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- Digital Versus Conventional Rehabilitation After Total Hip Arthroplasty: A Single-Center, Parallel-Group Pilot StudyPublication . Dias Correia, Fernando; Nogueira, André; Magalhães, Ivo; Guimarães, Joana; Moreira, Maria Excelsa; Barradas, Isabel; Molinos, Maria; Teixeira, Laetitia; Pires, Joaquim; Seabra, Rosmaninho; Lains, Jorge; Bento, VirgílioBackground: The demand for total hip arthroplasty (THA) is rising. In the face of rapidly increasing health care costs, ensuring widespread, cost-effective rehabilitation is a priority. Technologies allowing independent home-based rehabilitation may be the key to facilitate access, improve effectiveness, and lower costs of care. Objective: The aim of this study was to assess the feasibility of a novel artificial intelligence-powered digital biofeedback system following THA and compare the clinical outcomes against supervised conventional rehabilitation. Methods: This was a single-center, parallel-group pilot study, with an 8-week intervention program. Patients were assessed at baseline, during the program (at 4 and 8 weeks), and 3 and 6 months after surgery. The primary outcome was the Timed Up and Go (TUG) score and secondary outcomes were the Hip dysfunction and Osteoarthritis Outcome Scale (HOOS; a patient-reported outcome) and hip range of motion (ROM). Results: A total of 66 patients were included: 35 digital physiotherapy (PT) versus 31 conventional. There were no differences at baseline between groups except for lower HOOS quality of life (QoL) subscale scores in the digital PT group. Clinically relevant improvements were noted in both groups at all time points. The digital PT group showed a retention rate of 86% (30/35). Per-protocol analysis revealed a superiority of the digital PT group for all outcome measures. Intention-to-treat analysis revealed the superiority of the digital PT group at all time points for TUG (change between baseline and 4 and 8 weeks: P<.001; change between baseline and 3 and 6 months: P=.001 and P=.005, respectively), with a difference between median changes of -4.79 seconds (95% CI -7.24 to -1.71) at 6 months post-THA. Between baseline and month 6, results were also superior in the digital PT group for the HOOS sports and QoL subscales and all ROM except for standing flexion. Conclusions: This study demonstrates this novel solution holds promise in rehabilitation after THA, ensuring better clinical outcomes than conventional rehabilitation while reducing dependence on human resources.
- Medium-Term Outcomes of Digital Versus Conventional Home-Based Rehabilitation After Total Knee Arthroplasty: Prospective, Parallel-Group Feasibility StudyPublication . Dias Correia, Fernando; Nogueira, André; Magalhães, Ivo; Guimarães, Joana; Moreira, Maria Excelsa; Barradas, Isabel; Molinos, Maria; Teixeira, Laetitia; Tulha, José; Seabra, Rosmaninho; Lains, Jorge; Bento, VirgílioBackground: Physical rehabilitation is recommended after total knee arthroplasty (TKA). With the expected increase in TKA over the next few decades, it is important to find new ways of delivering cost-effective interventions. Technological interventions have been developed with this intent, but only preliminary evidence exists regarding their validity, with short follow-up times. Objective: This study aimed to present the follow-up results of a feasibility study comparing two different home-based programs after TKA: conventional face-to-face sessions and a digital intervention performed through the use of an artificial intelligence-powered biofeedback system under remote clinical monitoring. Methods: The digital intervention uses a motion tracker allowing 3D movement quantification, a mobile app and a Web portal. This study presents the results of the previous single-center, prospective, parallel-group, feasibility study including an 8-week active treatment stage and further assessments at 3 and 6 months post-TKA. Primary outcome was the Timed Up and Go score, and secondary outcomes were the Knee Osteoarthritis Outcome Scale (KOOS) score and knee range of motion. Results: A total of 59 patients completed the study (30 in the digital intervention group and 29 in the conventional rehabilitation group) and follow-up assessments. During the active treatment stage, patients in the digital intervention group demonstrated high engagement and satisfaction levels, with an 82% retention rate. Both groups attained clinically relevant improvements from baseline to 6 months post-TKA. At the end of the 8-week program, clinical outcomes were superior in the digital intervention group. At the 3- and 6-month assessments, the outcomes remained superior for the Timed Up and Go score (P<.001) and all KOOS subscale scores (at 3 months, P<.001 overall; at 6 months, KOOS Symptoms: P=.006, Pain: P=.002, Activities of Daily Living: P=.001, Sports: P=.003, and Quality of Life: P=.001). There was progressive convergence between both groups in terms of the knee range of motion, which remained higher for standing flexion in the digital intervention group than the conventional group at 6 months (P=.01). For the primary outcome, at 6 months, the median difference between groups was 4.87 seconds (95% CI 1.85-7.47), in favor of the digital intervention group. Conclusions: The present study demonstrates that this novel digital intervention for independent home-based rehabilitation after TKA is feasible, engaging, and capable of maximizing clinical outcomes in comparison to conventional rehabilitation in the short and medium term; in addition, this intervention is far less demanding in terms of human resources.
- SINAS: Effective Impact in the Quality Improvement of Ambulatory Surgery at an Ambulatory CentrePublication . Castro Alves, Eurico; Correia, Teresa; Brandão, Pedro; Teixeira, Laetitia; Povo, AnaIntroduction: The National Health Assessment System is a system designed by the Portuguese Health Regulatory Entity in order to evaluate the overall quality of the health care institutions. One of the key areas evaluated by the National Health Assessment System is ambulatory surgery. The aim of this study is to demonstrate that the introduction of the National Health Assessment System evaluation at our ambulatory centre not only improved the overall quality of ambulatory surgery but also the quality of the clinical record entries. Material and methods: A retrospective analysis was performed from the hospital's clinical database. The study was carried out at the ambulatory centre of the Hospital and University Centre of Porto, and included 100 consecutive surgical procedures, across all surgical specialties, previously selected by the National Health Assessment System audit performed in 2015 in our ambulatory surgery centre and other 46 surgical procedures performed in 2008 at our hospital, before the National Health Assessment System was implemented. The main outcome measure was the validation and record of the seven indicators of National Health Assessment System for ambulatory surgery. Results: We have seen an improvement in all indicators after the National Health Assessment System implementation, except for criterion 4. Discussion: Our study demonstrates that the introduction of the National Health Assessment System in our ambulatory centre resulted in the improvement in the quality of both of clinical practice, and clinical record keepingConclusion: We can conclude that the application of evaluation of quality indicators and benchmarking practices can be used to enhance healthcare outcomes.