main outcomes considered in the recommendations were impairment, disability, medico-economic implications and postoperative complications. RESULTS: A preoperative rehabilitation program, comprising at least physical therapy and education, is recommended before total hip and knee arthroplasty. Occupational therapy could be combined with patient home visits. Isolated physical therapy before total knee arthroplasty (TKA) is not recommended. Multidisciplinary rehabilitation comprising at least occupational therapy and education is desirable for the most fragile patients because of major disability, co-morbidity or social problems. Complementary studies are required to confirm the impact of pre-operative rehabilitation before total hip and knee arthroplasty, to define components of rehabilitation and the patients most likely to benefit. CONCLUSION: Rehabilitation before total hip and knee arthroplasty contributes to reduced hospital length of and modifying discharge conditions. This rehabilitation necessitates the collaboration of qualified health care professionals in the educational topic and return-home preparation. Preoperative patient assessment is important.

Coudeyre E, Jardin C, Givron P, Ribinik P, Revel M, Rannou F. · Centre de médecine physique et réadaptation Notre-Dame, BP 86, 4, avenue Joseph-Claussat, 63404 Chamalières cedex, France. · Ann Readapt Med Phys. · Pubmed #17343952 No free full text.

This publication has no abstract.

Rannou F, Coudeyre E, Ribinik P, Macé Y, Poiraudeau S, Revel M. · Service de rééducation, APHP, université René-Descartes, groupe hospitalier Cochin, 27, rue du faubourg-Saint-Jacques, Paris 75014, France. · Ann Readapt Med Phys. · Pubmed #17306408 No free full text.

Abstract: OBJECTIVE: The development of a rigorous methodology based on published results of clinical trials, evaluation of daily practice in France and multidisciplinary expert opinion to elaborate recommendations for rehabilitation interventions. METHODS AND RESULTS: The following describes the methodology of SOFMER (Société Française de Médecine Physique et de Réadaptation [French Society of Physical Medicine and Rehabilitation]) for developing recommendations for rehabilitation interventions. The test case was developing recommendations for rehabilitation in hip or knee osteoarthritis (OA) and hip or knee arthroplasty. Physicians in rehabilitation, orthopedic surgery and rheumatology identified, synthesized, and analyzed data from the literature by use of the usual French system of grading trials (the French Agency for Accreditation and Evaluation in Healthcare [ANAES] scale). The data were published results of comparative controlled studies such as randomized controlled trials, controlled clinical trials, cohort studies, case control studies, reviews of clinical trials, and case series, as well as uncontrolled cohort studies. The resulting recommendations were presented to the three annual French national congresses of rehabilitation, rheumatology, and orthopedic surgery for comment and for adapting to French professional practice. Finally, a panel of multidisciplinary experts (physicians in physical medicine and rehabilitation, rheumatologists, orthopedic surgeons, general practitioners, physical therapists, social workers, podologists, occupational therapists, nurses, and patients) validated the recommendations. CONCLUSION: The SOFMER methodology could be an interesting tool for use in developing recommendations elaborated by all the concerned medical and surgical specialists in the wide domain of rehabilitation.

Boutron I, Rannou F, Jardinaud-Lopez M, Meric G, Revel M, Poiraudeau S. · INSERM, U738, Paris, France. · Osteoarthritis Cartilage. · Pubmed #18276169 No free full text.

Abstract: OBJECTIVE: To assess disability and health-related quality of life (HRQoL) of patients with knee or hip OA in primary care and to determine factors associated with GPs' opinion that their patients will need prosthetic replacement within 1 year after the consultation. METHODS: Design: A cross-sectional national survey. Setting: Primary care in France. Participants: 1471 GPs and 4183 patients with hip or knee OA. Measures: Pain on an 11-point numeric scale (0-10), disability on the Western Ontario and MacMaster Universities Osteoarthritis Index (WOMAC) (1-100) and Lequesne index (0-24), and quality of life on the Medical Outcomes Study 36-item Short Form (MOS SF-36; 0-100). RESULTS: We analyzed records of 4121 patients (2540 knee, 1581 hip OA). Patients with knee or hip OA exhibited high and similar levels of pain (5.2+/-2.1 and 5.3+/-2.3) and disability (Lequesne score: 12.0+/-4.2 and 11.8+/-4.3; WOMAC score: 45.7+/-19.3 and 45.2+/-17.3) The decrease in HRQoL was similar for patients with either location of the disease. GPs more often considered that their patients with hip OA would need prosthetic replacement within 1 year (28.1%) than those with knee OA (15.8%). Most factors associated with GPs' opinion were identified for both locations of disease and were related to disability and pain levels. CONCLUSIONS: In the primary care setting, patients with knee or hip OA have similar, high disability levels and substantially low HRQoL. Patients' disability seems to play a central role in GPs' opinion of the need for their patients with either type of OA to undergo prosthetic replacement within 1 year.

Genêt F, Gouin F, Coudeyre E, Revel M, Rannou F. · Service de médecine physique et de réadaptation, APHP, université Versailles-Saint-Quentin, groupe hospitalier Raymond-Poincaré, hôpital Maritime-de-Berck, 104, boulevard Raymond-Poincaré, 92380 Garches, France. · Ann Readapt Med Phys. · Pubmed #17963972 No free full text.

Abstract: AIM: To develop clinical practice guidelines for prescribing ambulatory physiotherapy for patients able to leave the surgery department directly for home just after total knee replacement (THR). METHOD: We used the SOFMER (French Society of Physical and Rehabilitation Medicine) methodology, which associates a systematic revue of the literature, collection of information regarding current clinical practice and external review by a multidisciplinary expert panel. Main outcomes considered in the recommendations were impairment, disability, medico-economic implications and postoperative complications. RESULTS: The literature review results showed some advantage for programs of ambulatory physiotherapy for patients able to return home just after total hip replacement. The main outcomes ameliorated are muscle strength and function. However, studies were methodologically limited. When the patient can return home directly from the surgery department, we recommend ambulatory physiotherapy as suggested by French clinical practice. The program and number and objectives of the ambulatory rehabilitation must be defined in future trials with good methodology. No difference in cost was found if home therapy is used.

