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Nonoperative Care Including Rehabilitation Should Be Considered and Clearly Defined Prior to Elective Orthopaedic Surgery to Maximize Optimal Outcomes.

Publication ,  Journal Article
Rhon, DI; Tucker, CJ
Published in: Arthrosc Sports Med Rehabil
January 2022

UNLABELLED: Orthopaedic surgery has revolutionized the expectations for restoration of physical function after musculoskeletal injury and, along with physical therapy, has transformed the limits of recovery. Many orthopaedic procedures have a high success rate for improving quality of life and patient-reported outcomes, yet these procedures carry some level of risk, including postoperative complications. The stepped-care model of health care delivery, when applied to musculoskeletal care, recommends implementing less-intense and lower-risk treatments with known efficacy, such as promotion and education of self-management strategies and physical therapy, before more-invasive and higher-risk treatments such as surgery. This model of managing musculoskeletal disability can improve efficiency of care delivery and reduce medical costs at the health system level. Unfortunately, there is a documented lack of implementing an appropriate course of conservative care, especially physical therapy, prior to surgery across multiple orthopaedic disciplines including sports, spine, and trauma medicine and joint arthroplasty. Failure to respond to nonsurgical treatment has been suggested as a requisite component of the surgical appropriateness criteria, yet practical application can be elusive. Multiple barriers to adequate utilization of conservative treatment exist, including U.S. payment models that increase out-of-pocket expense for patients, negative patient perception of therapy, unreasonable patient expectations from therapy versus surgery, and communication barriers between patient, surgeon, and therapist. Surgeons should ensure that high-quality guideline-appropriate care is delivered early and adequately to their patients. Rehabilitation professionals have a responsibility to deliver high-value care, properly documenting the type and extent of treatment to improve surgical decision-making between surgeons and patients. Criteria to determine appropriateness for surgery should include a standardized and extensive assessment of failed therapies prior to certain elective surgeries. Improved collaboration between surgeons and rehabilitation professionals can result in improved outcomes for patients with musculoskeletal disorders. LEVEL OF EVIDENCE: V, expert opinion.

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Published In

Arthrosc Sports Med Rehabil

DOI

EISSN

2666-061X

Publication Date

January 2022

Volume

4

Issue

1

Start / End Page

e231 / e236

Location

United States
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Rhon, D. I., & Tucker, C. J. (2022). Nonoperative Care Including Rehabilitation Should Be Considered and Clearly Defined Prior to Elective Orthopaedic Surgery to Maximize Optimal Outcomes. Arthrosc Sports Med Rehabil, 4(1), e231–e236. https://doi.org/10.1016/j.asmr.2021.09.038
Rhon, Daniel I., and Christopher J. Tucker. “Nonoperative Care Including Rehabilitation Should Be Considered and Clearly Defined Prior to Elective Orthopaedic Surgery to Maximize Optimal Outcomes.Arthrosc Sports Med Rehabil 4, no. 1 (January 2022): e231–36. https://doi.org/10.1016/j.asmr.2021.09.038.
Rhon, Daniel I., and Christopher J. Tucker. “Nonoperative Care Including Rehabilitation Should Be Considered and Clearly Defined Prior to Elective Orthopaedic Surgery to Maximize Optimal Outcomes.Arthrosc Sports Med Rehabil, vol. 4, no. 1, Jan. 2022, pp. e231–36. Pubmed, doi:10.1016/j.asmr.2021.09.038.

Published In

Arthrosc Sports Med Rehabil

DOI

EISSN

2666-061X

Publication Date

January 2022

Volume

4

Issue

1

Start / End Page

e231 / e236

Location

United States