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post-operatively

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post-operatively

     Independent Interview and Assessment

     POST-OPERATIVE FOLLOW-UP FORM:

2/3mt / 6mt / 12mt / 3yr / 5yr / 10yr (circle as appropriate)

Extra Assessment: ......... / ........ / ..…….. (add date if applicable)

     ACTIVE Patient Trial No:

Patient‟s Initials: …………Patient‟s DoB: ......... / ........ / ..……..

    Name of Independent Assessor: ....................................................

Hospital: ..................................................

Date of Assessment: ......... / ........ / ..……..

Important information for the Independent Assessor

    After doing Section 1 and while you are writing a summary of the semi-structured interview please ask the patient to complete the questionnaire pack as rehearsed in your training session, see also, ”Guidance notes for Independent Assessors” on the ACTIVE

    website. This independent interview and assessment is designed to enable you to document trial patients‟ post-operative knee condition and knee-related quality of life. This assessment should be sufficiently comprehensive so that you can judge whether or not the patient has improved in comparison to his/her pre-operative state.

    Try to choose a quiet room where you and the patient can sit comfortably without being interrupted. Have the following equipment ready:

    Goniometer

    Stopwatch

    Tape measure/metre rule

    Tubi-grip (so patient can cover knees to maximise „blinding‟)

    You may also need access to steps/stairs, a skipping rope or the physiotherapy gym (if available) for testing the patient.

To maximise blinding, please follow this advice:

    Avoid carrying out the assessment in areas of the hospital where the patient‟s treatment might be discussed, e.g. the orthopaedic surgeon‟s outpatient clinic

    Ask the patient not to disclose what type of surgery they had (remind them of this several times).

    Avoid seeing the patient‟s scar - ask the patient in advance to wear trousers and for

    them to bring a pair of shorts ready to change into. For the physical assessment have some tubi-grip ready and ask the patient to put shorts on and cover both knees with the tubi-grip. Ensure you are not able to see the patient‟s knees when he/she is changing.

     INDEPENDENT INTERVIEW & ASSESSMENT Version 4 Oct 2004

    SECTION 1: SEMI-STRUCTURED INTERVIEW

    The semi-structured interview should address the same general questions for each patient whilst allowing you to use your own follow-up questions to gain further insights or explore unexpected responses. Immediately after the interview please use pages 3-4 to write a summary of the interview, documenting the patient‟s main problems, impact of main problems, current exercise,

    sports and activities, review of goals set, post-operative changes and impact of post-operative changes.

Starting the interview

    Begin with a bit of preamble, for example:

    “Hello my name is ________ we have spoken recently on the phone. It’s nice to see you again.

    As part of the ACTIVE research study I’d like to ask you some questions and assess you. It will probably take about 45-60 minutes, is that OK? Thank you.”

General questions post-operatively: impact on quality of life

Q1 Have you experienced any problems recently because of your knee?

Q2 Could you describe to me the main problems you are having?

Q3 How are these problems affecting your daily life and quality of life? (if necessary probe

    further to find out about the impact on general activities of daily living, work, leisure, life aspirations, social life, mental health)

    Q4 Apart from your knee, have you experienced any other health problems recently?

Q5 Has your knee condition changed since shortly before your treatment? (state how long ago

    this was)

Q6 Can you describe to me the main changes? (if changed)

    Q7 How would you say you feel now compared to how you felt just before your knee operation? (probe to find out whether patient’s quality of life has improved/deteriorated, whether pre-op

    goals are being achieved or have changed, find out current level of activity note any new goals,

    taking into account whether patient has adapted his/her goals over the course of time).

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     INDEPENDENT INTERVIEW & ASSESSMENT Version 4 Oct 2004

    ASSESSOR’S NOTES write a description below of the patient, summarising responses to the general questions and including any other relevant insights. It‟s helpful to include a few quotes from the patient. Remember your pre-operative notes provide a baseline from which you decide whether the patient has improved / deteriorated on subsequent assessments. Referring back to these notes will enable you to complete the “Cessation of Benefit form”.

Main problems/impact of main problems:

Current exercise and activity:

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     INDEPENDENT INTERVIEW & ASSESSMENT Version 4 Oct 2004

    Review of goals set: (refer to goals set pre-operatively - are they being achieved? Have they changed?)

    Post-operative changes/Impact of post-operative changes:

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     INDEPENDENT INTERVIEW & ASSESSMENT Version 4 Oct 2004

    SECTION 2: PHYSICAL AND FUNCTIONAL ASSESSMENT

    1. Patient is in the trial because of surgery on ................... knee (specify which knee)

    2. Identify pain in knee and body using charts

    Using the knee charts on pages 6-7 ask patient to point to where he/she is getting pain in

    the knee. Shade and number the main problems and complete details in table below

    knee chart. Also ask patient to point to any painful parts of the body other than the knee

    using the body chart on page 8 and complete the table below.

    3. Ask patient about the following and note answers:

    Sleep disturbance because of knee:

    .............................................................................................................................................

    Locking/ frequency of locking:

    .............................................................................................................................................

    Giving way/ frequency of giving way:

    .............................................................................................................................................

    4. Check for swelling on both knees (grade on 1-3 scale if possible through tubi-grip)

Swelling right knee: grade ....../3

    Comment: ....................................................................................................................................

Swelling left knee: grade ....../3

    Comment: ....................................................................................................................................

