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Huang L, Han W, Qi W, Zhang X, Lv Z, Lu Y, Zou D. Early unrestricted vs. partial weight bearing after uncemented total hip arthroplasty: a systematic review and meta-analysis. Front Surg 2023; 10:1225649. [PMID: 38033533 PMCID: PMC10684916 DOI: 10.3389/fsurg.2023.1225649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 10/31/2023] [Indexed: 12/02/2023] Open
Abstract
Background The choice of postoperative weight bearing protocol after uncemented total hip arthroplasty (THA) remains controversial. The aim of this study was to assess the efficacy and safety of immediate unrestricted weight bearing (UWB) compared with partial weight bearing (PWB) in patients undergoing uncemented THA. Methods Relevant articles were retrieved from electronic databases. Both randomized controlled trials (RCTs) and non-RCTs were included but analyzed separately. All functional and clinical outcomes with at least 2 independent study outcomes were meta-analyzed. Results A total of 17 studies were investigated. No adverse effect was found regarding micromotion of the femoral stem with immediate UWB following uncemented THA. There was also no correlation between immediate UWB and failure of ingrowth fixation and higher risks of femoral stem subsidence and surgical revision in RCTs. Harris hip score was better in patients with immediate UWB than those with PWB at 1 year post surgery, but the difference was not statistically significant. Conclusions Immediate UWB did not have extra harm compared with PWB in patients undergoing uncemented THA. UWB was not superior to PWB. Considering the improvement of Harris score and the compliance of patients, UWB can be encouraged in THA rehabilitation.
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Affiliation(s)
- Li Huang
- Department of Joint and Orthopedics, Orthopedic Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Weiyu Han
- Department of Joint and Orthopedics, Orthopedic Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Weizhong Qi
- Department of Joint and Orthopedics, Orthopedic Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaomeng Zhang
- Department of Joint and Orthopedics, Orthopedic Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Zhou Lv
- Department of Joint and Orthopedics, Orthopedic Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Yao Lu
- Department of Joint and Orthopedics, Orthopedic Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Danfeng Zou
- Huiqiao Medical Center, Nanfang Hospital of Southern Medical University, Guangzhou, China
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2
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Foussell I, Negley M, Thompson A, Turner A, Wygal A, Devries A, Hilton C, Pritchard KT. Characteristics of Early Interventions for Pain and Function Following Lower Extremity Joint Replacement: Systematic Review. Occup Ther Health Care 2023; 37:627-647. [PMID: 35654087 PMCID: PMC9715835 DOI: 10.1080/07380577.2022.2066239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 04/11/2022] [Indexed: 10/18/2022]
Abstract
Occupational therapy is beneficial among adults with chronic pain; however, occupational therapy interventions addressing earlier phases of pain have not been clearly explicated. This systematic review characterized acute and subacute interventions billable by occupational therapy after hip or knee replacement to improve pain and function. Seven articles met inclusion criteria. Six articles had a low risk of bias. Three intervention types were found: task-oriented exercise, water-based, and modalities. Only task-oriented interventions improved both pain and function one-year after surgery. There are long-term benefits to early task-oriented exercise. Further research is needed to contextualize occupational therapy's role in early pain interventions.
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Affiliation(s)
- Isabella Foussell
- Department of Occupational Therapy, School of Health
Professions, University of Texas Medical Branch, Galveston, TX, USA
| | - Marisa Negley
- Department of Occupational Therapy, School of Health
Professions, University of Texas Medical Branch, Galveston, TX, USA
| | - Abigail Thompson
- Department of Occupational Therapy, School of Health
Professions, University of Texas Medical Branch, Galveston, TX, USA
| | - Andrea Turner
- Department of Occupational Therapy, School of Health
Professions, University of Texas Medical Branch, Galveston, TX, USA
| | - Amanda Wygal
- Department of Occupational Therapy, School of Health
Professions, University of Texas Medical Branch, Galveston, TX, USA
| | - Alison Devries
- Moody Medical Library, University of Texas Medical Branch,
Galveston, TX, USA
| | - Claudia Hilton
- Department of Occupational Therapy, School of Health
Professions, University of Texas Medical Branch, Galveston, TX, USA
| | - Kevin T. Pritchard
- Department of Nutrition, Metabolism, and Rehabilitation
Sciences, School of Health Professions, University of Texas Medical Branch,
Galveston, TX, USA
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3
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Hasebe Y, Akasaka K, Otsudo T, Hall T, Yamamoto M. Effects of cross-training on motor function and length of stay after total hip arthroplasty: A randomized controlled trial. J Back Musculoskelet Rehabil 2023; 36:163-171. [PMID: 35871319 DOI: 10.3233/bmr-210325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND There is no consensus about which training methods will give better early outcomes after total hip arthroplasty (THA). OBJECTIVE To investigate the short-term effects of cross trainer exercise on physical function and walking ability following THA. METHODS Fifty patients who underwent THA were randomly allocated into two groups. The intervention program was started 3 days after surgery. The main physical function results were pain, hip range of motion, knee extensor strength, single-leg stance time, and walking performance test. In addition, the number of days of requiring to walk and the length of hospital stay were recorded. RESULTS In the comparison between groups at discharge, the patients in the cross trainer group had significantly less hip pain while walking, improvement in knee extensor strength, increased single-leg stance time, as well as increased walking speed and stride length at discharge. The number of days required to walk and length of stay were also significantly lower in the intervention group. CONCLUSIONS Conclusions: Cross trainer exercise commencing 3 days postoperatively improves physical function and walking ability after THA.
