Wie standardisiert sind Nachbehandlungsschemata für Knieendoprothesen in der Schweiz?

Zusammenfassung

Hintergrund: In der Diskussion unter Physiotherapeuten zeigen sich große Unterschiede in der postoperativen Nachbehandlung von Patienten mit Knietotalprothese.

Ziel: Welche Verordnungen zur postoperativen Physiotherapie von Knieendoprothesen werden gemacht und sind diese Evidenz-basiert.

Methode: Auswertung von aktuellen physiotherapeutischen Nachbehandlungsschemata von Knieendoprothesen in Schweizer Kliniken und Literatursuche zur Evidenz dieser Schemata.

Ergebnisse: 30 Nachbehandlungsschemata aus 28 Kliniken konnten analysiert werden. Die 5 häufigsten Verordnungen bezogen sich auf die Verwendung von Bewegungsschienen (93 %), gefolgt von Bettmobilisation (87 %), Beinbelastung und passiver Gelenksmobilisation (83 %) sowie Quadrizepstraining (73 %). Ein standardisiertes Vorgehen war nicht zu erkennen. Angaben zur sozialen und beruflichen Reintegration fehlten weitgehend. Teilweise fehlte die wissenschaftliche Evidenz für diese Maßnahmen.

Schlussfolgerungen: Die unterschiedlichen Nachbehandlungsschemata zur physiotherapeutischen Behandlung nach Knieendoprothesen erschweren die postoperative Behandlung. Ein einheitliches Vorgehen ist dringend nötig.

Abstract

Background: Physiotherapists report that there are large differences in the post surgical treatment of patients with total knee arthroplasty.

Objective: Which treatment prescriptions are made and are these evidence based.

Method: An evaluation of the current physiotherapy prescriptions after total knee arthroplasty in Swiss clinics and a literature search for the evidence of these prescriptions was made.

Results: 30 post surgical treatment procedures from 28 clinics were analysed. The five most frequently prescribed treatments were continuous passive motion (93 %), followed by bed mobilisation (87 %), weight bearing and passive joint mobilisation (83 %) and quadriceps strengthening (73 %). A standardised procedure could not be identified. Indications aiming for a social and occupational reintegration were almost completely lacking. Scientific evidence for some measures was missing.

Conclusions: The variable prescriptions for post surgical physiotherapy after total knee arthroplasty complicate the treatment. Standardised treatment guidelines are urgently required.

Schlüsselwörter

Nachbehandlung - Richtlinien - Knietotalprothese - Physiotherapie - Evidenz

Key words

post-surgical physiotherapy - guidelines - knee arthroplasty - evidence

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