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M. R. Reed - One of the best experts on this subject based on the ideXlab platform.
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knee replacement bandaging study krebs evaluating the effect of a two layer Compression Bandage system on knee function following total knee arthroplasty study protocol for a randomised controlled trial
Trials, 2019Co-Authors: Liz Cook, Matthew Northgraves, Caroline Fairhurst, Sarah Ronaldson, David J Torgerson, Jonathan Kent, M. R. ReedAbstract:Data from a feasibility study suggest that the use of an inelastic, short-stretch Compression Bandage following total knee arthroplasty is a safe technique that may improve patient-reported health outcomes, and that it is feasible to recruit to a full-scale study. We will conduct a randomised controlled trial (RCT) of 2600 adult patients, which has 80% power to detect a 1 point difference in the Oxford Knee Score (a patient self-reported assessment of knee pain and function) at 52 weeks. Short stretch Compression bandaging will be compared with standard wool and crepe bandaging following total knee arthroplasty. Recruitment will take place in orthopaedic units across the United Kingdom. Secondary outcomes include the EuroQol 5 Dimensions (EQ-5D)-5 L and EQ-5D-3 L scores, pain, length of hospital stay, and complications. The Knee Replacement Bandaging Study (KReBS) is a large study which aims to contribute to the evidence base for informing clinical decisions for the use of Compression bandaging following knee arthroplasty. International Standard Randomised Controlled Trial Register, ISRCTN 87127065 . Registered on 20 February 2017.
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STICKS study – Short-sTretch Inelastic Compression Bandage in Knee Swelling following total knee arthroplasty – a feasibility study
Trials, 2017Co-Authors: T. M. Brock, A. P. Sprowson, S. Muller, M. R. ReedAbstract:Background Postoperative knee swelling is common and impairs early postoperative function following total knee arthroplasty. It was hypothesised that the use of a short-stretch, inelastic Compression Bandage would reduce knee swelling and improve pain and early function. The aim of this study was to provide preliminary data and test feasibility with a view to informing a larger, future trial. Methods Fifty consecutive patients selected for primary total knee arthroplasty underwent distance randomisation to receive a short-stretch, inelastic Compression Bandage or a standard wool and crepe Bandage for the first 24 h postoperatively. Study feasibility including recruitment rates, retention rates and complications were analysed. The Oxford Knee Score, the EQ-5D-3L index score, knee swelling, knee range of motion, visual analogue pain score and length of stay were compared between groups. Analysis of covariance (ANCOVA) was performed adjusting for the preoperative measurement. Results Sixty-eight percent of eligible patients were recruited into the trial. The retention rate was 88%. There were no complications regarding Compression Bandage use. There was a greater mean but non-significant improvement in Oxford Knee Score ( p = 0.580; point estimate = 2.1; 95% CI −3.288 to 7.449) and EQ-5D-3L index score ( p = 0.057; point estimate = 0.147; 95% CI −0.328 to 0.005) in the Compression Bandage group at 6 months. There was no significant difference between groups regarding knee swelling, knee range of motion, visual analogue pain score, complications and length of stay. Conclusion Preliminary data suggests that the use of an inelastic, short-stretch Compression Bandage following total knee arthroplasty is a safe technique that is acceptable to patients. A larger, multicentre trial is required to determine its effect postoperatively. Trial registration The study was registered with Current Controlled Trials, identifier: ISRCTN86903140 . Registered on 30 May 2013.