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Affiliation(s)
- Yuki Hasebe
- Department of Physical Therapy, Saitama Medical University Graduate School of Medicine, Moroyama, Saitama, Japan.,Department of Rehabilitation, Saitama Medical University Saitama Medical Center, Kawagoe, Saitama, Japan
| | - Kiyokazu Akasaka
- Department of Physical Therapy, Saitama Medical University Graduate School of Medicine, Moroyama, Saitama, Japan
| | - Takahiro Otsudo
- Department of Physical Therapy, Saitama Medical University Graduate School of Medicine, Moroyama, Saitama, Japan
| | - Toby Hall
- Manual Concept, Perth, Australia.,Curtin School of Allied Health, Curtin University, Perth, Australia
| | - Mitsuru Yamamoto
- Department of Rehabilitation, Saitama Medical University Saitama Medical Center, Kawagoe, Saitama, Japan
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Konnyu KJ, Pinto D, Cao W, Aaron RK, Panagiotou OA, Bhuma MR, Adam GP, Balk EM, Thoma LM. Rehabilitation for Total Hip Arthroplasty: A Systematic Review. Am J Phys Med Rehabil 2023; 102:11-18. [PMID: 35302955 PMCID: PMC9464790 DOI: 10.1097/phm.0000000000002007] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
ABSTRACT We sought to determine the comparative benefits and harms of rehabilitation interventions for patients who have undergone elective, unilateral THA surgery for the treatment of primary osteoarthritis. We searched PubMed, Embase, The Cochrane Register of Clinical Trials, CINAHL, PsycINFO, Scopus, and ClinicalTrials.gov from January 1, 2005, through May 3, 2021. We included randomized controlled trials and adequately adjusted nonrandomized comparative studies of rehabilitation programs reporting performance-based, patient-reported, or healthcare utilization outcomes. Three researchers extracted study data and assessed risk of bias, verified by an independent researcher. Experts in rehabilitation content and complex interventions independently coded rehabilitation interventions. The team assessed strength of evidence. Large heterogeneity across evaluated rehabilitation programs limited conclusions. Evidence from 15 studies suggests that diverse rehabilitation programs may not differ in terms of risk of harm or outcomes of pain, strength, activities of daily living, or quality of life (all low strength of evidence). Evidence is insufficient for other outcomes. In conclusion, no differences in outcomes were found between different rehabilitation programs after THA. Further evidence is needed to inform decisions on what attributes of rehabilitation programs are most effective for various outcomes.
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Affiliation(s)
- Kristin J. Konnyu
- Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Dan Pinto
- Department of Physical Therapy, Marquette University, Milwaukee, Wisconsin
| | - Wangnan Cao
- Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Roy K. Aaron
- Department of Orthopaedic Surgery, Warren Albert Medical School of Brown University, Providence, Rhode Island; Orthopedic Program in Clinical/Translational Research, Warren Albert Medical School of Brown University, Providence, Rhode Island; Miriam Hospital Total Joint Replacement Center, Providence, Rhode Island
| | - Orestis A. Panagiotou
- Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Monika Reddy Bhuma
- Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Gaelen P. Adam
- Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Ethan M. Balk
- Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Louise M. Thoma
- Division of Physical Therapy, Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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5
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Tang W, Flavell CA, Grant A, Doma K. The effects of exercise on function and pain following total hip arthroplasty: a systematic literature review and meta-analysis. PHYSICAL THERAPY REVIEWS 2022. [DOI: 10.1080/10833196.2022.2062967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Wilson Tang
- College of Healthcare Sciences, James Cook University, Townsville, QLD, Australia
| | - Carol Ann Flavell
- College of Healthcare Sciences, James Cook University, Townsville, QLD, Australia
| | - Andrea Grant
- Orthopaedic Research Institute of Queensland, Townsville, QLD, Australia
| | - Kenji Doma
- College of Healthcare Sciences, James Cook University, Townsville, QLD, Australia
- Orthopaedic Research Institute of Queensland, Townsville, QLD, Australia
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Alves SA, Preuße M, Hommel H, Duda GN, Agres AN. The Recovery of Weight-Bearing Symmetry After Total Hip Arthroplasty Is Activity-Dependent. Front Bioeng Biotechnol 2022; 10:813345. [PMID: 35284427 PMCID: PMC8907721 DOI: 10.3389/fbioe.2022.813345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/28/2022] [Indexed: 11/26/2022] Open
Abstract
