• 한방재활의학과학회지
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• 제32권2호
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• pp.123-138
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• 2022

Objectives This study was conducted to evaluate the clinical efficacy and safety of the chuna combination treatment for patients who complain of functional impairment and pain even 3 months after total knee arthroplasty. Methods 24 patients who had 3 months of surgery and who had knee joint pain with a score of 4 or higher on the numerical rating scale (NRS) for more than a week were selected as subjects. The test group received usual care and Chuna treatment and the control group received the administration of drugs as usual care. And then the clinical efficacy and safety were compared and evaluated. Follow-up was performed 1 month after the end of treatment. Results As a result of the analysis, it was confirmed that the primary parameter Korean Western Ontario and McMaster Universities (K-WOMAC) showed statistical significance in the amount of change in visit 2-visit 10 (V2-V10) in the pain domain and in the amount of change in visit 2-follow 1 (V2-FU1) in the functional domain and total score domain. The secondary parameter (NRS, risk of fall, and range of motion) showed a tendency to decrease in the degree of discomfort, but statistical significance could not be confirmed. Conclusions Because this study did not have enough study subjects, it is difficult to use the results as confirmatory evidence. However, it was confirmed that the 4-week Chuna treatment had a significant effect and safety in patients who underwent total knee arthroplasty. Therefore, this study is meaningful as a prior research data to prepare confirmatory evidence in the future.

• 한국의료질향상학회지
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• 제28권2호
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• pp.30-38
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• 2022

Purpose: The Health Insurance Review and Assessment Service (HIRA) in South Korea initiated a quality assessment (QA) program for blood transfusion healthcare services in 2020 to ensure patient safety and appropriate blood use. This study examines the quality of blood transfusion services since the first national QA program for blood transfusion services in Korea. Methods: We analyzed HIRA claims and QA investigation data based on inpatient medical records from all tertiary, general, and primary hospitals between October 2020 and March 2021. The target population was patients aged 18 years and older who received either total knee arthroplasty or red blood cell transfusion. The QA indicators for transfusion healthcare service consisted of four quality indicators and four monitoring indicators. Results: We analyzed the results of QA indicators for transfusion service from the medical records of 189,668 patients from 1,171hospitals and expressed indicators as proportions. The average results for evaluation indicators were as follows: transfusion checklist presence, 64.8%; irregular antibody tests, 61.8%; transfusions in which the hemoglobin levels before transfusion met the transfusion guidelines for patients undergoing total knee arthroplasty, 20.6%, and transfusions in patients undergoing total knee arthroplasty, 59.3%. The average results for monitoring indicators were as follows: transfusion management implementation in medical institutions, 56.9%; preoperative anemia management in anemia patients undergoing total knee arthroplasty, 43.9%; one-unit transfusions, 82.5%; and the transfusion index. Conclusion: The quality of blood transfusion healthcare varied and the assessment revealed that there is scope for improvement. Hospitals require more effective blood transfusion management and this can be facilitated by providing feedback on the QA results about blood transfusion healthcare services to medical institutions, and by disclosing the results to the public.

• 국제물리치료학회지
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• 제5권2호
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• pp.743-751
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• 2014

This study aims to identify the effect of home physical therapy on patients who left the hospital after total knee arthroplasty, compared to the Daily living group, when it was applied to them, under the guidance of physical therapists. As research subjects, 20 patients that were scheduled to leave the hospital after unilateral total knee arthroplasty, were chosen, and they were randomly divided into a home physical therapy group(10 patients) and an Daily living group(10 patients) in order to conduct an experiment. During the 4-week research, home physical therapy was offered for 40 mins once for 5 days a week, and muscular strength, gait components were measured. For muscular strength, quadriceps muscle strength, hamstring muscle strength were measured, and as gait components, endurance, speed, step time, single-limb support were analysed. For this experiment, pre- and post-measurement were performed, and collected data were analyzed using SPSS ver. 18.0 statistical program. From the analysis of data, the following study results were obtained. Home physical therapy group and Daily living group both showed significant improvements in quadriceps muscle strength, hamstring muscle strength, and quadriceps muscle strength, hamstring muscle strength of home physical therapy group more significantly improved than Daily living group's. In relation to gait components, gait endurance, gait speed, step time significantly improved in both of home physical therapy group and Daily living group, whereas home physical therapy group only showed significant improvements in single-limp support. According to the comparison between two groups, gait speed, single-limp support and step time improved more significantly in the home physical therapy group than in the Daily living group. In conclusion, positive results were revealed in both home physical therapy group and Daily living group, with regard to muscular recovery of lower limbs of patients discharged from the hospital after total knee arthroplasty and walking, but considering the comparison results between two groups, it seems that applying home physical therapy is more effective than maintaining a daily life.

