Process of Posthospital Care Involving Telemedicine Solutions for Patients after Total Hip Arthroplasty
Abstract
:1. Introduction
- 389,642 THA (63.09% of all joint replacement)—in Poland;
- 625,097 THA (33.3% of all joint replacement)—in USA.
- In total, in 91% of cases result from primary bilateral coxarthrosis (M16.0), femoral neck fracture (S72.0) or other primary coxarthrosis (M16.1);
- In total, arthroplasty occurs in 87% of cases;
- Women represent over 57% of implants.
2. Materials and Methods
2.1. Research Process Diagram
2.2. Literature Search
- (A) What is the process of post-hospital care for patients after THA in Poland and in the world? (B) What telemedicine technologies are used in post-hospital care?
- How does the use of telemedicine technologies affect the effectiveness of post-hospital care for patients after THA?
- What is the opinion of patients and staff about telemedicine technologies used in post-hospital care after THA?
2.3. Data Collection Methods in Our Empirical Research
2.3.1. Participant Observation
2.3.2. Structured Interviews
- to determine the general stages of posthospital care in everyday clinical practice in a Polish hospital specializing in THA and providing outpatient specialist care in the field of trauma and orthopedic surgery;
- to define knowledge on example telemedicine tools possible to be used in patient care processes;
- to define causes and consequences of possible postoperative complications;
- to define disadvantages of the current posthospital care process.
2.3.3. Ethical Considerations
2.4. Previous Attempts to Develop a More Modern Version of Patient Care Process after Hip Arthroplasty
2.4.1. Analysis of Posthospital Care Recommended by AOTMiT in the Report on Comprehensive Patient Care in Hip Arthroplasty
2.4.2. Characteristics of Telerehabilitation before and after Hip and Knee Arthroplasty within CLEAR Project
- The patient uses at home videos with exercises selected for him by the therapist;
- The patient uses the phone application with exercises selected for him by the therapist;
- The therapist tracks the patient’s exercises on an ongoing basis through video consultation;
- The therapist follows the patient’s exercise performance on an ongoing basis via the internet platform.
- Patients with neurological diseases—research team from Spain;
- Patients with lung diseases and chronic pain—a research team in the Netherlands;
- Patients after a stroke—a research team in Italy;
- Patients with osteoarthritis of the hip and knee joints—research team in Poland.
2.5. Characteristics of Hybrid Cardiac Telerehabilitation
- An initial visit to the doctor: examination, ECG and exercise test or an ergospirometry test or a six-minute walk test, planning training loads, including the range of the training heart rate and qualification for the appropriate model of HCTR;
- Five days of visits to the outpatient clinic (two to three h each): educational meetings, learning how to use telerehabilitation equipment, learning exercises, dietician’s consultation, psychologist’s consultation, training sessions and lectures on the validity of rehabilitation and a healthy lifestyle.
- Between 20 and 24 training sessions (40–60 min each) at home or at the patient’s current location;
- Two procedures repeated daily: permission to start the exercise and training session. Each session is preceded by a phone contact of the patient with the telemonitoring center and data transmission, i.a., resting ECG, blood pressure and body weight measurement. After analyzing the monitoring center, in the absence of contraindications, the patient begins a training session. During each session, telemedicine supervision over the patient is carried out and after the end of the training session, the physiotherapist calls the patient by phone to discuss the course of exercises and determine the degree of effort load;
- A final medical visit to the outpatient clinic: examination, exercise or ergospirometry test or six-minute walk test, evaluation of the effectiveness and summary of the hybrid telerehabilitation cycle and further recommendations.
3. Results
3.1. Design Guidelines
3.1.1. Answers to Research Questions
- (A) What is the process of post-hospital care for patients after THA in Poland and in the world? (B) What telemedicine technologies are used in post-hospital care?
- Personal follow-up visits to the orthopedist should take place 6 weeks and 1 year after the procedure, then every 2 years [33].
- Personal follow-up visits should take place at least in the first year after surgery, 5 years after surgery or earlier if the orthopedic surgeon considers as necessary [34].
- It is vital to make the patient aware of the importance of personal follow-up visits in the postoperative period. The issue of the frequency of follow-up visits in the postoperative period requires standardization. Clinics schedule 3 control visits in the first year after surgery, at least 3 control visits in the next 10 years and then annual control visits [35].
- First period—immediately after the surgery—including standing upright in the hospital ward, in the absence of complications the patient stays in the hospital ward few days, up to a week;
- Second period—from the end of the week 1 to the beginning of the week 5—including walking on crutches or a walking frame with the relief of the operated limb;
- Third period—from 5 to 12 weeks—including exercises of all muscle groups and improvement of self-service and gradual increase in training load after 4–6 weeks.
- 2.
- How does the use of telemedicine technologies affect the effectiveness of post-hospital care for patients after THA?
- 3.
- What is the opinion of patients and staff about telemedicine technologies used in post-hospital care after THA?
3.1.2. Design Guidelines from Participant Observation
- Types of rehabilitation in posthospital patient care process:
- ambulatory rehabilitation—stationary;
- ambulatory rehabilitation—at patient home;
- rehabilitation ward, recommended depending on the patient’s health condition;
- Physiotherapists’ instructions directed to patient in hospital in the field of self-rehabilitation at home in posthospital period:
- oral instructions;
- presentation of exercise/body and limb movement performance, written instructions (printed instruction with text descriptions and graphic visualization of exercises) given during patients stay at the hospital after THA;
- Patient registration process for control visits in posthospital period:
- patients register control visits at outpatient specialist care on the referral received upon discharge from hospital;
- all information in regard to dates and intervals between visits are given at outpatient specialist care by reception personnel;
- comprehensive patient care after THA is possible in medical facility offering access to services needed in posthospital patient care (patient can register for control visit at the same day of discharge from hospital at the medical facility);
- Observation on video consultation tool implemented as commercial service for patients:
- The orthopedist efficiently uses the video-consultations tool without administration assistance;
- the video consultation system includes the possibility of electronic medical records storage;
- the orthopedist using the telemedicine tool has a work schedule previously set up in the telemedicine system;
- the orthopedist cooperates with administration personnel and shares opinions on the functioning of telemedicine system resulting from his experience after video consultation is conducted.
