a-novel-approach-to-overcome-movement-artifact-when-using-laser

A Novel Approach to Overcome Movement Artifact When Using a Laser Speckle Contrast Imaging System for Alternating Speeds of Blood Microcirculation

The laser speckle contrast imager (LSCI) provides a powerful yet simple technique for measuring microcirculatory blood flow. Ideal for blood dynamic ...

Bournemouth University

A 71-year-old man presenting with hip osteoarthritis, with a complex range of comorbidities was referred by his general practitioner to CHAIN (Cycling against Hip PAIN), a 6 week programme developed to aid self-management of hip osteoarthritis through exercise, education and advice, as defined by the National Institute for Health and Care Excellence (NICE) guidelines. Significant improvements were seen in Oxford hip score, the Hip disability and Osteoarthritis Outcome Score (HOOS) - function score, sit-to-stand test, timed up and go test, pain scores and hip flexion. There was also a weight loss of 2.1 kg. The man reported 'an amazing difference' in his affected hip and leg, and improved fitness. Many clinicians would have questioned the man's suitability for the programme due to his coexisting medical conditions. This case study shows that patients may be much more able than we think to achieve significant improvement with exercise.

Hip osteoarthritis: patients with complex comorbidities can make exceptional improvements following intensive exercise and education.

This article examines the relevance of applying the Enhanced Recovery after Surgery (ERAS) approach to patients undergoing major spinal surgery. The history of ERAS, details of the components of the approach and the underlying rationale are explained. Evidence on outcomes achieved by using the ERAS approach in other orthopaedic and complex surgical procedures is then outlined. Data on major spinal surgery rates and current practice are reviewed; the rationale for using ERAS in major spinal surgery is discussed, and potential challenges to its adoption are acknowledged. A thorough literature search is then undertaken to examine the use of ERAS pathways in major spinal surgery, and the results are presented. The article then reviews the evidence to support the application of individual ERAS components such as patient education, multimodal pain management, surgical approach, blood loss, nutrition and physiotherapy in major spinal surgery, and discusses the need for further robust research to be undertaken. The article concludes that given the rising costs of surgery and levels of patient dissatisfaction, an ERAS pathway that focuses on optimising clinical procedures by adopting evidence-based practice and improving logistics should enable major spinal surgery patients to recover more quickly with lower rates of morbidity and improved longer-term outcomes.

Enhanced recovery after surgery (ERAS) and its applicability for major spine surgery.

Osteoarthritis of the hip is associated with pain, stiffness and limitations to activities of daily living. The aims of this quality improvement project were to introduce a service developed to promote the self-management of hip osteoarthritis through exercise and education and to assess the impact of the programme on pain, function and quality of life. The service was a six-week cycling and education programme and 119 participants took part. Statistically significant improvements were found for Oxford Hip Scores (Mean (SD) change 4.14, 95%, CI 3.02, 5.25, p < 0.001); Sit-to-stand scores (mean change 3.06, 95%, CI 2.33, 3.79, p < 0.001); EQ5D-5L Utility (mean change 0.06, 95%, CI 0.03, 0.09, p < 0.001); EQ5D VAS (mean change 7.05, 95%, CI 4.72, 9.39, p < 0.001); pain on weight-bearing (WB) (mean change 1.56, 95%, CI 0.77, 2.36, p < 0.001), HOOS function (median change (IQR) 7.35, 1.84 to 19.12, p < 0.001) and TUG test (median change 1.11, 0.31 to 2.43, p < 0.001). Participants reported improvements in pain and function; increased confidence in managing hip pain and an increase in motivation to exercise. These findings were supported by a patient and public involvement forum who suggested extending the programme to eight weeks. These results suggest that the service has potential in the management of hip osteoarthritis.

A cycling and education programme for the treatment of hip osteoarthritis: a quality improvement study.

This study compares the effectiveness of a neuromuscular electrical stimulation (NMES) device and an intermittent pneumatic compression (IPC) device on enhancing microcirculatory blood flow in the thigh of healthy individuals, when stimulation is carried out peripherally at the calf.

The effect of calf neuromuscular electrical stimulation and intermittent pneumatic compression on thigh microcirculation.

Total hip replacement (THR) and total knee replacement (TKR) are common orthopaedic procedures. However, an optimal programme for post-operative rehabilitation has yet to be established. Stair negotiation is a challenging, habitual task, regularly used as a post-operative functional outcome measure; yet as a physical rehabilitation intervention it appears to be rarely used.

Article	Year
Hip osteoarthritis: patients with complex comorbidities can make exceptional improvements following intensive exercise and education. BMJ case reports\| PubMed ID: 25678618	2015
Enhanced recovery after surgery (ERAS) and its applicability for major spine surgery. Best practice & research. Clinical anaesthesiology\| PubMed ID: 27036606	2016
A cycling and education programme for the treatment of hip osteoarthritis: a quality improvement study. International journal of orthopaedic and trauma nursing\| PubMed ID: 27575875	2016
The effect of calf neuromuscular electrical stimulation and intermittent pneumatic compression on thigh microcirculation. Microvascular research\| PubMed ID: 28077312	2017
Stair negotiation as a rehabilitation intervention for enhancing recovery following total hip and knee replacement surgery. International journal of orthopaedic and trauma nursing\| PubMed ID: 28302377	2017
How long before routine next-day discharge for primary hip and knee replacement patients in the United Kingdom? Clinical nutrition ESPEN\| PubMed ID: 28531666	2016
Patient reported importance of occupational therapy in a hip and knee replacement ERAS protocol. Clinical nutrition ESPEN\| PubMed ID: 28531751	2016
What is the role of occupational therapy in an Enhanced Recovery after Surgery (ERAS) protocol? Clinical nutrition ESPEN\| PubMed ID: 28531754	2016

Tikki Immins

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