• January/ February 2018 Issue of Becker's Spine Review

    January/February 2018 Issue of Becker's Spine Review  By Super User -
  • What being a patient taught me about knee replacement surgery dos and don’ts

    In my role as both a physical therapist (PT) and founder of a leading independent network for PTs, I work closely with orthopedists and surgeons. We talk at length personally, professionally and philosophically about what patients want, what they need, and how we can help. I've known more than a few orthopedists who, over the years, have undergone orthopedic procedures, and they often ask me for tips on maximizing their outcomes and getting back on their feet sooner. So when I had to face my own decision about knee replacement surgery, I figured I'd be a great patient. After all, as a therapist, I knew what to expect, how to prepare, who the best surgeons were, and so on. Imagine my surprise to learn a thing or two (and more) on my way through surgery and back to recovery – things I now want to share with others in the orthopedic community to help us better help our patients and ensure they get the most from this important surgical procedure. 1. Be empathetic. I've known PTs, orthopedic surgeons and other healthcare professionals who have undergone knee replacement surgery and felt some anxiety about it. How would the artificial joint feel? Would there be pain or discomfort? What about the risk of falling? If providers like us feel that apprehension, imagine how our patients feel? Let's remember not to minimize their concerns or fears, but to help them overcome their anxiety through education, understanding and reassurance.2. Discomfort is good. Discomfort is clearly a primary concern of patients; it often causes high levels of anxiety, and causes many people to postpone or simply not have a procedure. Former patients often don't help matters by sharing their own post-surgery "the pain was so bad I . . ." anecdotes. I learned that discomfort is good. Stretching helps improve function; it does cause some pain – but that discomfort leads to mobility. Help patients understand what pain is "normal" and to be expected, and ensure they know that their doctors and therapists will help them manage that discomfort.3. Be prepared. I think the single biggest factor in my recovery was that I went to my primary care physician and to a physical therapist prior to the surgery to get a baseline for my mobility and to undergo pre-operative conditioning. I can say from first-hand experience, that kind of preparation helps with recovery. Even if the patient has some dysfunction prior to surgery, a therapist can provide education, isometric exercises and help get the body ready for surgery. Therapists also need to know where a patient's functionality was before surgery to better identify and build toward goals. Working with a therapist before surgery also helped me understand what to expect. Plus, I learned how to use a walker and cane. That is something better done before surgery, before a patient is in post-op.4. Move it. In part because of my pre-conditioning and work with my PT, I was up and walking the day of surgery. Patients should understand that first 24 to 36 hours after surgery there is often minimal pain because of the spinal. This is an ideal opportunity to move – to practice walking – to take steps to avoid thrombosis and other post-op complications. We must help patients understand this lack of pain/discomfort is temporary, but that it is an important time to begin recovery and exercise.5. Get dressed. I didn't allow myself time to lounge around in pajamas. That first day post-surgery, in the hospital, I got dressed. Pain and recovery are as much psychological and physical. Too often patients think of themselves as sick, not well. It's important not to focus on the negative, or the discomfort, even if there are some setbacks along the way. Getting dressed and engaging in every-day activities early helps patients get over the, "I'm sick" mentality.6. Encourage your patients be positive. Another way to help patients not get trapped in the "sick' mentality is to focus on something positive, some trip, an activity they enjoy, whatever brought them happiness that they are unable to do, but will do again once they recover.7. Celebrate. Tell patients to celebrate small accomplishments and remind them that each accomplishment gets them one step closer to their goal.8. Don't rush recovery or get overly confident. I went to a see my beloved Los Angeles Dodgers shortly after surgery. I felt great and had a marvelous time, but I was over-confident and I didn't listen to my surgeon and therapist. The walk to and from the car was just too much, too soon. Remind patients to listen to their body and to be patient, it will take at least 3 months to return to normal.9. Educate. An educated patient is a good patient, is a patient who will have better outcomes and who will be more independent and take less time for you and your staff. PTs can help provide that pre-surgical education as well as exercises and training that will ensure patients are in better shape prior to surgery. They can also help surgeons understand the patient's pre-surgery capabilities – what they could do and need to be able to do following surgery. Those are important insights to have as they help set realistic goals. I am now several months post-surgery. I have more recovery ahead, and continue my own PT and exercise, but am doing very well and I'm very happy I overcame my apprehension and underwent surgery. As professionals we must carefully screen patients for knee replacement surgery; it simply isn't for every patient. However, for those who are candidates, but who may be hesitant because of fears of pain, or the unknown or any other "what ifs," physicians and physical therapists need to work together to give them the education, tools and support to have optimal outcomes. The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.​ By Michael Weinper, PT, DPH, MPH, President and Founding Partner, PTPN -
  • Despite challenges, bundled payments for spine, orthopedics are coming quickly

    Government action can feel slow, but when it comes to making inroads on reimbursement patterns, the government as a payer moves pretty swiftly. By Super User -
  • Thank you for downloading "How Evidence-Based Medicine Drives Decision-Making in Healthcare"

    The "How Evidence-Based Medicine Drives Decision-Making in Healthcare" whitepaper has been sent to the email address you provided!   If you come across any problems, please email eboehmer@beckershealthcare.com By Leah Fishbein -

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