3.1.3. Design Guidelines from Structured Interviews
- Control visits after THA:
- control visits are important for monitoring patient condition;
- there is no strict standardization of the frequency of control visits;
- number of control visits depends on patient condition;
- patients do not always attend control visits on the set dates;
- there is no role of coordinator provided in the structure of the posthospital care process who is the patient’s guardian, e.g., in regard to phone control visits reminders;
- Rehabilitation after THA:
- the type of rehabilitation depends on the patient’s health condition;
- instructed self-rehabilitation at home has an important impact on patient recovery;
- patients perform self-rehabilitation at home according to the given oral and written instructions with pictures;
- Common causes of medical complications after THA:
- lack of patient rehabilitation;
- patient collapse;
- failure to follow specialistic instructions (from orthopedist and physiotherapist) regarding temporarily prohibited patient’s body movements;
- Patient attitude after THA:
- patient can be stressed/unsure just after surgery in regard to proper body movement, activity and general functioning;
- patients are open to use orthopedic aids and devices facilitating their functioning;
- Telemedicine tools:
- there is no telemedicine tool (telerehabilitation programs, collapse wrist bands) widely known and/or used to supervise patients’ physical condition, activity and the correctness and frequency of exercise at home by the patient;
- hospital personnel have general knowledge on telemedicine solutions (e.g., hybrid cardiac telerehabilitation was mentioned as application example);
- patients are open to using collapse sensors if equipped.
3.1.4. Diagram of Current Posthospital Patient Care Process after THA and Synthetic Conclusions for New Process Design
- First follow-up visit—takes place one week after the procedure to assess the patient’s general condition and control of the postoperative wound;
- Second follow-up visit—takes place after two weeks to assess the general condition of the patient and remove the stitches;
- Third follow-up visit—takes place after 6–8 weeks to assess the patient’s physical condition, verify the rehabilitation plan and, if necessary, take a control X-ray of the hip joints;
- Fourth, fifth and sixth follow-up visits—take place after 3, 6 and 12 months, respectively, to assess the patient’s physical condition, take a control X-ray of the hip joints, or in individually recommended periods depending on patient condition.
- There is a lack of tools for sufficient patient supervision during his stay at home, i.a., the lack of monitoring of the patient’s collapse, general physical activity in everyday life and realization of rehabilitation program after discharge from the hospital.
- There is a lack of comprehensive care model to ensure proper patient care after THA which is major surgery with risk of complications.
3.2. Project of Improved Posthospital Patient Care Process Using High Technologies—Final Results
- Physiotherapy;
- Outpatient specialist care;
- Telemonitoring.
4. Discussion
5. Conclusions
- Can increase the patient’s safety;
- Enables the conduction of rehabilitation remotely in the event of the lack of access to outpatient physiotherapy services or the lack of the patient transport to the rehabilitation center;
- It may contribute to shortening the convalescence time, reducing the risk of complications, as well as reducing treatment costs.
- Current process of post-hospital care process for patient after THA is not applying the full potential of available telemedicine technologies.
- High quality post-hospital care to maintain the intended effect of recovery is needed, increasing the number of costly THA procedures.
- The post-hospital period for patients undergoing THA is important, including the monitoring of fails that may be the cause of repeated need for surgery.
- This type of procedure minimizes personal interaction a contributing to limiting epidemiological threats development, for example, those caused by the COVID-19 pandemic.
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Aspect of Interest/Subject of Observation | Observed Occupational Group | Number of Participant Observation |
---|---|---|
Types of rehabilitation in posthospital patient care process. | orthopedist, physiotherapist, nurse | 4 |
Physiotherapists instructions directed to patient in hospital in the field of self-rehabilitation at home in posthospital period. | physiotherapist | 4 |
Patient registration process for control visits in posthospital period. | reception personnel | 4 |
Observation on video-consultation tool implemented as commercial service for patients. | orthopedist, administration personnel | 2 |
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Kamecka, K.; Rybarczyk-Szwajkowska, A.; Staszewska, A.; Engelseth, P.; Kozlowski, R. Process of Posthospital Care Involving Telemedicine Solutions for Patients after Total Hip Arthroplasty. Int. J. Environ. Res. Public Health 2021, 18, 10135. https://doi.org/10.3390/ijerph181910135
Kamecka K, Rybarczyk-Szwajkowska A, Staszewska A, Engelseth P, Kozlowski R. Process of Posthospital Care Involving Telemedicine Solutions for Patients after Total Hip Arthroplasty. International Journal of Environmental Research and Public Health. 2021; 18(19):10135. https://doi.org/10.3390/ijerph181910135
Chicago/Turabian StyleKamecka, Karolina, Anna Rybarczyk-Szwajkowska, Anna Staszewska, Per Engelseth, and Remigiusz Kozlowski. 2021. "Process of Posthospital Care Involving Telemedicine Solutions for Patients after Total Hip Arthroplasty" International Journal of Environmental Research and Public Health 18, no. 19: 10135. https://doi.org/10.3390/ijerph181910135