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sticks study short stretch inelastic Compression Bandage in knee swelling following total knee arthroplasty a feasibility study
Trials, 2017Co-Authors: T. M. Brock, A. P. Sprowson, S D Muller, M. R. ReedAbstract:Postoperative knee swelling is common and impairs early postoperative function following total knee arthroplasty. It was hypothesised that the use of a short-stretch, inelastic Compression Bandage would reduce knee swelling and improve pain and early function. The aim of this study was to provide preliminary data and test feasibility with a view to informing a larger, future trial. Fifty consecutive patients selected for primary total knee arthroplasty underwent distance randomisation to receive a short-stretch, inelastic Compression Bandage or a standard wool and crepe Bandage for the first 24 h postoperatively. Study feasibility including recruitment rates, retention rates and complications were analysed. The Oxford Knee Score, the EQ-5D-3L index score, knee swelling, knee range of motion, visual analogue pain score and length of stay were compared between groups. Analysis of covariance (ANCOVA) was performed adjusting for the preoperative measurement. Sixty-eight percent of eligible patients were recruited into the trial. The retention rate was 88%. There were no complications regarding Compression Bandage use. There was a greater mean but non-significant improvement in Oxford Knee Score (p = 0.580; point estimate = 2.1; 95% CI −3.288 to 7.449) and EQ-5D-3L index score (p = 0.057; point estimate = 0.147; 95% CI −0.328 to 0.005) in the Compression Bandage group at 6 months. There was no significant difference between groups regarding knee swelling, knee range of motion, visual analogue pain score, complications and length of stay. Preliminary data suggests that the use of an inelastic, short-stretch Compression Bandage following total knee arthroplasty is a safe technique that is acceptable to patients. A larger, multicentre trial is required to determine its effect postoperatively. The study was registered with Current Controlled Trials, identifier: ISRCTN86903140 . Registered on 30 May 2013.
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short stretch inelastic Compression Bandage in knee swelling following total knee arthroplasty study sticks study protocol for a randomised controlled feasibility study
Trials, 2015Co-Authors: T. M. Brock, A. P. Sprowson, S D Muller, M. R. ReedAbstract:Enhanced recovery programmes in total knee arthroplasty are well established. Post-operative knee swelling is common and impairs early post-operative function. The use of a short-stretch, inelastic Compression Bandage is hypothesised to reduce knee swelling and improve pain and early function. A study was designed to test feasibility with a view to informing a larger, future trial and to provide preliminary data. This is a randomised controlled feasibility study. Fifty consecutive patients selected for primary total knee arthroplasty will be enrolled in the trial. Patients with a BMI >35, latex allergy or neurological or peripheral vascular disease are excluded. Patients are randomised by distance randomisation to receive a Compression Bandage for 24 hours after surgery or a standard wool and crepe Bandage. The Bandages are applied by one of two consultant surgeons who have had training with their application. Knee swelling, range of motion and pain scores will be compared pre-operatively and at day 1, day 2 and at 6 weeks between groups. The Oxford knee score and EQ-5D health status will be compared pre-operatively and at 6 months between groups. Recruitment rates, retention rates, resource allocation, completeness of data collection, and tolerance and complications with the Compression Bandage are recorded. Descriptive statistics are used to calculate a standard deviation for post-operative knee swelling in the groups and to perform a power calculation incorporating anticipated patient retention rates to inform a future trial. Preliminary data will be analysed using the independent samples t-test for equal distributions and the Mann-Whitney U for unequal distributions with the significance denoted at P <0.05. Enhanced recovery programmes have revolutionized the management of total knee arthroplasty. There is a paucity of clinical data regarding the efficacy of Compression Bandages. Large, randomised controlled trials are uncommon in orthopaedic surgery. The results of this study will provide feasibility and preliminary data prior to the construction of a larger, multicentre study. The study was registered with Current Controlled Trials ( ISRCTN86903140 ) on 30 May 2013.
Henrik Kehlet - One of the best experts on this subject based on the ideXlab platform.
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local infiltration analgesia in joint replacement the evidence and recommendations for clinical practice
Acta Anaesthesiologica Scandinavica, 2011Co-Authors: Henrik Kehlet, L O AndersenAbstract:Relief of acute pain after hip and knee replacement represents a major therapeutic challenge as post-operative pain hinders early mobilisation and rehabilitation with subsequent consequences on mobility, duration of hospitalisation and overall recovery. In recent years, there has been increased interest in high-volume local wound infiltration/infusion techniques in these operations with a combined administration of local anaesthetics, NSAIDs and epinephrine. This review provides an update of the current knowledge of the efficacy of the high-volume wound infiltration technique based on randomised trials. It is concluded that a predominant part of the data have had an insufficient design by not being placebo-controlled or with comparable systemic analgesia provided in the investigated groups. It is concluded that there is little evidence to support the use of the technique in hip replacement either intraoperatively or with a post-operative wound infusion catheter technique, provided that multimodal, oral non-opioid analgesia is given. In knee replacement, the data support the intraoperative use of the local infiltration technique but not the post-operative use of wound catheter administration. In knee replacement, a Compression Bandage prolongs the analgesic effect. There are limited data to support the use of NSAIDs or epinephrine in the solution and the data on post-operative hospitalisation and recovery are conflicting. Thus, shorter lengths of stay have been achieved by oral multimodal, non-opioid analgesia together with organisational optimisation of care according to the fast-track methodology.
