Guest guest Posted July 6, 2000 Report Share Posted July 6, 2000 - I find your question to be very interesting. In a literature search I did a year ago, research does not show a difference in patients function who use the CPM and those who do not, yet most orthopedic surgeons continue to use the CPM. In our hospital, orthopedic surgeries are 50% of our caseload. All the surgeons place CPM's on their patients. When I started to question this practice based on the research I had reviewed there was strong resistance to even considering that the CPM is not beneficial. Unfortunately, the surgeons aren't willing to support any internal research with some patients receiving the CPM and others not receiving it because they are so sold on the concept they feel they would jeopardize the functional outcomes of the patients not receiving CPM. Just for a reference our average LOS for TKA patients is 3.5 days receiving BID PT 7 days per week. Sincerley, M. Vinson, MPA, PT Ingham Regional Medical Center Lansing, MI vinsontm@irmcmail@... >>> " Angelle Driggs " 07/06 12:33 AM >>> I am currently a second year student at the U of Mobile Graduate School of PT. I am trying to find out about the functional outcomes obtained between TKA patients who use continuous passive motion (CPM) vs patients who receive active physical therapy. I have performed a search through Medline, but would like to know what other PTs are doing concerning the use of CPM with post TKA patients. Thanks in advance, Driggs OTin1999@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 6, 2000 Report Share Posted July 6, 2000 What % of your TKA patients go directly home at 3.5 days? What % go on to skilled level of care? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 6, 2000 Report Share Posted July 6, 2000 One of our Orthopedistist went to a course a couple of years ago where the research taht discussed was presented. He came back and did an internal study of his own and concluded there was no difference at 6 months post op so he has discontinued the routine use of the CPM and we have a very aggressive protocol for his patients. He does 70+ % of the total joints at this facility. Two of his partners does 25% and one other the rest. We are working on a pathway that will standardize the treatment for all the TJ patients no matter the doctor. Of his partners one routinely orders CPM the other 50% of the time. The other doc has his own routine!! The MD that does the most only uses CPM on manipulations or revisions or if we requestr it. The CPMS are owned by this department. Pat >>> " Vinson " 07/06/00 09:03AM >>> - I find your question to be very interesting. In a literature search I did a year ago, research does not show a difference in patients function who use the CPM and those who do not, yet most orthopedic surgeons continue to use the CPM. In our hospital, orthopedic surgeries are 50% of our caseload. All the surgeons place CPM's on their patients. When I started to question this practice based on the research I had reviewed there was strong resistance to even considering that the CPM is not beneficial. Unfortunately, the surgeons aren't willing to support any internal research with some patients receiving the CPM and others not receiving it because they are so sold on the concept they feel they would jeopardize the functional outcomes of the patients not receiving CPM. Just for a reference our average LOS for TKA patients is 3.5 days receiving BID PT 7 days per week. Sincerley, M. Vinson, MPA, PT Ingham Regional Medical Center Lansing, MI vinsontm@irmcmail@... Pat Corrigan Jobes, PT Director of Rehabilitation Services Methodist Healthcare-North Hospital 3960 New Covington Pike Memphis, Tn 38128 Phone: (901)384-5320 Fax: (901)384-5099 E-Mail: jobesm@... >>> " Angelle Driggs " 07/06 12:33 AM >>> I am currently a second year student at the U of Mobile Graduate School of PT. I am trying to find out about the functional outcomes obtained between TKA patients who use continuous passive motion (CPM) vs patients who receive active physical therapy. I have performed a search through Medline, but would like to know what other PTs are doing concerning the use of CPM with post TKA patients. Thanks in advance, Driggs OTin1999@... Coming September 22,2000 - Helene Fearon on Coding and Reimbursement - Rochester Michigan. Register at today. Rehab Pro - The New Way...A Better Way to Rehab Success! Call for details (800) 540-0774 LAMP Summit 2000. July 23-25, 2000 Register at . Visit our EStore at www.RehabBusiness.