• 임상간호연구
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• 제21권2호
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• pp.266-275
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• 2015

Purpose: The objective of this study was to verify the effects of elastic-band exercise on pain, range of motion, and fear of falling in patients with total knee replacement. Methods: The study design was a nonequivalent control group non-synchronized quasi-experimental design. Data were collected from December 10, 2014 to January 10, 2015 in an orthopedic specialty hospital located in the C city. Forty-eight patients participated in the study, and each twenty-four were assigned to the experimental group and the control group. The elastic-band exercise was used with the experimental group for 10 days. The numeric rating scale was used to measure pain, goniometer to measure range of motion, and a questionnaire to measure fear of falling. The data were analyzed using $x^2-test$, Fisher's exact, t-test and paired t-test. Results: Compared to the control group, pain in the experimental group decreased (t=-2.89, p=.006), range of motion increased (t=2.98, p=.005), and fear of falling decreased (t=-4.63 p<.001). Conclusion: The elastic-band exercise for total knee replacement patients is considered to be an effective nursing intervention to decrease pain and fear of falling, and to increase range of motion.

• The Korean Journal of Pain
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• 제32권1호
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• pp.30-38
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• 2019

Background: The adductor canal block (ACB) is an effective intervention for postoperative analgesia following total knee arthroplasty (TKA). However, the ideal ACB regimen has not yet been established. We compared the analgesic effects between a continuous ACB group and fentanyl-based intravenous patient-controlled analgesia (IV-PCA) with a single-shot ACB group. Methods: Patients who underwent TKA were randomly allocated to either a continuous ACB group (Group CACB) or IV-PCA with a single-shot ACB group (Group IVACB). Before the surgery, ultrasound guided ACB with 0.5% ropivacaine 20 cc was provided to all patients. Before skin incision, the infusion system (0.2% ropivacaine through an adductor canal catheter in group CACB vs. intravenous fentanyl in group IVACB) was connected. The postoperative pain severity; the side effects of local anesthetics and opioids; administration of rescue analgesics and anti-emetics; and sensorimotor deficits were measured. Results: Postoperative pain severity was significantly higher in the IVACB group at 30 min, 4 h, 24 h, and 48 h after surgery. The averages and standard deviations (SD) of the NRS score of postoperative pain were $0.14{\pm}0.37$, $4.57{\pm}2.37$, $6.00{\pm}1.63$, and $4.28{\pm}1.49$, respectively in the IVACB group. Rescue analgesic requirements and quadriceps muscle strength were not statistically different between the groups throughout the postoperative period. Moreover, rescue antiemetic requirements were higher in group IVACB than group CACB. Conclusions: In this study, the continuous ACB provided superior analgesia and fewer side effects without any significant motor deficit than the IV-PCA with a single-shot ACB.

• 한국엔터테인먼트산업학회논문지
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• 제14권6호
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• pp.201-208
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• 2020

본 연구는 건강보험심사평가원의 청구 자료를 바탕으로 만65세 이상의 주진단이 무릎 관절증으로 슬관절 전치환술을 시행한 환자를 대상으로 의료기관 종별에 따라 재원일수에 영향을 주는 요인을 분석하였다. 연구결과 의료기관 종별에 따라 성별, 연령, 의료보장형태, 중증도, 거주지역 및 병상규모가 재원일수에 영향을 미치는 요인으로 분석되었다. 인구의 고령화로 인한 노인 인구의 증가와 이로 인한 노인 진료비 증가는 가계 및 국가 경제의 많은 부담으로 작용하는 시점에서 본 연구결과를 토대로 재원일수 단축효과와 함께 효율적인 병상운영을 도모해야 할 것이다. 뿐만 아니라 환자의 진료비 부담을 경감시키는 위한 체계적인 관리시스템을 도입하여 노인환자의 양질의 라이프케어를 위한 기초자료로 활용하는 데 본 연구의 의의가 있다.

• 대한정형도수물리치료학회지
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• 제27권1호
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• pp.51-62
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• 2021

Background: The purpose of this study was conducted to investigate the effects of the ankle mobilization with movement (MWM) technique on ankle dorsiflexion range of motion (ROM), balance, and gait in patients who underwent total knee replacement (TKR). Methods: Thirty patients with knee osteoarthritis were recruited and randomly divided into two groups: the experimental group (EG; n=15) and the control group (CG; n=15). For five days a week for 3 weeks, participants in the EG were treated with the ankle MWM technique and traditional total knee replacement (TKR) exercise, and those in the CG only performed traditional TKR exercises. The dorsiflexion ROM, balance, and gait of the patients were before and after exercise. Results: Balance system SD was used compare changes in dynamic balance. Patients in the EG group showed statistically significant differences after the intervention (p<.05). In addition, there was a statistically significant difference in dynamic balance between the EG and CG groups after the intervention (p<.05). STT-IBS was used to compare changes in velocity, step length, stride length, and ankle dorsiflexion ROM. Patients in the EG group showed statistically significant differences after the intervention (p<.05). In addition, there was a statistically significant difference in the velocity, step length, stride length, and ankle dorsiflexion ROM between the EC and CG groups after the intervention (p<.05). Conclusion: Our results showed that applying the ankle MWM technique with traditional TKR exercises improved ankle dorsiflexion ROM, dynamic balance, and gait in patients.

