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Pre op Rehabilitation in Hip/Knee OA

Pre op Rehabilitation in Hip/Knee OA. Deborah Earl Deputy Manager, Physiotherapy MSc Hons, MCSP, HCPC. OVERVIEW Role of physiotherapy in the pre operative phase Treatment modalities Case Study Current evidence Parkside hydro dept. WHAT IS PREHABILITATION?.

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Pre op Rehabilitation in Hip/Knee OA

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  1. Pre op Rehabilitation in Hip/Knee OA Deborah Earl Deputy Manager, Physiotherapy MSc Hons, MCSP, HCPC

  2. OVERVIEWRole of physiotherapy in the pre operative phase Treatment modalities Case Study Current evidence Parkside hydro dept

  3. WHAT IS PREHABILITATION? “Prehabilitationis the process of optimizing physical functionality preoperatively to enable the individual to maintain a normal level of function during and after surgery”

  4. KEY AIMS OF PREHABILITATIONPain management Improvement of biomechanics Strengthening of key muscle groupsStretching of tight musclesEducation and mental preparationGuidance re:weightreduction/maintenance of CV fitness

  5. ROLE OF PHYSIOTHERAPY: PREHABILITATION

  6. CASE STUDY65 yr old female3 yr Hx of knee painXR: severe medial knee OAWalking distance ↓ to 10 minsPSFS score: 4/20Surgeon has recommended TKR but due to treatment for unrelated condition postponed for 6 months

  7. OBJECTIVEKnee valgus General joint swellingLoss of last 10 degrees extensionPoor footwearTight gastrocPoor inner range quads strength

  8. TREATMENTEducation!Referral for bracing optionsAdvice on weight managementHome Exercise ProgrammeFootwear adviceManual therapy calf, ankle, hams

  9. OUTCOME (5sessions)Walking tolerance ↑ to 45 minsKnee extension 0 degreesPSFS score ↑ 12/20 Pt reports ↑ confidence and feels ‘mentally ready’ for surgery when it happens

  10. RESEARCH EVIDENCE Good level of evidence that…..1. Prehab improves function even in the most severely compromised patients with OA 2. Prehab ↓ post op pain levels and ↑ function in pts undergoing TKR/THR3. Pre-op education useful in managing pts expectations post TKR/THR

  11. TAKE HOME MESSAGESPhysio referral for pts who are listed for/are considering TKR/THRAdvice re: weight management, maintaining mobilityLook out for more complex cases

  12. PART 2: HYDROTHERAPY

  13. HYDROTHERAPY AT PARKSIDE

  14. OUR POOL 5.4m x 4.3m poolAverage temp: 34-36°cDeep end 1.3mShallow end 1.1m9 hydrotherapy trained physiosHuge variation in pts: orthopaedics, neuro, oncology, rheumatologySelf help group sessions

  15. BENEFITSPain reliefJoint mobilisationRelaxationReduction in mm spasmReduction in oedemaGait re-education/WB statusImprove CV fitness

  16. HYDROSTATICSImmersed object is subject to opposing forcesBuoyancyDepth of water (s2 level: 50% WB, T11 level: 30% WB, C7 level: 10% WB)Therapeutic effects of heat

  17. PRE AND POST OP PATIENTS May use for pre op patientsAlways use for post op TKR/THR from day 2 for duration of stayContinued use for 2-3/52 post opHip/knee classOther conditions: rheumatology, trauma, neuro

  18. TYPES OF EXERCISE

  19. OTHER SERVICESMLD therapyMassage Neuro specialistsHand therapyBike fit axWomens health TMJ specialistPilates classes

  20. THANK YOU!

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