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 7, 2000 Report Share Posted July 7, 2000 The issue of using CPMS on TJR (specifically total knee replacements) is a bit of a clinical bugaboo.... Interestingly, the original research related to CPMs was done by Salter (on New Zealand rabbits I believe), and it studied the effects of " cage activity " vs. immobilization (there may also have been a group of rabbits that got continuous motion without weight bearing...but I can't remember the details) on rabbits whose articular cartilage had been experimentally damage. The results as we all know now is that the rabbits that got " motion " showed some ability to repair their cartilage (though it was fibrocartilage that replaced the damaged articular cartilage)....those that had their " knees " immobilized did the worse. The good news is that we now manage cartilage injury/repair/grafting and other soft tissue arthroplasty much differently as a result. (When was the last time you saw a patient rigidly immobilized after ACL reconstruction, or for a meniscal tear/repair?). The bad news is that the principle was applied to artificial joint replacement.....based somewhat on assumption of benefit. Granted, there is obviously soft tissue involvement with total joint replacement, so early motion is obviously necessary and beneficial (versus immobilization), but the question really is about whether continuous passive motion is better then early mobilization on nonarticular soft tissue. As cited, studies done to look at this (one done here about 10 years ago or so), show no functional difference between patients getting CPM vs. " just " (ugh) P.T., in the long run, but they have shown benefit in pain management and (small) decrease in incidence of DVT. Since the time many of those studies were done, pain management has greatly improved. Our own patients are on epidural analgesia for 48 hours (sometimes a little longer), and it is so effectively managed that they usually have motor control while achieving near zero pain. As a result, the knee is already moving well once the epidural is removed, so effective pain management continues as a result of good mobilization. So, the debate about efficacy of CPMs on TKR needs to continue. From this perspective, it may not contribute to any better short or long term outcomes, and it's possible it is more costly. The problem is that we're now dealing w/precedent and perspective. As one of our orthopedists commented, his patients expect to see " high tech " , and CPMs are part of that perception! E. Arslanian, PT, MS Director of Rehabilitation Services Brigham & Women's Hospital Boston, MA 02115 larslanian1@... > Re: CPM for TKA > > > One of our Orthopedistist went to a course a couple of years ago where the > research taht discussed was presented. He came back and did an > internal study of his own and concluded there was no difference at 6 months > post op so he has discontinued the routine use of the CPM and we have a very > aggressive protocol for his patients. He does 70+ % of the total joints at > this facility. Two of his partners does 25% and one other the rest. We are > working on a pathway that will standardize the treatment for all the TJ > patients no matter the doctor. > > > Of his partners one routinely orders CPM the other 50% of the time. The > other doc has his own routine!! > > The MD that does the most only uses CPM on manipulations or revisions or if > we requestr it. > > The CPMS are owned by this department. > > Pat > >>> " Vinson " 07/06/00 09:03AM >>> > - > I find your question to be very interesting. In a literature search I did a > year ago, research does not show a difference in patients function who use > the CPM and those who do not, yet most orthopedic surgeons continue to use > the CPM. In our hospital, orthopedic surgeries are 50% of our caseload. > All the surgeons place CPM's on their patients. When I started to question > this practice based on the research I had reviewed there was strong > resistance to even considering that the CPM is not beneficial. > Unfortunately, the surgeons aren't willing to support any internal research > with some patients receiving the CPM and others not receiving it because > they are so sold on the concept they feel they would jeopardize the > functional outcomes of the patients not receiving CPM. Just for a reference > our average LOS for TKA patients is 3.5 days receiving BID PT 7 days per > week. > > Sincerley, > M. Vinson, MPA, PT > Ingham Regional Medical Center > Lansing, MI > > vinsontm@irmcmail@... > > Pat Corrigan Jobes, PT > Director of Rehabilitation Services > Methodist Healthcare-North Hospital > 3960 New Covington Pike > Memphis, Tn 38128 > Phone: (901)384-5320 > Fax: (901)384-5099 > E-Mail: jobesm@... > > >>> " Angelle Driggs " 07/06 12:33 AM >>> > I am currently a second year student at the U of Mobile Graduate School of > PT. I am trying to find out about the functional > outcomes obtained