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a Compression Bandage improves local infiltration analgesia in total knee arthroplasty
Acta Orthopaedica, 2008Co-Authors: L O Andersen, Henrik Husted, Kristian Stahl Otte, Billy B Kristensen, Henrik KehletAbstract:Background High-volume local infiltration analgesia has been shown to be an effective pain treatment after knee replacement, but the role of bandaging to prolong analgesia has not been evaluated.Methods 48 patients undergoing fast-track total knee replacement with high-volume (170 mL) 0.2% ropivacaine infiltration analgesia were randomized to receive a Compression or a non-Compression Bandage, and pain was assessed at rest and with mobilization at regular intervals for 24 h postoperatively.Results Pain at rest, during flexion, or on straight leg lift was lower for the first 8 h in patients with Compression Bandage than in those with non-Compression Bandage and with a similar low use of oxycodone. Mean hospital stay was similar (2.8 days and 3.3 days, respectively).Interpretation A Compression Bandage is recommended to improve analgesia after high-volume local infiltration analgesia in total knee arthroplasty.
L O Andersen - One of the best experts on this subject based on the ideXlab platform.
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local infiltration analgesia in joint replacement the evidence and recommendations for clinical practice
Acta Anaesthesiologica Scandinavica, 2011Co-Authors: Henrik Kehlet, L O AndersenAbstract:Relief of acute pain after hip and knee replacement represents a major therapeutic challenge as post-operative pain hinders early mobilisation and rehabilitation with subsequent consequences on mobility, duration of hospitalisation and overall recovery. In recent years, there has been increased interest in high-volume local wound infiltration/infusion techniques in these operations with a combined administration of local anaesthetics, NSAIDs and epinephrine. This review provides an update of the current knowledge of the efficacy of the high-volume wound infiltration technique based on randomised trials. It is concluded that a predominant part of the data have had an insufficient design by not being placebo-controlled or with comparable systemic analgesia provided in the investigated groups. It is concluded that there is little evidence to support the use of the technique in hip replacement either intraoperatively or with a post-operative wound infusion catheter technique, provided that multimodal, oral non-opioid analgesia is given. In knee replacement, the data support the intraoperative use of the local infiltration technique but not the post-operative use of wound catheter administration. In knee replacement, a Compression Bandage prolongs the analgesic effect. There are limited data to support the use of NSAIDs or epinephrine in the solution and the data on post-operative hospitalisation and recovery are conflicting. Thus, shorter lengths of stay have been achieved by oral multimodal, non-opioid analgesia together with organisational optimisation of care according to the fast-track methodology.
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a Compression Bandage improves local infiltration analgesia in total knee arthroplasty
Acta Orthopaedica, 2008Co-Authors: L O Andersen, Henrik Husted, Kristian Stahl Otte, Billy B Kristensen, Henrik KehletAbstract:Background High-volume local infiltration analgesia has been shown to be an effective pain treatment after knee replacement, but the role of bandaging to prolong analgesia has not been evaluated.Methods 48 patients undergoing fast-track total knee replacement with high-volume (170 mL) 0.2% ropivacaine infiltration analgesia were randomized to receive a Compression or a non-Compression Bandage, and pain was assessed at rest and with mobilization at regular intervals for 24 h postoperatively.Results Pain at rest, during flexion, or on straight leg lift was lower for the first 8 h in patients with Compression Bandage than in those with non-Compression Bandage and with a similar low use of oxycodone. Mean hospital stay was similar (2.8 days and 3.3 days, respectively).Interpretation A Compression Bandage is recommended to improve analgesia after high-volume local infiltration analgesia in total knee arthroplasty.
Malte Kuniss - One of the best experts on this subject based on the ideXlab platform.