• 대한정형외과학회지
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• 제55권6호
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• pp.527-533
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• 2020

목적: 슬관절 인공관절 전치환술(total knee arthroplasty, TKA) 후 통증 조절을 위한 부프레노르핀 경피 패치(buprenorphine transdermal patch, BTDP)의 흉부 적용 및 무릎 적용 효과를 비교하고자 하였다. 대상 및 방법: 2018년 8월부터 2019년 8월까지 TKA를 시행한 231명 중에서 나이, 성별, 체질량 지수(body mass index) 등을 고려한 환자-대조군 연구를 통해 선별된 200예를 대상으로 후향적으로 분석하였다. BTDP를 적용하기 전후에 Numeric Rating Scale (NRS), 부작용 및 순응도를 측정하였으며 흉부 적용군(A군=100명)과 무릎 적용군(B군=100명) 사이의 모든 측정치를 비교하였다. 결과: 술 후 BTDP 적용군 간의 휴식 시 NRS는 전반적으로 비슷하였으나 B군의 술 후 2, 3일째 오후, 5일, 6일, 7일째 휴식 시 NRS는 A군의 NRS보다 통계적으로 유의하게 낮았다. BTDP 적용 후 중추신경계, 위장관계 부작용은 B군에서 유의하게 낮았다. 심혈 관계, 피부의 부작용은 두 군 간에 유의한 차이가 없는 것으로 나타났다. 통증 조절을 위한 지속적인 BTDP 유지에서도 B군이 A군에 비하여 유의하게 높게 나타났다. 결론: TKA 후 BTDP를 통증이 있는 무릎 관절에 직접 적용하는 것은 술 후 초기 통증 조절에 있어 우수한 결과를 보였으며 기존의 흉부 적용 방법보다 부작용 빈도를 줄여 환자의 순응도를 높일 수 있는 유용한 방법으로 판단된다.

• Physical Therapy Rehabilitation Science
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• 제8권3호
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• pp.170-174
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• 2019

Objective: The objective of this study was to investigate the differences in the quality of life between two groups of patients who received or did not receive total knee replacement (TKR) surgery after being diagnosed with knee osteoarthritis (OA), and to investigate changes in the quality of life for persons who had TKR surgery. Design: Cross-sectional study. Methods: The subjects were randomized into a surgery group (n=70) and a non-surgery group (n=65). Subjects were selected from individuals diagnosed with knee OA from Himchan Hospital in Seoul, South Korea. Their sex, age, weight, height, body mass index, unilateral or bilateral, and quality of life were evaluated. Changes in the quality of life was measured using the Short Form-36 Health Survey (SF-36). Seventy out of 135 patients had TKR surgery, and their quality of life was evaluated at 6 months and 12 months after the surgery. Results: SF-36 scores were significantly improved at 6 months and 12 months after the surgery compared to the scores before the surgery (p<0.05). Also, the comparison between 6 and 12 months after surgery showed that the Vitality and Social Function scores in the SF-36 were significantly increased (p<0.05). Conclusions: The findings of this study showed that TKR surgery has a positive effect on the quality of life for persons with knee OA as a therapeutic intervention.

• 대한간호학회지
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• 제43권3호
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• pp.352-360
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• 2013

Purpose: In this study an examination was done of the effects of the American Society of PeriAnesthesia Nurses (ASPAN) Evidence-Based Clinical Practice Guidelines on body temperature, shivering, thermal discomfort, and time to achieve normothermia in patients undergoing total knee replacement arthroplasty (TKRA) under spinal anesthesia. Methods: This study was an experimental study with a randomized controlled trial design. Participants (n=60) were patients who underwent TKRA between December 2011 and March 2012. Experimental group (n=30) received active and passive warming measures as described in the ASPAN's guidelines. Control group (n=30) received traditional care. Body temperature, shivering, thermal discomfort, time to achieve normothermia were measured in both groups at 30 minute intervals. Results: Experimental group had slightly higher body temperature compared to control group (p=.002). Thermal discomfort was higher in the experimental group before surgery but higher in the control group after surgery (p=.034). It decreased after surgery (p=.041) in both groups. Time to achieve normothermia was shorter in the experimental group (p=.010). Conclusion: ASPAN's guidelines provide guidance on measuring patient body temperature at regular intervals and on individualized and differentiated hypothermia management which can be very useful in nursing care, particularly in protecting patient safety and improving quality of nursing.