between TKA patients who use continuous passive motion > (CPM) vs patients who receive active physical therapy. I have performed a > search through Medline, but would like to know what other PTs are doing > concerning the use of CPM with post TKA patients. > > Thanks in advance, > Driggs > OTin1999@... > > > > > Coming September 22,2000 - Helene Fearon on Coding and Reimbursement - > Rochester Michigan. Register at today. > Rehab Pro - The New Way...A Better Way to Rehab Success! Call for details > > LAMP Summit 2000. July 23-25, 2000 Register at . > Visit our EStore at www.RehabBusiness.com > > > > > > > Coming September 22,2000 - Helene Fearon on Coding and Reimbursement - > Rochester Michigan. Register at today. > Rehab Pro - The New Way...A Better Way to Rehab Success! Call for details > > LAMP Summit 2000. July 23-25, 2000 Register at . > Visit our EStore at www.RehabBusiness.com > > > > > Coming September 22,2000 - Helene Fearon on Coding and Reimbursement - > Rochester Michigan. Register at today. > Rehab Pro - The New Way...A Better Way to Rehab Success! Call for details > > LAMP Summit 2000. July 23-25, 2000 Register at . > Visit our EStore at www.RehabBusiness.com > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 7, 2000 Report Share Posted July 7, 2000 " Arslanian, E. " wrote: > The issue of using CPMS on TJR (specifically total knee replacements) is a bit > of a clinical bugaboo.... I don't agree 100% with this statement. I think there is evidence to show that CPM is useful after TJR, including TKR, although I think that other joint problems may be more positively affected by CPM (eg. rotator cuff repair, adhesive capsulitis, hand joint replacement, etc.). I think we sometimes may make incorrect assumptions based on our failure to fully explore the vast literature available on this topic, or our own misunderstanding of the effects of CPM on joint soft tissue structures. I am *not* an expert in this area, but I do know that the use of CPM is a multi-faceted topic. I have listed just a few references at the end of this post that relate to CPM, there are literally thousands. I believe the article by et al. clearly makes the point that there are multiple effects of CPM, and that its use after joint replacement is just a tiny part of the picture. Based on the articles listed, my own reading over the years, and a project one of my student research groups did a few years ago, we might conclude: 1. CPM results in decreased stiffness of periarticular tissues (based mostly on Woo's and Amiel's work) 2. CPM results in cartilage healing (based mostly on Salter's work and later research) 3. CPM may result in decreased DVT formation after TKR and decreased LOS in hospital. (Gose, Phys Ther, 1987, see list below) 4. CPM after TKR does not have any long term benefit (see reference list) 5. CPM may be just as effective, and much less costly, than physical therapy after TKR (see Worland et al, J Arthoplasty, 1998, in reference list, and Montgomery and Eliassson, Acta Orthop Scand, 1996 in list) > > > Interestingly, the original research related to CPMs was done by Salter (on New > Zealand rabbits I believe), and it studied the effects of " cage activity " vs. > immobilization (there may also have been a group of rabbits that got continuous > motion without weight bearing...but I can't remember the details) on rabbits > whose articular cartilage had been experimentally damage. The purpose of the experiment was to examine the effects of CPM on articular cartilage healing, not the effects of cage activity per se. For historical reasons alone, this article should probably be familiar to all PTs (Salter RB, Simmonds DF, Malcolm BW, Rumble EJ, Mac D, Clements ND. The biological effect of continuous passive motion on the healing of full-thickness defects in articular cartilage. An experimental investigation in the rabbit.J Bone Joint Surg Am. 1980 Dec;62(8):1232-51. Here are a couple of later references that reflect further research and thoughts on the subject. It can be useful to follow the evolution of thinking on a topic over time. Salter RB. The biologic concept of continuous passive motion of synovial joints. The first 18 years of basic research and its clinical application. Clin Orthop. 