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safety and feasibility of percutaneous skin closure using purse string suture compared with Compression Bandage after pulmonary vein isolation
Journal of Cardiovascular Electrophysiology, 2017Co-Authors: Ersan Akkaya, Alexander Berkowitsch, Sergej Zaltsberg, Nikolas Deubner, Harald Greiss, Andreas Hain, Christian W. Hamm, Johannes Sperzel, Thomas Neumann, Malte KunissAbstract:Introduction This observational study was designed to analyze the safety and feasibility of percutaneous skin closure using a purse-string suture and compare it with the use of a Compression Bandage after pulmonary vein isolation. Methods and results A total of 407 patients undergoing pulmonary vein isolation (217 with radiofrequency and 190 with cryoballoon ablation) were treated with either purse-string sutures or Compression Bandages. The purse-string suture was applied after ablation before withdrawal of the sheaths. Patients were on bed rest of 6 h prior to suture removal, which was accomplished 18 to 24 h after ablation. The Compression Bandage was applied after sheath withdrawal and was removed after 12 h of bed rest. We analyzed the occurrence of any vascular or thromboembolic complication as well as hospital costs and hospital stay length after ablation. The incidence of vascular complications after Compression Bandage was higher than after purse-string suture in the cryoballoon and radiofrequency group (p<0.05, respectively). The hospital costs were lower and hospital stay was shorter in both radiofrequency (4921±3145 vs. 5802±4006 Euro; 2.34±1.32 vs. 2.98±1.57 days, p<0.05) and cryoballoon groups (4705±3091vs. 5661±3563 Euro; 2.14±1.37 vs. 2.61±1.55 days, p<0.05) in patients treated with a purse-string suture. Conclusions Percutaneous skin closure with a purse-string suture has the clinical impact to reduce vascular complications, hospital costs and hospital stay length after pulmonary vein isolation. This article is protected by copyright. All rights reserved
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Safety and feasibility of percutaneous skin closure using purse-string suture compared with Compression Bandage after pulmonary vein isolation
Journal of Cardiovascular Electrophysiology, 2017Co-Authors: Ersan Akkaya, Alexander Berkowitsch, Sergej Zaltsberg, Nikolas Deubner, Harald Greiss, Andreas Hain, Christian W. Hamm, Johannes Sperzel, Thomas Neumann, Malte KunissAbstract:Introduction This observational study was designed to analyze the safety and feasibility of percutaneous skin closure using a purse-string suture and compare it with the use of a Compression Bandage after pulmonary vein isolation. Methods and results A total of 407 patients undergoing pulmonary vein isolation (217 with radiofrequency and 190 with cryoballoon ablation) were treated with either purse-string sutures or Compression Bandages. The purse-string suture was applied after ablation before withdrawal of the sheaths. Patients were on bed rest of 6 h prior to suture removal, which was accomplished 18 to 24 h after ablation. The Compression Bandage was applied after sheath withdrawal and was removed after 12 h of bed rest. We analyzed the occurrence of any vascular or thromboembolic complication as well as hospital costs and hospital stay length after ablation. The incidence of vascular complications after Compression Bandage was higher than after purse-string suture in the cryoballoon and radiofrequency group (p
Sarah E Lamb - One of the best experts on this subject based on the ideXlab platform.
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mechanical supports for acute severe ankle sprain a pragmatic multicentre randomised controlled trial
The Lancet, 2009Co-Authors: Sarah E Lamb, Jennifer Marsh, Jane L Hutton, Rachel A Nakash, Matthew CookeAbstract:Summary Background Severe ankle sprains are a common presentation in emergency departments in the UK. We aimed to assess the effectiveness of three different mechanical supports (Aircast brace, Bledsoe boot, or 10-day below-knee cast) compared with that of a double-layer tubular Compression Bandage in promoting recovery after severe ankle sprains. Methods We did a pragmatic, multicentre randomised trial with blinded assessment of outcome. 584 participants with severe ankle sprain were recruited between April, 2003, and July, 2005, from eight emergency departments across the UK. Participants were provided with a mechanical support within the first 3 days of attendance by a trained health-care professional, and given advice on reducing swelling and pain. Functional outcomes were measured over 9 months. The primary outcome was quality of ankle function at 3 months, measured using the Foot and Ankle Score; analysis was by intention to treat. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN37807450. Results Patients who received the below-knee cast had a more rapid recovery than those given the tubular Compression Bandage. We noted clinically important benefits at 3 months in quality of ankle function with the cast compared with tubular Compression Bandage (mean difference 9%; 95% CI 2·4–15·0), as well as in pain, symptoms, and activity. The mean difference in quality of ankle function between Aircast brace and tubular Compression Bandage was 8%; 95% CI 1·8–14·2, but there were little differences for pain, symptoms, and activity. Bledsoe boots offered no benefit over tubular Compression Bandage, which was the least effective treatment throughout the recovery period. There were no significant differences between tubular Compression Bandage and the other treatments at 9 months. Side-effects were rare with no discernible differences between treatments. Reported events (all treatments combined) were cellulitis (two cases), pulmonary embolus (two cases), and deep-vein thrombosis (three cases). Interpretation A short period of immobilisation in a below-knee cast or Aircast results in faster recovery than if the patient is only given tubular Compression Bandage. We recommend below-knee casts because they show the widest range of benefit. Funding National Co-ordinating Centre for Health Technology Assessment.