    5. Measure passive and active range of knee flexion and extension for both legs using

    goniometer (to the nearest 5?) whilst patient is in one of the following positions:

    sitting/supine/prone. Use same position in subsequent assessments.

Seated / supine / prone (circle one position)

     Right leg (?) Left leg (?)

     Active flexion

Passive flexion

Active extension*

Passive extension*

    *Please make it clear whether there is hyper-extension (e.g. write 5? HE) or lacking full extension (e.g. write lacks 5?)

    6. Measure and grade muscle strength of quads and hamstrings for both legs while patient

    is sitting (using Oxford grading system)

    Muscle strength right leg: quads: grade ......./5 hams: grade ......./5

    Muscle strength left leg: quads: grade ......./5 hams: grade ......./5

Comment: ....................................................................................................................................

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     INDEPENDENT INTERVIEW & ASSESSMENT Version 4 Oct 2004

    Right Knee Chart

    Front Back

    Outside Inside

    No. DESCRIPTION:* AGGRAVATING EASING FACTORS (include

    INT/ CONST/ CONST V FACTORS (include duration) duration)

    & pain rating /10 (p9)

    *INT=Intermittent problem/pain, CONST=Constant problem/pain, CONST V=Constant & variable problem/pain

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     INDEPENDENT INTERVIEW & ASSESSMENT Version 4 Oct 2004

    Left Knee Chart

    Front Back

    Outside Inside

    No. DESCRIPTION:* AGGRAVATING EASING FACTORS (include

    INT/ CONST/ CONST V FACTORS (include duration) duration)

    & pain rating /10 (p9)

    *INT=Intermittent problem/pain, CONST=Constant problem/pain, CONST V=Constant & variable problem/pain

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     INDEPENDENT INTERVIEW & ASSESSMENT Version 4 Oct 2004

Body Chart

    Shade and number main problem(s)

    No. DESCRIPTION:* AGGRAVATING EASING FACTORS (include INT/ CONST/ CONST V FACTORS (include duration) duration)

    & pain rating /10 (p9)

*INT=Intermittent problem/pain, CONST=Constant problem/pain, CONST V=Constant & variable

    problem/pain

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     INDEPENDENT INTERVIEW & ASSESSMENT Version 4 Oct 2004

Selecting Functional Exercises

    Please use you own clinical judgement to select functional exercises which are appropriate for the patients‟ stage of rehabilitation and regular activities. At 2/3, 6 & 12 months post-op, ask the

    patient what is the maximum level of activity he/she is currently permitted to do (according to their stage of rehab). Aim to do the assessment in the following order in the physiotherapy gym (if available):

    Pain during exertion patient rates pain on 0-10 pain scale (using adapted Borg scale, below) before and after doing relevant activity (e.g. walking/jogging on a treadmill) for 4 minutes at a self-selected speed. Encourage patient to increase exertion until symptoms limit performance.

Type of activity: ......................................................Length of time .........(minutes) ........(seconds)

Speed: ............(mph) Type of pain: ...............................................................................................

     PAIN RATING SCALE

    Please circle a number to indicate your levels of pain before

    and after doing the activity:

    0 No pain at all

    0.5 Very, very slight pain

    1 Very slight pain

    2 Slight pain

    3 Moderate pain

    4 Somewhat stronger pain

    5 Strong pain

    6

    7 Very strong pain

    8 Very, very strong pain

    9

    10 Maximal pain

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     INDEPENDENT INTERVIEW & ASSESSMENT Version 4 Oct 2004

    Functional performance select appropriate exercises and complete below

    Here are some examples:

    1. Sitting to standing (record lowest height achieved)

Sit-stand: lowest height acheived ........../cm

Comments: (e.g. used hands, didn’t bend knee beyond

    90?) ......................................................................................................................................................... .........................................................................................................................................................

    2. Step-ups/downs (record height of the steps used)

    (a) record number of step-ups performed before symptoms limit functional

    performance (stop at 50). Patient must lead up with the affected leg

    (b) record number of step-downs performed before symptoms limit functional

    performance (stop at 50). Patient must lead down with the unaffected leg

    Step-ups Total number ......./50 Height of step ...........cm

    Step-downs Total number ......./50 Height of step ...........cm

Comments: (e.g. type of pain, slight

    limp) ......................................................................................................................................................... .........................................................................................................................................................

    3. Skipping is patient able to skip/jump? No ? Yes ?

    If yes, how many skips before symptoms limit? ______ (stop at 50)

    Comments:.......................................................................................................................................

     .........................................................................................................................................................

    4. Hopping is patient able to hop on affected leg? No ? Yes ?

    If yes, beginning with the unaffected leg ask patient to hop as far as possible and measure

    the distance. Repeat until you have measured 3 single hops on each leg. Record distance.

    Left leg hop 1 ...........cm hop 2 ...........cm hop 3 ...........cm

    Right leg hop 1 ...........cm hop 2 ...........cm hop 3 ...........cm

     Comments:.......................................................................................................................................

    5. One-legged squat is patient able to squat on affected leg? No ? Yes ?

    Using the goniometer and stopwatch measure the angle and time before symptoms limit

    each one-legged squat (stop after 1 min)

    Left leg .........seconds at angle of ______? Right leg .........seconds at angle of ______?

    Comments: ................................................................................................................................

    ...................................................................................................................................................

    ...................................................................................................................................................

    ...................

    10 Now complete the Cessation of Benefit form and the Assessor Lysholm

    form independently of the patient’s own Lysholm ratings

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