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"Critical pathways"

Original Articles
Functional Outcomes After Critical Pathway for Inpatient Rehabilitation of Total Knee Arthroplasty
Jong Hyun Kim, Bo Ryun Kim, Sang Rim Kim, Eun Young Han, Kwang Woo Nam, So Young Lee, Won Bin Kim
Ann Rehabil Med 2019;43(6):650-661.   Published online December 31, 2019
DOI: https://doi.org/10.5535/arm.2019.43.6.650
Objective
To investigate functional outcomes after the application of a critical pathway for inpatient rehabilitation of total knee arthroplasty (TKA).
Methods
A total of 184 patients (57 males and 127 females; average age, 71.5±5.9 years) who underwent unilateral or bilateral TKA were included. The critical pathway included early, intensive individualized rehabilitation exercises. Patients completed the following performance-based physical function tests: the stair climbing test (SCT), 6-minute walk test (6MWT), and Timed Up and Go test (TUG) as well as measurement of isometric knee flexor and extensor strength of the operated knee, gait speed, and range of knee flexion and extension. Self-reported physical function and pain were measured using the Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) and visual analog scale (VAS), respectively, and self-reported quality of life was measured using the EuroQoL 5 dimension (EQ-5D) questionnaire. These evaluations were performed preoperatively and at 1 month and 3 months postoperatively.
Results
Performance-based and self-reported physical function and quality of life measures improved nonlinearly over time. Specifically, the 6WMT, TUG, gait speed, WOMAC-pain, WOMAC-function, VAS, and EQ-5D scores showed a significant improvement at 1-month post-TKA, whereas SCT, peak torque of the knee extensors and flexors, and WOMAC-stiffness scores showed gradual, but substantial, improvements over 3 months. There were between-group differences (unilateral and bilateral TKA groups) in the time course of the SCT, 6MWT, TUG, VAS, WOAMC-stiffness, and WOMAC-function results.
Conclusion
Patients who underwent critical pathway rehabilitation after TKA showed significant improvements in functional measurements during the first 3 months post-surgery.

Citations

Citations to this article as recorded by  
  • Comparison of postural stability and Romberg quotient before and after total knee arthroplasty in individuals with knee osteoarthritis
    Saidan Shetty, G. Arun Maiya, Mohandas Rao KG, Sandeep Vijayan, Shetty Shrija Jaya, Bincy M. George
    Disability and Rehabilitation.2026; : 1.     CrossRef
  • The Impact of Preoperative Muscle Mass on Postoperative Functional Outcomes Following Total Knee:An Investigation under a Criteria-Based Protocol
    Keita Kawabuchi, Shota Maniwa, Kenta Yamane, Ryoka Taniguchi, Kyohei Inoue, Masatoshi Nakamura
    The Japanese Journal of Rehabilitation Medicine.2026;[Epub]     CrossRef
  • Exercise with blood flow restriction among adults undergoing total knee arthroplasty: A scoping review
    Nelson Viscay-Sanhueza, Cristian Curilem Gatica, Carlos Bahamondes-Avila
    Journal of Bodywork and Movement Therapies.2025; 42: 665.     CrossRef
  • The effect of preoperative education on fear of first mobilization experienced after total knee arthroplasty in individuals
    Ayşegül Kaya İmrek, Meryem Yilmaz
    International Journal of Orthopaedic and Trauma Nursing.2025; 57: 101189.     CrossRef
  • Effectiveness of muscle strengthening in early postoperative total knee arthroplasty: systematic review with meta-analysis
    Alany Gabrielli Leite, Beatriz Batista Vicente, Alessandra Madia Mantovani, Allysiê Priscilla de Souza Cavina
    Fisioterapia e Pesquisa.2025;[Epub]     CrossRef
  • Eficácia do fortalecimento muscular no pós-operatório precoce de artroplastia total do joelho: revisão sistemática com metanálise
    Alany Gabrielli Leite, Beatriz Batista Vicente, Alessandra Madia Mantovani, Allysiê Priscilla de Souza Cavina
    Fisioterapia e Pesquisa.2025;[Epub]     CrossRef
  • Kinesiophobia and Pain Coping on Patients with Gonarthrosis: Postoperative Pain and Mobility
    Tevfik Şenol, Sevim Çelik
    Pain Management Nursing.2025;[Epub]     CrossRef
  • Recovery of gait speed and timed up and go test in three weeks after total knee arthroplasty
    Akira Iwata, Yuki Sano, Hideyuki Wanaka, Shingo Kobayashi, Kensuke Okamoto, Jun Yamahara, Masaki Inaba, Yuya Konishi, Junji Inoue, Atsuki Kanayama, Saki Yamamoto, Hiroshi Iwata
    European Journal of Physiotherapy.2024; 26(5): 256.     CrossRef
  • The real results of total knee arthroplasty in moderate-to-severe osteoarthritis: a 1-year cohort study
    André F. CANELAS, Paulo C. ARAÚJO, Raquel P. FONSECA, José B. FERREIRA, Simão E. SERRANO, Maria L. LUÍS, Filipa S. JANUÁRIO, Ana M. BÁRTOLO
    Minerva Orthopedics.2022;[Epub]     CrossRef
  • Establishment of a qualified integrated care system after total knee arthroplasty as a role of regional rheumatoid and degenerative arthritis centers
    Eun Young Han, Sang Rim Kim, Kye Hee Cho, Sang Hee Im
    BMC Geriatrics.2022;[Epub]     CrossRef
  • Comparison of simultaneous bilateral versus unilateral total knee replacement on pain levels and functional recovery
    Ahmad H. Alghadir, Zaheen A. Iqbal, Shahnawaz Anwer, Dilshad Anwar
    BMC Musculoskeletal Disorders.2020;[Epub]     CrossRef
  • Physical Performance Correlates with Self-Reported Physical Function and Quality of Life in Patients at 3 Months after Total Knee Arthroplasty
    Jun Hwan Choi, Bo Ryun Kim, Sang Rim Kim, Kwang Woo Nam, So Young Lee, Won Bin Kim, Youn Ji Kim
    Annals of Geriatric Medicine and Research.2020; 24(2): 99.     CrossRef
  • 11,240 View
  • 241 Download
  • 10 Web of Science
  • 12 Crossref
Retrospective Assessment of the Implementation of Critical Pathway in Stroke Patients in a Single University Hospital
Jin Hoan Kim, Ha Young Byun, Seungnam Son, Joong Hoon Lee, Chul Ho Yoon, Eun Shin Lee, Heesuk Shin, Min-Kyun Oh
Ann Rehabil Med 2014;38(5):603-611.   Published online October 30, 2014
DOI: https://doi.org/10.5535/arm.2014.38.5.603
Objective

