martedì 30 aprile 2013

Practice guideline for home setting and use of CPM devices for passive rehabilitation after orthopeadic surgery

Guideline for a correct use of CPM devices  at home
Practice and simple instructions for CPM device setting at home
Since some years, rental activities of CPM devices for patient dismissed are increased, who need to have an effective way to recover the mobility in the first weeks after surgery.
Generally, surgeons and physiotherapists recommend the use of CPM units at home, due to reasons which are linked to the time of the recovery.
Use of continuous passive motion (CPM) in the home setting may be considered medically necessary as an adjunct to physical therapy in the following situations:
- under conditions of low postoperative mobility or inability to comply with rehabilitation exercises following a total knee arthroplasty (TKA) or TKA revision;
- during the non-weight-bearing rehabilitation period following intra-articular cartilage repair procedures of the knee (e.g. microfracture,..);
- post articular cruciate ligament (or multi-ligament) reconstruction;
- post release ofadhesive capsulitis of the knee requiring manipulation under anesthesia;
Obviously CPM devices have (general) limitations and exclusions, which can be different from patient to patient, but normally applicable:
1) CPM therapy is recommended to be initiated within 72 hours of surgery (usually within 24-48) and is tipically utilized for a period of 7-10 days (not to exceed 21 days - (3 weeks)). Continued use beyond 21 days has not been shown to be effective and is therefore not considered to be medically necessary.
2) Continued use of CPM is not medically necessary after 95 degrees of knee flexion (measured by goniometry) is achieved;
3) CPM therapy is not considered medically necessary in individuals who are able to participate in an active physical therapy program;
4) CPM therapy is not considered medically necessary for the treatment of non-operatively treated degenerative joint diseases and / or chronic contractures;
Which are the critical points when a dismissed patient have to use a CPM device at home?
First of all the setting of the frame, and secondly the programming of the functions.
This two step have been solved by CPM manufacturers introducing practical guide, tutorial videos, pocket guides with images.
In this way, patient can follow the rehab session and participate actively in first person.
The only things to do? An electrical power unit is used to set the variable range of motion (ROM) and speed: even if the initial settings for ROM is based on patient's level of comfort, in next steps he has to set a different ROM. The ROM is increased by 3-5 deegres per day, as tolerated. The speed and ROM can be varied, depending on joint stability.
Actually Rimec is going to develop a new series of CPM devices, Fisiotek 3000, for passive rehabilitation of hip, knee and ankle.
Thinking to rental activities at home, we have thought to develop a device completely  "self-sufficient": about this point, symbols have been added to graphic in order to improve the easyness in programming.
Graphic symbols are useful for patients because they're self-explanatory and can be identified by everyone.
You want further information about the new graphic of Fisiotek 3000?
Visit our blog on Google Plus: Rimec S.r.l.

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