ARTHROPLASTY
Telemedicine support shortens length of stay after fast-track hip replacement
This report has been verified
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. 2017;5(18):1 Acta Orthop. 2017 Feb;88(1):41-4773 patients scheduled for fast-track total hip arthroplasty were randomized to a telemedicine intervention for use after scheduled discharge on postoperative day one, or to a standard pathway with training and rehabilitation on postoperative day one, and discharge on postoperative day two. Patients were assessed for mean length of stay, health-related quality-of-life, function, and readmission rate. Results demonstrated a significantly shorter length of stay in the telemedicine group compared to the control group. Health-related quality-of-life, function, and readmission rate over the 12-month follow-up were similar between groups
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。
2/4
Randomization
2/4
Outcome Measurements
3/4
Inclusion / Exclusion
3/4
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？
The number of total hip arthroplasty procedures performed per year is expected to increase with the aging population. This has placed pressure on health care systems to improve efficiency, making fast-track procedures an attractive option. While some trials have demonstrated the efficacy of fast-track techniques the addition of telemedicine during the early postoperative period could allow for earlier discharge from the hospital. However, the effect of earlier discharge and the addition of telehealth medicine on quality of life outcomes and safety has yet to be assessed in rigorous clinical trials.
主な研究課題は何ですか？
In fast-track total hip arthroplasty, does a telemedicine intervention have a significant effect on length of stay, health-related quality-of-life, function, anxiety, or re-admission rate when compared to a standard fast-track postoperative program?
重要な知見は？
- Length of stay was significantly shorter in the telemedicine group compared to the control group (MD; -0.72 days [95%CI -1.02, -0.42]; p<0.001).
- Discharge home on the first postoperative day occurred in 34/36 patients of the telemedicine group. Discharge home on the first postoperative day occurred in 8/36 in the control group, and on the second postoperative day in 26/36 day.
- There was no significant difference in change in EQ-5D-3L scores after 12 months between groups (MD -0.01 [95%CI -0.063, 0.036]; p=0.6).
- There was no significant difference between groups in change in OHS after 12 months (MD 0.39 [95%CI -2.1, 2.9]; p=0.8), or change in TUG test results after 12 months (MD 0.6 seconds [95%CI -0.05, 1.26]; p=0.07).
- There were no significant differences between groups in the number of extra visits to the hospital (p=0.4) or in the number of readmissions (p=0.3). There were significantly fewer calls placed among patients of the telemedicine (0.92 [95%CI 0.56-0.73]) compared to the control group (1.5 [95%CI 1.1-1.9]) (p=0.04).
最も覚えておくべきことは？
In patients undergoing fast-track total hip arthroplasty, the implementation of a telemedicine system allowed for a higher rate of patients discharged on the first postoperative day when compared to a standard postoperative program with training and rehabilitation on the first postoperative day. Similar improvements in health-related quality-of-life, function, and anxiety were noted over the 12-month follow-up.
それが私の患者ケアにどのように影響するか？
The results of this study suggest that the implementation of a telemedicine could be beneficial in fast-track total hip arthroplasty pathways to allow for earlier discharge, along with similar quality-of-life and functional outcome to that achieved by a standard fast-track pathway which use the first postoperative day to implement training of rehabilitation prior to discharge.
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