1989 May;(242):12-25. Review. Salter RB. History of rest and motion and the scientific basis for early continuous passive motion. Hand Clin. 1996 Feb;12(1):1-11. Review. The experimental rabbits in Salter's original work did indeed get CPM without weightbearing. I remember hearing him present his research findings (early 80's, I believe) and he had a very amusing film clip that illustrated the CPM - a view from the hind end of the moving limbs, followed by a view from the front end of the rabbits happily chewing their food. It was not a study of cage activity per se, this difference had already been demonstrated for articular cartilage and for other tissues (for example, Zuckermanm J, Stull GA. Ligamentous separation force in rats as influenced by training, detraining and cage restriction, Med. Sci. Sports 5:44-49, 1973). Dr. Salter's groundbreaking research did lead to the development of commercial CPM devices (which were not available before that time), these devices were then used in many different ways depending on the interests of the investigators. > The results as we all > know now is that the rabbits that got " motion " showed some ability to repair > their cartilage (though it was fibrocartilage that replaced the damaged > articular cartilage)....those that had their " knees " immobilized did the worse. > The good news is that we now manage cartilage injury/repair/grafting and other > soft tissue arthroplasty much differently as a result. (When was the last time > you saw a patient rigidly immobilized after ACL reconstruction, or for a > meniscal tear/repair?). The bad news is that the principle was applied to > artificial joint replacement.....based somewhat on assumption of benefit. I think this is a bit of a misinterpretation of Salter's initial research, which related entirely to the physiological effects of CPM on articular cartilage. It certainly was good news, though, and combined with a *lot* of research on other soft tissues (ligament, primarily; eg. Noyes et al's ACL work, Vailas' MCL work) did lead to a shift in attitude toward the use of immobilization. Here, for example, is what Salter had to say about CPM in 1984, clearly joint replacement is a very small part of the picture: Salter RB, Hamilton HW, Wedge JH, Tile M, Torode IP, O'Driscoll SW, Murnaghan JJ, Saringer JH. Clinical application of basic research on continuous passive motion for disorders and injuries of synovial joints: a preliminary report of a feasibility study. J Orthop Res 1984;1(3):325-42 Since 1970, when the concept of continuous passive motion (CPM) was originated by one of the authors (R.B.S.), he and a succession of his research fellows have investigated its biological effects on the healing and regeneration of articular tissues in a wide variety of experimental models in rabbits. From this basic research he concluded that CPM is well tolerated, seems to be painless, stimulates the healing and regeneration of articular tissues, prevents joint stiffness, and permits the normal healing of arthrotomy incisions. Beginning in 1975, one of the authors (H.W.H.), and in 1978, the remaining authors, (from two additional Canadian cities) applied the knowledge from the basic research on CPM to the orthopaedic care of human patients. The CPM devices for humans (CPM Mobilimbs), which have been designed in collaboration with University of Toronto engineers, include, to date, devices for the ankle-knee-hip, the elbow, and the finger. Indications for CPM in patients have been the immediate postoperative management following such operative procedures as open reduction and internal fixation of fractures, arthrotomy and arthrolysis for post-traumatic arthritis, synovectomy, surgical drainage for septic arthritis, release of extraarticular contractures, metaphyseal osteotomies, total joint replacement, and ligamentous reconstruction. The case reports of nine selected patients are presented as examples of the clinical application of CPM. These patients have been relatively free of pain, have maintained the increased motion gained at operation, and have accepted the application of CPM well. There have been no complications of CPM; the operative wounds have healed well and the period of hospitalization has not been prolonged. The authors believe that the clinical application of CPM is feasible and that the clinical and radiographic results of CPM in these patients are encouraging. Long-term, prospective clinical investigations (including control patients in whom CPM is not used) will be required to assess the efficacy of CPM in relation to the various stated indications I think it was the availability of CPM devices, rather than Salter's research per se, that led investigators to explore their use in many other conditions. Followup research eventually led to the conclusion that CPM reduced LOS for TKR patients, but did not significantly effect ROM or function, see, for example: Maloney WJ, Schurman DJ, Hangen D, Goodman SB, Edworthy S, Bloch DA. The influence of continuous passive motion on outcome in total knee arthroplasty. Clin Orthop. 