Recovery And The Use Of Postoperative Physical Therapy After Total Hip Or Knee Replacement

Background: To investigate the relation between recovery and postoperative physical therapy (PT) usage, including the presence of comorbidities, 6 months after total hip or knee arthroplasties (THA/TKA). Methods: Multicenter, observational study in primary THA/TKA patients who completed preoperative and 6 months postoperative assessments. The assessments included questions on PT use (yes/no and duration; long term use defined as ≥12 weeks), comorbidities (musculoskeletal, non-musculoskeletal, sensory comorbidities). Recovery was assessed with the HOOS/KOOS on all 5 subdomains. Logistic regression with long term PT as outcome was performed adjusted for confounding including an interaction term (comorbidity*HOOS/KOOS-subdomain).Results: In total, 1289 THA and 1333 TKA patients were included, of whom 95% received postoperative PT, 56% and 67% received postoperative PT ≥12 weeks respectively. In both THA and TKA group, less improvement on all HOOS/KOOS domain scores was associated with ≥12 weeks of postoperative PT (range Odds Ratios 0.97-0.99). In the THA group the impact of recovery was smaller in patient with comorbidities as non- musculoskeletal comorbidities modified all associations between recovery and postoperative PT duration (Odds Ratios range 1.01-1.05). Musculoskeletal comorbidities modified the associations between Function-in-Daily-Living-and Sport-and-recreation recovery and postoperative PT. Sensory comorbidities only had an effect on Sport-and-recreation recovery and postoperative PT. In the TKA group comorbidity did not modify the associations. Conclusion: Worse recovery was associated with longer duration of postoperative PT suggesting that PT provision is in line with patients’ needs. The impact of physical recovery on the use of long-term postoperative PT was smaller in THA patients with comorbidities. Trial registration: Registered in the Dutch Trial Registry on March 13, 2012. TRIAL ID NTR3348; registration number: P12.047. https://www.trialregister.nl/trial/3197.

Biomarkers of Length of Stay On An Inpatient Eating Disorder Unit For Treatment of Anorexia Nervosa in Females

Background. Length of stay on an inpatient unit for treatment of anorexia nervosa (AN) is widely variable. Although previous research has used anthropometric and clinical variables and duration of illness to predict length of stay, there has been limited investigation of the predictive ability of biomarkers. Biomarkers, including those collected through a comprehensive metabolic panel (CMP) and appetite hormones, such as ghrelin and leptin, are impacted by disease presence and may play an etiological role in AN. Methods. Using a series of regression models, we retrospectively evaluated the associations of these putative biomarkers at admission with length of inpatient stay in 59 females receiving treatment on an inpatient eating disorder unit for anorexia nervosa. Results. Both lower levels of magnesium and higher active ghrelin levels at inpatient admission predicted length of stay. Conclusions. This research provides further evidence supporting both biological and psychological components of AN, identifying potential biomarkers that could aid in prospective prediction of treatment needs. Ghrelin monitoring throughout inpatient stays may aid clinicians in better predicting physical recovery and renourishment from AN and prepare for stepdown from an inpatient setting. Further research is necessary to replicate and extend these findings across treatment settings.

Decolonizing Healing Through Indigenous Ways of Knowing

The field of psychology is embarking on a process to interrupt the historical, colonial cycle of harm and beginning to work with and alongside Indigenous communities to understand the healing journey. From an Indigenous lens, healing incorporates more than the physical recovery; physical, emotional, mental, and spiritual healing exists through learning, which occurs along the healing journey. This healing journey has no definite beginning or end, and as we begin to move away from pathologizing healing to a strength-based healing process, the focus shifts to relationships—relationships with self, community, more-than-human, and the land. This chapter proposes that to decolonize Western healing processes, as a field, we must acknowledge the coexistence of learning during the healing journey. Building healing capacity through learning elucidates the understanding of the past, the needs of the present, and lays foundations for the future to work towards restoring integrity and prompting balanced care.

COVID-19 recovery: benefits of multidisciplinary respiratory rehabilitation

Many patients struggle with ongoing symptoms in different domains (physical, mental, cognitive) after hospitalisation for COVID-19, calling out for a multidisciplinary approach. An outpatient multidisciplinary rehabilitation programme, according to a respiratory rehabilitation strategy, was set up for adult patients who were able to attend group sessions during 12 weeks. Results of 22 adult patients with COVID-19, of which 15 had required intensive care, were analysed and some general impressions and challenges of rehabilitation in COVID-19 were reported. Impressive results on physical recovery were determined after 6 weeks and 3 months, with significant improvement of lung function, muscle force and exercise capacity variables. A positive evolution of mental and cognitive burden was present, although less pronounced than the physical recovery. These mental and cognitive consequences seem, next to musculoskeletal and medical complications, the most challenging aspect of rehabilitating patients with COVID-19. These real-world data show feasibility and efficiency of a multidisciplinary respiratory rehabilitation programme after moderate to severe COVID-19 disease.