Surgical Rehabilitation (Rheumatological Rehabilitation Series, Vol 5).

Surgical Rehabilitation (Rheumatological Rehabilitation Series, Vol 5) Melvin JL, Gall V, eds. Bethesda, MD 20814-3425, American Occupational Therapy Association, 1999, paperback, 214 pp, illus, ISBN: 1-56900-114-6, $52.

The primary goal of this series is to educate physical therapists and occupational therapists in the physical rehabilitation of patients with rheumatic disease. This volume begins with a chapter, written by the editors, that discusses rehabilitation of the patient with severe polyarticular disease who undergoes surgery. This introduction includes the roles of preoperative evaluation, conditioning, and patient education in addition to information on pain management, timing of surgery, and clinical pathways. A limited final section on future research precedes a reference list of relatively new publications by established authors.

The other 6 chapters of this volume are co-authored by physicians, physical therapists, occupational therapists, and rehabilitation nurses. Each chapter is devoted to the surgical intervention and rehabilitation of a specific joint: elbow, shoulder, spine, hip, knee, and foot and ankle. Each chapter ends with a bibliography that includes both classic and recent references.

The chapter on the elbow includes nonsurgical treatment, preoperative treatment, and surgery for rheumatoid arthritis of the elbow, followed by surgery and postoperative rehabilitation for periarticular disease. The chapter explains how postoperative rehabilitation is guided by stages of wound healing and discusses olecranon bursectomy and ulnar nerve transposition and their respective rehabilitation approaches. The coverage of surgery and rehabilitation for intra-articular disease includes discussion of synovectomy, total elbow arthroplasty, and arthrodesis. Thorough explanations of implications for surgery, implant design considerations, and surgical outcomes and complications are included. Postoperative management for both constrained and semiconstrained total joint arthroplasties is presented.

Although the anatomy and biomechanics content offered in the shoulder chapter is limited, surgical options, postoperative rehabilitation, shoulder arthroplasties, and postoperative exercises are thoroughly detailed. Other components of this chapter include expectations and functional limitation, phased protocols, postoperative evaluation of skin, neurovascular and wound conditions, positioning, pain management, precautions, complications, and discharge planning. Through the collaboration of a physician, physical therapist, occupational therapist, and nurse, this chapter provides a complete and thorough explanation of postsurgical shoulder rehabilitation based on recent literature citations. The appendixes at the end of the chapter are helpful.

Most of the content of the rheumatoid spine chapter focuses on the cervical area. A discussion of the relevant anatomy and clinical manifestations of cervical spine involvement precedes a detailed explanation and breakdown of types of cervical subluxation. The pathophysiology of cervical spine dysfunction, physical and radiological presentation of atlanto-axial subluxation, basilar invagination, and rotary (subaxial) subluxation are presented prior to a discussion of the indications, goals, and options for surgical management. Preoperative issues, such as activities of daily living, falling, and ambulatory aids are presented; however, the actual information about preoperative and postoperative management is general and nonspecific. A very brief consideration of thoracic and lumbar spine problems, such as vertebral fractures and spinal stenosis, is included.

All 3 lower extremity chapters (ie, hip, knee, foot and ankle) are presented in great detail. The primary emphasis of these chapters is on pathophysiology, surgical options, and postoperative rehabilitation approaches for lower-extremity conditions, and these chapters offer down-to-earth, useful information that can help develop programs for management of lower-extremity conditions. The chapter on the hip is notable because the authors clearly report evidence-based treatment and provide detailed information regarding osteotomy, arthroscopy, hemiarthroplasty, and total hip arthroplasty. The inclusion of a sample clinical pathway and functional milestones after total knee arthroplasty, along with information on chondrocyte implantation and its rehabilitation, demonstrates the timeliness of the chapter on the knee. Detailed information on footwear is included in the chapter on the foot and ankle. This final chapter separates discussion of surgical correction and rehabilitation for disorders of the forefoot from those of the hind foot. Information on various ankle procedures as well as postoperative footwear is discussed.

In summary, this volume offers physical therapists and occupational therapists a clear, concise reference for understanding the primary surgical procedures that patients with rheumatological disease may experience. Suggestions for preoperative and postoperative assessment as well as rehabilitation management protocols, educational issues, and discharge planning following various procedures are easy to locate and to understand. It would seem that the goals set out by the editors of this series have been met within in the limitations of this single volume.

Nancey A Bookstein, PT, EdD
University of Colorado Health Sciences
Center
Denver, Colo

Dr Bookstein is Assistant Professor in the Physical Therapy Program and Senior Instructor in the Department of Cellular and Structural Biology. She teaches gross anatomy to physical therapist, medical, and dental students.