1990 Jul;(256):162-8. > > > Granted, there is obviously soft tissue involvement with total joint > replacement, so early motion is obviously necessary and beneficial (versus > immobilization), but the question really is about whether continuous passive > Since the time many of those studies were done, pain > management has greatly improved. Our own patients are on epidural analgesia for > 48 hours (sometimes a little longer), and it is so effectively managed that they > usually have motor control while achieving near zero pain. As a result, the > knee is already moving well once the epidural is removed, so effective pain > management continues as a result of good mobilization. The issue of pain relief is an extremely important point, I think. Indeed, pain relief was one of the primary objectives of the early clinical users of CPM after TKR (like RD Coutts in San Diego). Anything that relieves the (substantial) pain after TKR should result in improved short term results. However, I would guess that the longterm effect (say one year) is neglible. > > > So, the debate about efficacy of CPMs on TKR needs to continue. From this > perspective, it may not contribute to any better short or long term outcomes, > and it's possible it is more costly. The problem is that we're now dealing > w/precedent and perspective. As one of our orthopedists commented, his patients > expect to see " high tech " , and CPMs are part of that perception! Well, according to at least one reference below, CPM is as effective as physical therapy in the short-term, and costs half as much! " We conclude that the CPM machine after the hospital discharge of patients having total knee replacement is an adequate rehabilitation alternative with lower cost and with no difference in results compared with professional therapy " (Worland et al, 1998).So it is clearly also *possible* that physical therapy that may not contribute significantly to the short term outcomes and may be more costly. (Please note that I am not arguing in support of this point, which flies in the face of clinical experience and other evidence, merely pointing out that someone found this to be so). Like all other treatment approaches, it is probably safe to assume that CPM is a useful device and may be indicated for some patients after TKR, i.e. it is probably not necessary for *all* TKR patients. Like all our patient categories, we need far better diagnostic/predictive criteria to decide when to use a particular treatment approach. Just as a diagnosis of " low back pain " is not enough to allow us to decide what treatment approach to select, TKR is not enough of a diagnostic label to automatically indicate that the use of CPM is necessary or beneficial. However, it does not mean it won't be, either, at least in terms of discharge time. Sandy Curwin Husson College Bangor, Maine Here are a few references that I gathered quickly. Sorry they are not neater, but I already spent way too much time on this post! Clin Orthop 1984 May;(185):113-25 Physiology and therapeutic value of passive joint motion. C, Akeson WH, Woo SL, Amiel D, Coutts RD Despite the long history of therapeutic experience with different types and amounts of passive joint motion, its effects and the principles of its use remain controversial. Through empiric success, a spectrum of passive motion has evolved for various clinical purposes, including joint diagnosis; correction of joint deformities; mobilization of stiff joints; stimulation of joint healing; neuromuscular re-education; and prevention of immobilization complications (e.g., contracture formation, connective tissue atrophy, relative healing inhibition, and associated stasis abnormalities). However, the potential abuses of passive motion (e.g., causing additional tissue trauma, mobilizing unprotected joints, and stretching the wrong joints or tissues) have created serious doubts as to the value of this therapy and raised important questions concerning the lack of proper definition (e.g., force, direction, speed, and duration) and the unknown margins of safety. Clinical and experimental evidence supports the probable effectiveness of passive joint motion on joint and tissue levels, but without a better quantitative understanding of the mechanisms of action, dose-responsiveness, specific tissue effects, and, most important, their controls. Thus, passive motion will continue to be used suboptimally with inconsistent results. When these clinical and research deficiencies are corrected, passive motion will attain its proper place as a powerful and reliable orthopedic tool. Phys Ther 1987 Jan;67(1):39-42 Continuous passive motion in the postoperative treatment of patients with total knee replacement. A retrospective study. Gose JC The purpose of this study was to evaluate the effects of adding three 1-hour sessions of continuous passive motion (CPM) each day to the entire postoperative