ELLIE FREDRIKSEN Flashcards
Shared Decision Making (Grenfell et al., 2022)
- Trust, communication, decision ability, decision preferences
- 2 way communication, power control, collaborative relationship, know risks and options
Biopsychosocial Model (Cormack et al., 2022)
- BPSM only partially implemented in healthcare
- Humanistic ( Patient centred care) and Causation (multi-factorial contributions to illness) interpretations
- George Engel’s model
- Human experience of illness and disease
- Increase rigour for Pt’s Hx
- Heuristic framework for clinical medicine
Value-Based Care (Cook et al., 2021)
- patient-centredness
- guideline-orientated strategies
- measurement of Pt outcomes and experiences
- cost-effectiveness
NICE 2020 Joint Replacement
- Physio offers rehab no more than 24hrs post-surgery
- goal is to restore Pt to previous baseline of functioning and independence
- advice on managing ADLs
- a home exercise programme
- mobilisation
- this reduces length of stay, early d/c increase QoL, cost saving, benefits outweigh adverse effects of pain
Hip # Prognosis (Anpalahan et al., 2013)
- 50% of Pts dies within 6 months of injury over the age of 65
- Sepsis (extreme reaction to infection) main cause of death
- 40-60% regain baseline mobility
- 20-60% require assistance with at least 1 ADL if they were independent prior
- Pre # function and age are superior factors for prognosis
- cognitive status influences prognosis
Dementia
- an umbrella term for the inability to remember, think and make decisions (interferes w ADLs)
- multiple causes, mutation of genes passed down through families
- Alzheimer’s = damage to hippocampus and amygdala
- damage to the white matter of the brain
- neurodegenerative disease, no cure currently
- ACh inhibitors prevent the breakdown of neurotransmitters which help to manage symptoms
Khan & Scott., 2008 (early mobilisation)
- early mob promotes bone remodelling via mechanotransduction
- reduces length of stay, improves Pt psychosocial outcomes
Mechanotransduction
- ongoing physiological process where cells sense and response to mech load
1. phys perturbation of cells from phys compression or shear force
2. cell to cell communication, response communicated to distant cells which register signal despite no exposure to stress
3. effector response, signalled cells respond by way of tissue growth and repair
Khan & Scott., 2009 (mechanotherapy)
- the employment of mechanotransduction for the stimulation of tissue growth and repair
Smith et al., 2008 (bed exercises)
- addition of bed exercises to GAIT re-education program following hip replacement did not significantly improve patient function of QoL
Haefeli et al., 2006 & Alghadir et al., 2022 (PAIN scales)
- VRS 0.88 (VAS) and 0.93 (NRS) criterion validity
- 0.93 test re test reliability
- excellent feasibility
Anatomy # Healing
(week 0-2) Haematoma Formation - haematoma formed around # site
(week 2-3) Fibrocartilaginous Callus Formation - chondrogenesis begins, collagen network laid down between # ends. woven bone formed by osteoprogenitor cells
(week 3-6) Bony Callus Formation - cartilaginous cells undergo ossification, callus reabsorbed and begins to calcify
(week 8-on) Bone Remodelling - hard callus continues to undergo remodelling from osteoclasts and osteoblasts
Horn et al., 2012 (PSFS, Sys Rev)
- construct validity 0.74
- re-test reliability 0.84
- high responsiveness for MSK issues including knee dysfunction, cervical radiculopathy, acute LBP, neck dysfunction
- shown to facilitate PCC
