M A Ruiz Iban1, A Tejedor2, E Gil Garay3, C Revenga4, J C Hermosa2, J Montfort5, M J Peña6, J M López Millán7, A Montero Matamala8, A Capa Grasa9, M J Navarro10, M Gobbo11, E Loza12. 1. Servicio Traumatología y Cirugía Ortopédica, Hospital Universitario Ramón y Cajal, Madrid, España. 2. Especialista en Medicina Familiar y Comunitaria, CS Las Ciudades, Getafe, Madrid, España. 3. Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario La Paz, Madrid, España. 4. Servicio de Traumatología y Cirugía Ortopédica, Hospital San Juan Grande, Jerez de la Frontera, Cádiz, España. 5. Servicio de Reumatología, Hospital del Mar, Barcelona, España. 6. Responsable de Enfermería de Atención Primaria del sector II, Zaragoza, España. 7. Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario Virgen Macarena, Sevilla, España. 8. Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitari Arnau de Vilanova, Lleida, España. 9. Servicio de Medicina Física y Rehabilitación Médica, Hospital Universitario La Paz, Madrid, España. 10. Servicio de Medicina Física y Rehabilitación Médica, Hospital Universitario Doctor Peset, Valencia, España. 11. Positivamente Centro de Psicología, Madrid, España. 12. Instituto de Salud Musculoesquelética, Madrid, España. Electronic address: estibaliz.loza@inmusc.eu.
Abstract
OBJECTIVE: To develop recommendations on the evaluation and management procedure in patients undergoing total knee replacement based on best evidence and the experience of a panel of experts. METHODS: A multidisciplinary group of 12 experts was selected that defined the scope, users and the document parts. Three systematic reviews were performed in patients undergoing knee replacement: (i)efficacy and safety of fast-tracks; (ii)efficacy and safety of cognitive interventions in patients with catastrophic pain, and (iii) efficacy and safety of acute post-surgical pain management on post-surgical outcomes. A narrative review was conducted on the evaluation and management of pain sensitization, and about the efficacy and safety of pre-surgical physiotherapy. The experts generated the recommendations and explicative text. The level of agreement was evaluated in a multidisciplinary group of 85 experts with the Delphi technique. The level of evidence was established as well for each recommendation. RESULTS: A total of 20 recommendations were produced. An agreement higher than 80% was reached in all of them. We found the highest agreement on the need for a full discharge report, on providing proper information about the process and on following available guidelines. CONCLUSIONS: There is consensus among professionals involved in the management of patients undergoing total knee replacement, in that it is important to protocolize the replacement process, performing a proper, integrated and coordinated patient evaluation and follow-up, paying special attention to the surgical procedure and postoperative period.
OBJECTIVE: To develop recommendations on the evaluation and management procedure in patients undergoing total knee replacement based on best evidence and the experience of a panel of experts. METHODS: A multidisciplinary group of 12 experts was selected that defined the scope, users and the document parts. Three systematic reviews were performed in patients undergoing knee replacement: (i)efficacy and safety of fast-tracks; (ii)efficacy and safety of cognitive interventions in patients with catastrophic pain, and (iii) efficacy and safety of acute post-surgical pain management on post-surgical outcomes. A narrative review was conducted on the evaluation and management of pain sensitization, and about the efficacy and safety of pre-surgical physiotherapy. The experts generated the recommendations and explicative text. The level of agreement was evaluated in a multidisciplinary group of 85 experts with the Delphi technique. The level of evidence was established as well for each recommendation. RESULTS: A total of 20 recommendations were produced. An agreement higher than 80% was reached in all of them. We found the highest agreement on the need for a full discharge report, on providing proper information about the process and on following available guidelines. CONCLUSIONS: There is consensus among professionals involved in the management of patients undergoing total knee replacement, in that it is important to protocolize the replacement process, performing a proper, integrated and coordinated patient evaluation and follow-up, paying special attention to the surgical procedure and postoperative period.
Authors: Anna M Anderson; Christine Comer; Toby O Smith; Benjamin T Drew; Hemant Pandit; Deborah Antcliff; Anthony C Redmond; Gretl A McHugh Journal: BMC Musculoskelet Disord Date: 2021-04-14 Impact factor: 2.362