program of patients who received a total knee replacement (TKR). A retrospective chart review was completed for 55 patients (8 with bilateral involvement, totaling 63 knees) who received a TKR between 1981 and 1984. The data analysis compared the following variables for 32 patients who received CPM and 23 patients who received no CPM: the length of hospital stay (LOS), the number of postoperative days (PODs) before discharge, the frequency of postoperative complications, and the knee range of motion at discharge. The CPM Group showed significant decreases in the frequency of complications (p less than .05), the LOS (p less than .01), and in the number of PODs (p less than .001). No difference was demonstrated in the ROM of the two groups. These results support the use of postoperative applications of CPM, but not as strongly as those reported from studies that used longer periods of CPM. Further research is indicated to delineate the minimum dosage of CPM needed to obtain the maximum beneficial effects. J Rehabil Res Dev 2000 Mar-Apr;37(2):179-88 Continuous passive motion (CPM): theory and principles of clinical application. O'Driscoll SW, Giori NJ Mayo Clinic, Rochester, MN 55905, USA. odriscoll.shawn@... [Medline record in process] Stiffness following surgery or injury to a joint develops as a progression of four stages: bleeding, edema, granulation tissue, and fibrosis. Continuous passive motion (CPM) properly applied during the first two stages of stiffness acts to pump blood and edema fluid away from the joint and periarticular tissues. This allows maintenance of normal periarticular soft tissue compliance. CPM is thus effective in preventing the development of stiffness if full motion is applied immediately following surgery and continued until swelling that limits the full motion of the joint no longer develops. This concept has been applied successfully to elbow rehabilitation, and explains the controversy surrounding CPM following knee arthroplasty. The application of this concept to clinical practice requires a paradigm shift, resulting in our attention being focused on preventing the initial or delayed accumulation of periarticular interstitial fluids. J Arthroplasty 1998 Oct;13(7):784-7 Home continuous passive motion machine versus professional physical therapy following total knee replacement. Worland RL, Arredondo J, Angles F, -Jimenez F, Jessup DE Advanced Orthopaedic Centers, HealthSouth Medical Center, Richmond, Virginia 23294, USA. A vigorous rehabilitation program following discharge from the hospital is necessary for patients having a total knee arthroplasty to maintain and improve range of motion and function. To compare the effectiveness of the continuous passive motion (CPM) machine as a home therapy program versus professional physical therapy, a prospective, comparative, randomized clinical study of 103 consecutive primary total knee arthroplasties in 80 patients (23 bilateral) was performed. The CPM group consisted of 37 patients (49 knees), and the physical therapy group consisted of 43 patients (54 knees). At 2 weeks, knee flexion was similar in the two groups, but a flexion contracture was noted in the CPM group (4.2 degrees). This difference is felt by the authors to be clinically insignificant. At 6 months, there were no differences in knee scores, knee flexion, presence of flexion contracture, or extensor lag between the two groups. The cost for the CPM machine group was $10,582 ($286 per patient), and the cost for professional therapy was $23,994 ($558 per patient). We conclude that the CPM machine after the hospital discharge of patients having total knee replacement is an adequate rehabilitation alternative with lower cost and with no difference in results compared with professional therapy. Clin Orthop 1997 Dec;(345):38-43 Continuous passive motion with accelerated flexion after total knee arthroplasty. Yashar AA, Venn- E, Welsh T, Colwell CW Jr, Lotke P Bluegrass Orthopaedic Group, Louisville, Kentucky, USA. The use of continuous passive motion after total knee arthroplasty remains controversial. A new approach, starting continuous passive motion at 70 degrees to 100 degrees flexion in the recovery room (Group I) was evaluated. A randomized, prospective study of 210 consecutive total knee arthroplasties was performed at two institutions. The control population (Group II) started continuous passive motion at 0 degree to 30 degrees, and progressed toward 100 degrees flexion. Flexion at postoperative Day 3 (Group I = 82.5 degrees, Group II = 72.8 degrees), and at discharge (Group I = 89.1 degrees, Group II = 84.3 degrees) were significantly different. There was no significant difference between the groups at 4 weeks (Group I = 5.0 degrees-104.1 