After Knee surgery, should you rehabilitate at home or the hospital?

I have had my knee replaced and I may have to have my second knee replaced because I have osteoarthritis, so I was interested in the results of this study done by Donghai Li, Zhouyuan Yang, Pengde Kang, Xiaowei Xie. which was published by the  American journal of physical and medical rehabilitation in  August 2016 Aug.

The researchers asked the question “How does home-based rehabilitation compare to hospital-based rehabilitation in terms of quality of life and physical performance after hospital discharge following knee replacement surgery for osteoarthritis?”

This is a great question because I did my rehabilitation at home but the hospital based rehab was an option that was presented to me. For a number of reasons, I chose not to use this option and did my rehabilitation at home.

Many of us who undergo knee replacement surgery to treat pain and joint dysfunction resulting from osteoarthritis. However, upon discharge, we have a number of options and a choice of numerous rehabilitation programs. What I was not aware of was that there was little evidence or no evidence supporting their effectiveness.

Currently, patients are discharged to home after knee replacement surgery and receive outpatient rehabilitation routinely at the hospital. However, one idea catching interest is home-based rehabilitation which allows patients to receive physiotherapy and rehabilitation in their homes.

This study aimed to compare home-based with hospital-based rehabilitation after knee replacement surgery for osteoarthritis patients, in terms of quality of life and physical performance improvements.

How the review was done

A detailed search of four electronic databases was conducted for studies published from 1974 to February 2016. Studies that compared the effects and costs of home-based rehabilitation to hospital-based rehabilitation after knee replacement surgery for osteoarthritis patients were included.

A total of 168 studies were identified in searches, and seven were included in the review after assessments for eligibility.

This review was funded with support from the National Natural Science Fund of China.

What the researchers found

This review found that home-based rehabilitation is similar to hospital-based rehabilitation in terms of physical performance at 12 and 52 weeks post-surgery.

The review also found that the hospital-based group had less pain than the home-based group. However, the range of motion of knee flexion in the home-based group was better than the hospital-based group.

This review found that the costs of the two rehabilitation programs were similar. 

Conclusion

This review found that the use of home-based rehabilitation is comparable to hospital-based rehabilitation, in terms of quality of life and physical performance of patients such as knee range of motion. The study concludes that rehabilitation at home can be recommended as an alternative. However, these results should be used with caution as further research with more participants is required.

Having completed my rehabilitation at home, I am in favour of the home alternative, but that is based on personal experience, not research.

Perception Management

Try another way of looking at the world, by changing your perception, I call this Personal Perception Management:

The next time someone upsets you, think, "Thanks for pointing out that I've begun depending on you. It is about time I lose these expectations." 

And the next time someone doesn't take your view into account, think, "That's okay, I was once like that and today I listen and take the other person's view into account." 

And if someone steals from you, think, "It was nothing, they must think they need it more than I and I forgive them." 

Or lies to you, think, "I'm sorry you feel that need  to lie to me, what is it I have done to make you afraid of me." 

When someone:

• Is rude to you, "Cheer up, it'll be okay, they must be having a terrible day, I hope I can make their day better." 
• Judges you, "Thanks for sharing your truth, but I have my own truth." 
• Drives by you like a bat out of hell, "Be careful, my friend. I want you to arrive alive where ever it is you need to be now." 

And the next time someone greets you with a smile, smile back like you're sharing a secret. 

Do self management programs work for older seniors?

Self-management programs are an effective means of improving the ability of older adults to carry out daily activities according to a study by van Het Bolscher-Niehuis MJ, den Ouden ME, de Vocht HM, Francke AL. Effects of self-management support programmes on activities of daily living of older adults: A systematic review published in the International Journal of Nursing Studies.

The researchers asked the following question, What are the effects of self-management support programs on the ability of older adults to perform important daily activities?

The reason for the study is that older adults living in the community often face health challenges that impair their ability to carry out important daily activities (e.g., eating, bathing, dressing). In addition, older adults living in the community are seldom given specific instruction on how to manage their own daily activities when dealing with chronic conditions and other health problems. So, a review was done to assess the effectiveness of self-management programs in improving the ability of older adults to carry out daily activities.

The researchers completed a detailed search of five electronic databases was conducted for studies published up to and including February 2016. Studies that focused on community-dwelling adults aged 65 years or older, self-management support programs, and outcomes relating to the performance of daily activities were included in the review.  They reviewed a total of 5,220 studies were identified in searches and decided to include 10 in the review after assessments for eligibility.

What the researchers found that self-management support programs may prevent or delay the decline the ability of older adults to perform daily activities. The authors reinforced the idea that effective self-management support interventions had a multi-component structure, contained disease-specific information, and included personalized instruction and feedback for older adults.

Conclusion

This review found that self-management support programs improve the ability of older adults to perform important daily tasks, such as eating and bathing. More evidence is required to identify whether self-management support programs should be taught in group or individual settings and whether they should be delivered with or without usual care programs.

We live in a time

We live in a time when politics are shaped by extremes, and chaos seems to unfold in a polarized world.

You probably won't believe this, but I'm as powerless as you when it comes to living other people's lives.

On the other hand, you are as powerful as I am when it comes to living your own life. 

You decide what's meant to be. You can have anything you want and everything is possible – whether you lean left or right, are on the top or bottom 1%, read the fake news, or dispense covfefe.

Don't give away your power waiting to see what happens to the rest of the world, when you can decide what will happen in yours.