To evaluate the effects of the implementation of critical pathway (CP) in stroke patients treated at a single university hospital.

Methods

A retrospective medical review collected data from 497 patients who had suffered acute stroke in the rehabilitation center. Stroke outcomes were compared between before and after the implementation of CP based on factors including demographic factors, stroke characteristics, pre-existing medical conditions, medical complications, functional states, and length of stay (LOS).

Results

After the implementation of CP, the patients showed significantly higher stage for upper proximal (p=0.008) and lower extremity (p=0.001) on Brunnstrom stage and significantly lower scores for modified Rankin Scale (p=0.003) at transfer. For those with pre-existing medical conditions, there were significantly increased osteoarthritis (p=0.002) and valvular heart disease (p=0.011). Regarding medical complications during acute inpatient rehabilitation, there were significantly decreased shoulder pain (p=0.001) and dysphagia (p=0.017), and significantly increased gastrointestinal symptoms (p=0.001). Functional gain and efficiency of stroke patients during rehabilitation center hospitalization did not significantly change after implementation of CP. But, shorter LOS of total hospitalization, pre-rehabilitation center hospitalization, and rehabilitation center hospitalization were evident.

Conclusion

After the implementation of CP, patients less often developed complications and displayed no changes in functional gain and efficiency. They had shorter LOS of total hospitalization, pre-rehabilitation center hospitalization and rehabilitation center hospitalization.

Citations

Citations to this article as recorded by  
  • Prevalence, Impact, and Treatment of Co-Occurring Osteoarthritis in Patients With Stroke Undergoing Rehabilitation
    John Fournier, Hillel Finestone, Julia Lauzon, T. Mark Campbell
    Stroke.2021;[Epub]     CrossRef
  • Assessment of the Implementation of Critical Pathway in Stroke Patients: A 10‐Year Follow‐Up Study
    Yun Jeong Jang, Dahye Park, Hyeong Seop Kim, Chang Han Lee, Ha Young Byun, Chul Ho Yoon, Eun Shin Lee, Heesuk Shin, Se-Woong Chun, Seung-Kyu Lim, Min-Kyun Oh, Adriana Carrá
    BioMed Research International.2020;[Epub]     CrossRef
  • Ischemic stroke: clinical pathway impact
    Antonio Giulio de Belvis, Franziska Michaela Lohmeyer, Andrea Barbara, Gabriele Giubbini, Carmen Angioletti, Giovanni Frisullo, Walter Ricciardi, Maria Lucia Specchia
    International Journal of Health Care Quality Assurance.2019; 32(3): 588.     CrossRef
  • Temporal Trends and Predictors of Drug Utilization and Outcomes in First-Ever Stroke Patients: A Population-Based Study Using the Singapore Stroke Registry
    See-Hwee Yeo, Wai-Ping Yau
    CNS Drugs.2019; 33(8): 791.     CrossRef
  • ESPEN guideline clinical nutrition in neurology
    Rosa Burgos, Irene Bretón, Emanuele Cereda, Jean Claude Desport, Rainer Dziewas, Laurence Genton, Filomena Gomes, Pierre Jésus, Andreas Leischker, Maurizio Muscaritoli, Kalliopi-Anna Poulia, Jean Charles Preiser, Marjolein Van der Marck, Rainer Wirth, Pie
    Clinical Nutrition.2018; 37(1): 354.     CrossRef
  • Clinical application of ICF key codes to evaluate patients with dysphagia following stroke
    Yi Dong, Chang-Jie Zhang, Jie Shi, Jinggui Deng, Chun-Na Lan
    Medicine.2016; 95(38): e4479.     CrossRef
  • 5,913 View
  • 56 Download
  • 7 Web of Science
  • 6 Crossref
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