degrees, Group II = 5.6 degrees-102.0 degrees), 6 weeks (Group I = 2.3 degrees-104.8 degrees, Group II = 2.7 degrees-103.6 degrees), 12 weeks (Group I = 1.7 degrees-107.7 degrees, Group II = 4.7 degrees-108.2 degrees), or at 1 year (Group I = 0.5 degree-113.2 degrees, Group II = 1.8 degrees-110.5 degrees). In Group I, wound necrosis developed in one patient that required a gastrocnemius flap. This major complication was caused by a tight dressing, and not necessarily to the accelerated flexion continuous passive motion. This investigation shows that continuous passive motion using accelerated flexion allows increased flexion during the hospital stay without increased risk of complications, pain, or blood loss. This has significant implications for achieving safe, early discharge. However, no difference was found at followup of 4 weeks or greater, and this did not add significantly to the final outcome. J Bone Joint Surg Br 1997 Nov;79(6):914-7 Continuous passive motion after primary total knee arthroplasty. Does it offer any benefits? Pope RO, Corcoran S, McCaul K, Howie DW Royal Adelaide Hospital, Australia. We report a prospective randomly controlled trial to examine the effectiveness of continuous passive motion (CPM) in improving postoperative function and range of movement after total knee arthroplasty (TKA). We allocated 53 patients (57 knees) to one of three postoperative regimes: no CPM (n = 19); CPM at 0 to 40 degrees (0 to 40 CPM; n = 18); and CPM at 0 to 70 degrees (0 to 70 CPM; n = 20). Those in the CPM groups had CPM for 48 hours and all patients had an identical regime of physiotherapy. There was an even distribution of various cemented and cementless TKAs in each group. Patients were assessed preoperatively and at one week and at one year postoperatively. At one week, there was a statistically significant increase in the range of flexion and total range of movement in the 0 to 70 CPM group compared with the no-CPM group. At one year we found no significant differences in mean flexion, overall range of movement, fixed flexion deformity or functional results in the three groups. Those who had CPM had a significant increase in analgesic requirement (p = 0.04). There was an increased mean blood drainage postoperatively in those who had 0 to 70 CPM (1558 ml) compared with those with no CPM (956 ml) (t = 2.96, p = 0.005) and with 0 to 40 CPM (1017 ml) (t = 2.62, p = 0.01). Our findings show that CPM had no significant advantage in terms of improving function or range of movement, and that its use increased blood loss and analgesic requirements. Hand Clin 1996 Feb;12(1):1-11 History of rest and motion and the scientific basis for early continuous passive motion. Salter RB Division of Orthopaedic Surgery, University of Toronto, Canada. The history of rest, early motion, and CPM is described. The success of CPM stems from two main factors: basic research has validated the concept, and the clinical applications of CPM for various joints of the extremities have produced very satisfactory results. Acta Orthop Scand 1996 Feb;67(1):7-9 Continuous passive motion compared to active physical therapy after knee arthroplasty: similar hospitalization times in a randomized study of 68 patients. Montgomery F, Eliasson M Department of Orthopedics, Malmo University Hospital, Lund University, Sweden. 68 consecutive patients who had primary knee arthroplasties because of arthrosis were randomized to postoperative continuous passive motion (CPM) or active physical therapy (APT). Rehabilitation in both groups was initiated on the first postoperative day. The CPM group sustained less postoperative knee swelling with more rapid initial improvement in knee flexion than did the APT group, but there were no differences between the groups in knee flexion at discharge. Postoperative pain rating and hospitalization times were similar in the two groups. Nutrition 1995 Sep-Oct;11(5):428-32 Effect of passive stretching on the wasting of muscle in the critically ill. Griffiths RD, Palmer TE, Helliwell T, MacLennan P, MacMillan RR Department of Medicine, University of Liverpool, United Kingdom. This study examine whether muscle wasting in critically ill patients can be prevented by passive stretching alone in the absence of contractile activity. Five critically ill patients who required a complete neuromuscular blockade for 7 days of ventilator support were studied. One leg of each patient was treated with continuous passive motion (CPM) for three 3-h periods daily while the other leg received only routine nursing care. Fiber atrophy was prevented in the more severely ill patients and there was a slight gain in fiber area (mean increase, +11%) in the CPM limb compared with the control leg, which decreased (mean decrease, -35%) over 7 days. Fiber area was preserved in both fiber types but was more pronounced in type I muscle fibers. Protein loss was significantly less in the CPM limb. There was a significantly greater increase in wet weight per mg DNA in the control limb. However, as an index of wasting, the ratio of protein to DNA decreased similarly in both limbs. Passive stretching can preserve the architecture of muscle fibers. Whether it can prevent muscle wasting remains uncertain. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 7, 2000 Report Share Posted July 7, 2000 Has anyone looked at DC destination from acute comparing CPM vs no CPM use. IE: Are CPM users more likely to be DC'd home? > Re: CPM for TKA > > > One of our Orthopedistist went to a course a couple of years ago where the > research taht discussed was presented. He came back and did an > internal study of his own and concluded there was no difference at 6 > months > post op so he has discontinued the routine use of the CPM and we have a > very > aggressive protocol for his patients. He does 70+ % of the total joints > at > this facility. Two of his partners does 25% and one other the rest. We > are > working on a pathway that will standardize the treatment for all the TJ > patients no matter the doctor. > > > Of his partners one routinely orders CPM the other 50% of the time. The > other doc has his own routine!! > > The MD that does the most only uses CPM on manipulations or revisions or > if > we requestr it. > > The CPMS are owned by this department. > > Pat > >>> " Vinson " 07/06/00 09:03AM >>> > - > I find your question to be very interesting. In a literature search I did > a > year ago, research does not show a difference in patients function who use > the CPM and those who do not, yet most orthopedic surgeons continue to use > the CPM. In our hospital, orthopedic surgeries are 50% of our caseload. > All the surgeons place CPM's on their patients. When I started to > question > this practice based on the research I had reviewed there was strong > resistance to even considering that the CPM is not beneficial. > Unfortunately, the surgeons aren't willing to support any internal > research > with some patients receiving the CPM and others not receiving it because > they are so sold on the concept they feel they would jeopardize the > functional outcomes of the patients not receiving CPM. Just for a > reference > our average LOS for TKA patients is 3.5 days receiving BID PT 7 days per > week. > > Sincerley, > M. Vinson, MPA, PT > Ingham Regional Medical Center > Lansing, MI > > vinsontm@irmcmail@... > > Pat Corrigan Jobes, PT > Director of Rehabilitation Services > Methodist Healthcare-North Hospital > 3960 New Covington Pike > Memphis, Tn 38128 > Phone: (901)384-5320 > Fax: (901)384-5099 > E-Mail: jobesm@... > > >>> " Angelle Driggs " 07/06 12:33 AM >>> > I am currently a second year student at the U of Mobile Graduate School of > PT. I am trying to find out about the functional > outcomes obtained between TKA patients who use continuous passive motion > (CPM) vs patients who receive active physical therapy. I have performed a > search through Medline, but would like to know what other PTs are doing > concerning the use of CPM with post TKA patients. > > Thanks in advance, > Driggs > OTin1999@... > > > > > Coming September 22,2000 - Helene Fearon on Coding and Reimbursement - > Rochester Michigan. Register at today. > Rehab Pro - The New Way...A Better Way to Rehab Success! Call for details > > LAMP Summit 2000. July 23-25, 2000 Register at . > Visit our EStore at www.RehabBusiness.com > > > > > > > Coming September 22,2000 - Helene Fearon on Coding and Reimbursement - > Rochester Michigan. Register at today. > Rehab Pro - The New Way...A Better Way to Rehab Success! Call for details > > LAMP Summit 2000. July 23-25, 2000 Register at . > Visit our EStore at www.RehabBusiness.com > > > > > Coming September 22,2000 - Helene Fearon on Coding and Reimbursement - > Rochester Michigan. Register at today. > Rehab Pro - The New Way...A Better Way to Rehab Success! Call for details > > LAMP Summit 2000. July 23-25, 2000 Register at . > Visit our EStore at www.RehabBusiness.com > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 16, 2000 Report Share Posted July 16, 2000 We have recently opened a Joint Center. P.T. is initiated BID on POD #1. CPM's are being used much less now. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 26, 2000 Report Share Posted July 26, 2000 In a message dated 7/6/00 7:06:07 AM Pacific Daylight Time, vinsontm@... writes: << vinsontm@irmcmail@... >> Quote Link to comment Share on other sites More sharing options...
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