PHYSICAL THERAPY & REHAB
The Influence of Early Weight-Bearing Compared with Non-Weight-Bearing After Surgical Repair of the Achilles Tendon
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by one or more authors of the
original publication.
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これにより、臨床的に意義のある研究をより早く認識することが可能になり、読者は将来の診療を形成する可能性が最も高い論文に集中することができます。
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(3):51 J Bone Joint Surg Am. 2008 Sep;90(9):1876-83Exclusive Author Interview
Dr. Beaupre on Early Weight-Bearing after Surgical Repair of the Achilles Tendon.
110 patients (ages of 17-70 years) after undergoing a surgical repair for Achilles tendon rupture were kept non-weight-bearing for the first two weeks after surgery. Subsequently, they were randomized to be kept either weight-bearing or non-weight-bearing for an additional four weeks. Early weight-bearing at 2 weeks following surgical repair of an acute Achilles tendon rupture improved the health-related quality of life in the early postoperative period with no consequential detrimental effect on the overall recovery process.
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
はい = 1
不確実＝0.5
無関係 = 0
いいえ = 0
報告基準評価では、著者が出版物内で試験の方法論的特徴や試験特性を報告する際の透明性を評価します。評価は以下の5つのカテゴリーに分類されます。
3/4
Randomization
3/4
Outcome Measurements
4/4
Inclusion / Exclusion
4/4
Therapy Description
4/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
Fragility Indexは、重要な所見の解釈を助けるツールで、結果の強さの尺度を提供します。Fragility Indexは、その所見が有意でなくなるために、二項対立の結果に追加する必要がある連続した事象の数を表します。数値が小さいほど弱い所見を表し、数値が大きいほど強い所見を表します。
なぜ今この研究が必要なのですか？
Achilles tendon rupture is a common condition, often managed with open surgical repair. The importance of post-operative rehabilitation can't be over emphasized. The study was conducted, as the the optimal rehabilitation protocol post surgical repair of an Achilles tendon rupture was not well outlined.
主な研究課題は何ですか？
Does the early weight-bearing translates into quicker postoperative recovery following repair of an acutely ruptured Achilles tendon in comparison to non-weight bearing?
重要な知見は？
- At 6 weeks, the weight-bearing group had significantly better scores in RAND-36 domains of physical functioning, social functioning, role-emotional and vitality scores, than the non-weight-bearing group (p<0.05). Also, the weight-bearing group reported fewer limitations of daily activities (p < 0.001).
- 89% (98/109) patients completed the 6-month follow-up
- At 6 months, no significant differences between the groups were seen in any of the outcome measures, although both groups had poor endurance of the calf musculature.
- No re-rupture reportedly occurred in either group at 6 month follow up.
最も覚えておくべきことは？
Early weight-bearing at 2 weeks following surgical repair of an acute Achilles tendon rupture improved the health-related quality of life in the early postoperative period with no consequential detrimental effect on the overall recovery process.
それが私の患者ケアにどのように影響するか？
In the light of this study's findings, this protocol of early weight bearing should be recommended for adoption, as the new standard of care for carefully selected group of patients. Further research with larger sample sizes is needed.
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