Effectiveness and Cost-effectiveness of Outpatient Physiotherapy After Knee Replacement for Osteoarthritis: Study Protocol for a Randomised Controlled Trial

Background: Primary total knee replacement is a common operation that is performed to provide pain relief and restore functional ability. Inpatient physiotherapy is routinely provided after surgery to enhance recovery prior to hospital discharge. However, international variation exists in the provision of outpatient physiotherapy after hospital discharge. While evidence indicates that outpatient physiotherapy can improve short-term function, the longer term benefits are unknown. The aim of this randomised controlled trial is to evaluate the long-term clinical effectiveness and cost-effectiveness of a 6-week group-based outpatient physiotherapy intervention following knee replacement. Methods/design: Two hundred and fifty-six patients waiting for knee replacement because of osteoarthritis will be recruited from two orthopaedic centres. Participants randomised to the usual-care group (n = 128) will be given a booklet about exercise and referred for physiotherapy if deemed appropriate by the clinical care team. The intervention group (n = 128) will receive the same usual care and additionally be invited to attend a group-based outpatient physiotherapy class starting 6 weeks after surgery. The 1-hour class will be run on a weekly basis over 6 weeks and will involve task-orientated and individualised exercises. The primary outcome will be the Lower Extremity Functional Scale at 12 months post-operative. Secondary outcomes include: quality of life, knee pain and function, depression, anxiety and satisfaction. Data collection will be by questionnaire prior to surgery and 3, 6 and 12 months after surgery and will include a resource-use questionnaire to enable a trial-based economic evaluation. Trial participation and satisfaction with the classes will be evaluated through structured telephone interviews. The primary statistical and economic analyses will be conducted on an intention-to-treat basis with and without imputation of missing data. The primary economic result will estimate the incremental cost per quality-adjusted life year gained from this intervention from a National Health Services (NHS) and personal social services perspective. Discussion: This research aims to benefit patients and the NHS by providing evidence on the long-term effectiveness and cost-effectiveness of outpatient physiotherapy after knee replacement. If the intervention is found to be effective and cost-effective, implementation into clinical practice could lead to improvement in patients’ outcomes and improved health care resource efficiency.

The Usability of a Commercial Game Physics Engine to Develop Physics Educational Materials: an Investigation

Commercial computer games contain “physics engine” components, responsible for providing realistic interactions among game objects. The question naturally arises of whether these engines can be used to develop educational materials for high school and university physics education. To answer this question, the author's group recently conducted a detailed scientific investigation of the physics engine of Unreal Tournament 2004 (UT2004). This article presents their motivation, methodology, and results. The author presents the findings of experiments that probed the accessibility and fidelity of UT2004's physics engine, examples of educational materials developed, and an evaluation of their use in high school classes. The associated pedagogical implications of this approach are discussed, and the author suggests guidelines for educators on how to deploy the approach. Key resources are presented on an associated Web site.

Applications of a Collaborative Open Object Oriented Learning Environment to Electronics, Computing and Mathematics Education

A lightweight Java application suite has been developed and deployed allowing collaborative learning between students and tutors at remote locations. Students can engage in group activities online and also collaborate with tutors. A generic Java framework has been developed and applied to electronics, computing and mathematics education. The applications are respectively: (a) a digital circuit simulator, which allows students to collaborate in building simple or complex electronic circuits; (b) a Java programming environment where the paradigm is behavioural-based robotics, and (c) a differential equation solver useful in modelling of any complex and nonlinear dynamic system. Each student sees a common shared window on which may be added text or graphical objects and which can then be shared online. A built-in chat room supports collaborative dialogue. Students can work either in collaborative groups or else in teams as directed by the tutor. This paper summarises the technical architecture of the system as well as the pedagogical implications of the suite. A report of student evaluation is also presented distilled from use over a period of twelve months. We intend this suite to facilitate learning between groups at one or many institutions and to facilitate international collaboration. We also intend to use the suite as a tool to research the establishment and behaviour of collaborative learning groups. We shall make our software freely available to interested researchers.