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treatment of severe ankle sprain a pragmatic randomised controlled trial comparing the clinical effectiveness and cost effectiveness of three types of mechanical ankle support with tubular Bandage the cast trial
Health Technology Assessment, 2009Co-Authors: Matthew Cooke, Jennifer Marsh, Jane L Hutton, Rachel A Nakash, Michael Clark, R M Jarvis, Ala Szczepura, Susan R Wilson, Sarah E LambAbstract:OBJECTIVE To estimate the clinical effectiveness and cost-effectiveness of three methods of ankle support compared with double layer tubular Compression Bandage. DESIGN A randomised controlled trial, designed to reflect practice in UK hospital emergency departments. SETTING Eight emergency departments in England. PARTICIPANTS Aged 16 or over with acute severe ankle sprain, unable to weight bear, no fracture. INTERVENTIONS 584 participants were randomised to one of four treatment arms: tubular Bandage, below knee cast, Aircast ankle brace or Bledsoe boot, all applied 2-3 days after presentation to allow swelling to resolve. MAIN OUTCOME MEASURES Response to treatment was assessed using the Foot and Ankle Outcome Score and generic measures (Functional Limitations Profile, SF-12 and EQ-5D). RESULTS When adjusted for age, sex and baseline scores, the below knee cast offered a small but statistically significant benefit at 4 weeks in terms of pain (FAOS pain difference 5.1; 95% CI 0.4-9.8), foot- and ankle-related quality of life (QoL) (FAOS QoL difference 5.9; 95% CI 0.1-11.8) and the physical component of the SF-12 (SF-12 score difference 2.2; 95% CI 0.0-4.4). Neither the Aircast brace nor the Bledsoe boot was statistically or clinically better. At 12 weeks the below knee cast was significantly better than tubular Bandage in terms of pain (FAOS pain difference 5.1; 95% CI 0.3-10.0), activities of daily living (FAOS ADL difference 3.5; 95% CI 0.4-6.6), sports (FAOS sports difference 8.7; 95% CI 1.6-15.7) and QoL (FAOS QoL difference 8.7; 95% CI 2.4-15.0), and the Aircast brace was better only in terms of ankle-related QoL and mental health. The Bledsoe boot conferred no significant advantage over tubular Bandage. By 9 months there were no significant differences. Based on mean direct health-care costs per participant, the Bledsoe boot was the most expensive (215 pounds) and tubular Bandage the least so (1 pound 44 pence). Inclusion of indirect costs (sick leave) raised overall costs substantially and removed any significant differences between the therapies. Cost-utility analysis demonstrated that the Aircast brace [301 pounds per quality-adjusted life-year (QALY)] and below knee cast (339 pounds per QALY) were more cost-effective than the Bledsoe boot (2116 pounds per QALY). However, inclusion of indirect costs produced different rank orders, depending on the assumptions made, and results should be treated with caution. CONCLUSIONS The below knee cast and the Aircast brace offered cost-effective alternatives to tubular Bandage for acute severe ankle sprain, the former having the advantage in terms of overall recovery at 3 months. As there were no differences in long-term outcome, practitioners should consider likely compliance and acceptability to patients when choosing a brace.