Barrois B, Ribinik P, Gougeon F, Rannou F, Revel M. · Service de MPR, centre hospitalier de Gonesse, 25, rue Pierre-de-Theilley, BP 30071, 95503 Gonesse cedex, France. · Ann Readapt Med Phys. · Pubmed #17959266 No free full text.

Abstract: OBJECTIVES: To develop clinical practice guidelines concerning the interest of post-operative rehabilitation in physical medicine and functional rehabilitation (PMR) ward after total knee arthroplasty (TKA). METHOD: The SOFMER (French Physical Medicine and Rehabilitation Society) methodology, associating a systematic literature review, collection of everyday clinical practice, and external review by a multidisciplinary expert panel, was used. Main outcomes were impairment, disability, medico-economic implications and postoperative complications. RESULTS: Post-operative rehabilitation in a PMR ward after TKA is recommended for patients because of preoperative joint stiffness, and/or associated co-morbidities. The other parameters used by French physician for post-operative rehabilitation in a PMR ward after TKA are: the self-governing of the patient at home, the wishes of the patient and the opinion of the surgeon on the post-operative functional evolution of the patients. For patients in whom sustained rehabilitation is not necessary but who cannot return home, a stay in a non-specific (non-PMR) post-operative centre could be recommended. Post-operative rehabilitation in a PMR ward after TKA could reduce the length of stay in a surgical ward and increase the functional status of patients with co-morbidities. Studies with good methodological quality are needed to evaluate the cost/benefit ratio in the French health care system. CONCLUSION: This study suggests a value of rehabilitation in a PMR ward after TKA, but good methodological quality studies are needed to evaluate the cost/benefit ratio of rehabilitation in a PMR ward after TKA in the French health care system.

Boutron I, Poiraudeau S, Ravaud P, Baron G, Revel M, Nizard R, Dougados M, Ravaud JF. · National Institute of Statistics and Economic Studies (INSEE), Paris, France. · J Rheumatol. · Pubmed #15088304 No free full text.

Abstract: OBJECTIVE: To describe and compare participation restrictions and environmental factors of persons with and without hip or knee arthroplasty in a national community based survey: the Handicap, Disability, Dependence Survey. METHODS: During the 1999 French Census, a screening questionnaire was proposed to 417,500 persons, for which the response rate was 86%. A stratified random sample with an overrepresentation of disabled persons was performed to constitute the selected population. A computer assisted interview was proposed to 21,760 persons, with a 78% response rate. Chronic conditions, impairment, disability, participation restrictions, and the description of environmental factors were ascertained from the subjects' reports. RESULTS: The hip and knee arthroplasty group was estimated at 691,000 persons in the French population. Although reporting a higher level of disability, this population did not report more participation restrictions than the general population in terms of their economic situation, housing, social relationships, and holidays. Moreover, when comparing environmental factors, this population reported better housing accessibility, more assistive devices (OR 5.2, 95% CI 3.7-7.2), specific fittings (OR 2.9, 95% CI 2.0-4.2), and helpers (OR 1.8, 95% CI 1.3-2.5). These environmental factors may have compensated for the higher level of disability. Nevertheless, individuals with hip and knee arthroplasty reported more disadvantages when moving within their environment (OR 2.1, 95% CI 1.5-2.9). CONCLUSION: This study provides a detailed description based on a national random sample of participation restrictions and environmental factors of adults with hip and knee arthroplasty.

Boutron I, Poiraudeau S, Ravaud JF, Baron G, Revel M, Nizard R, Dougados M, Ravaud P. · Département de Médecine Physique et de Réadaptation, Hôpital Cochin (AP-HP), Université R Descartes, 75014 Paris, France. · Ann Rheum Dis. · Pubmed #12860730 links to  free full text

Abstract: OBJECTIVES: To compare levels of disability of people with and without hip and knee arthroplasty in a random national sample. METHODS: In 1999 a screening questionnaire to classify people into groups of increasing probabilities of disability was sent to 417 500 people; response rate 86%. The study population was obtained by a stratified randomisation, with a high sampling rate for the most severely disabled group and a minimum sampling rate for people without daily living restrictions. A computer assisted interview to assess levels of disability, dependence, and handicap was given to 21 760 people; response rate 78%. A weighting factor was applied to obtain estimates representative of the French population. The presence of chronic conditions, impairments, and disability was ascertained from the subjects' reports. RESULTS: The hip and knee arthroplasty group comprised 815 subjects in the sample, indicating an estimated 691 000 subjects (95% confidence interval (CI) 597 000 to 785 000) in the French non-institutionalised population. The prevalence of arthroplasty is estimated at 1.2%. After adjustments for confounding factors, activity limitations were greater among subjects with arthroplasty for the following activities: climbing stairs (odds ratio (OR)=4.0, 95% CI 2.8 to 5.8); walking distance (OR=3.4, 95% CI 2.5 to 4.6 for a walking distance less than 500 m); bending forward (OR=3.2, 95% CI 2.2 to 4.7); cutting toenails (OR=2.8, 95% CI 1.9 to 3.9); carrying (OR=2.6, 95% CI= 1.8 to 3.8); shopping (OR=2.1, 95% CI 1.5 to 2.9). CONCLUSIONS: This study would be useful to policy-makers considering population strategies for managing disabling arthritis.