This study aimed to characterize ipsilateral loading and return to weight-bearing symmetry (WBS) in patients undergoing total hip arthroplasty (THA) during activities of daily living (ADLs) using instrumented insoles. A prospective study in 25 THA patients was performed, which included controlled pre- and postoperative follow-ups in a single rehabilitation center of an orthopedic department. Ipsilateral loading and WBS of ADLs were measured with insoles in THA patients and in a healthy control group of 25 participants. Measurements in the THA group were performed at 4 different visits: a week pre-THA, within a week post-THA, 3–6 weeks post-THA, and 6–12 weeks post-THA, whereas the healthy control group was measured once. ADLs included standing comfortably, standing evenly, walking, and sit-to-stand-to-sit (StS) transitions. All ADLs were analyzed using discrete methods, and walking included a time-scale analysis to provide temporal insights in the ipsilateral loading and WBS waveforms. THA patients only improved beyond their pre-surgery levels while standing comfortably (ipsilateral loading and WBS, p < 0.05) and during StS transitions (WBS, p < 0.05). Nevertheless, patients improved upon their ipsilateral loading and WBS deficits observed within a week post-surgery across all investigated ADLs. Ipsilateral loading and WBS of THA patients were comparable to healthy participants at 6–12 weeks post-THA, except for ipsilateral loading during walking (p < 0.05) at the initial and terminal double-leg support period of the stance phase. Taken together, insole measurements allow for the quantification of ipsilateral loading and WBS deficits during ADLs, identifying differences between pre- and postoperative periods, and differentiating THA patients from healthy participants. However, post-THA measurements that lack pre-surgery assessments may not be sensitive to identifying patient-specific improvements in ipsilateral loading and WBS. Moreover, StS transitions and earlier follow-up time points should be considered an important clinical metric of biomechanical recovery after THA.
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Affiliation(s)
- Sónia A. Alves
- Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany
- *Correspondence: Sónia A. Alves,
| | - Marco Preuße
- Klinik für Orthopädie und Traumatologie, Krankenhaus Märkisch-Oderland, Wriezen, Germany
| | - Hagen Hommel
- Klinik für Orthopädie und Traumatologie, Krankenhaus Märkisch-Oderland, Wriezen, Germany
| | - Georg N. Duda
- Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany
| | - Alison N. Agres
- Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany
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7
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Rapolthy-Beck A, Fleming J, Turpin M, Sosnowski K, Dullaway S, White H. A comparison of standard occupational therapy versus early enhanced occupation-based therapy in a medical/surgical intensive care unit: study protocol for a single site feasibility trial (EFFORT-ICU). Pilot Feasibility Stud 2021; 7:51. [PMID: 33602337 PMCID: PMC7889705 DOI: 10.1186/s40814-021-00795-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 02/08/2021] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Admissions to intensive care units (ICUs) are increasing due to an ageing population, and rising incidence of cardiac and respiratory disease. With advances in medical care, more patients are surviving an initial stay in critical care; however, they can experience ongoing health and cognitive limitations that may influence return to baseline function up to a year post-admission. Recent research has focused on the introduction of early rehabilitation within the ICU to reduce long-term physical and cognitive complications. The aim of this study is to explore the feasibility and impact of providing early enhanced occupation-based therapy, including cognitive stimulation and activities of daily living, to patients in intensive care. METHODS This study involves a single site randomised-controlled feasibility trial comparing standard occupational therapy care to an early enhanced occupation-based therapy. Thirty mechanically ventilated ICU patients will be recruited and randomly allocated to the intervention or control group. The primary outcome measure is the Functional Independence Measure (FIM), and secondary measures include the Modified Barthel Index (MBI), Montreal Cognitive Assessment (MoCA), grip strength, Hospital Anxiety and Depression Scale (HADS) and Short-Form 36 Health survey (SF-36). Measures will be collected by a blind assessor at discharge from intensive care, hospital discharge and a 90-day follow-up. Daily outcome measures including the Glasgow Coma Scale (GCS), Richmond Agitation and Sedation Scale (RASS) and Confusion Assessment Measure for intensive care units (CAM-ICU) will be taken prior to treatment. Participants in the intervention group will receive daily a maximum of up to 60-min sessions with an occupational therapist involving cognitive and functional activities such as self-care and grooming. At the follow-up, intervention group participants will be interviewed to gain user perspectives of the intervention. Feasibility data including recruitment and retention rates will be summarised descriptively. Parametric tests will compare outcomes between groups. Interview data will be thematically analysed. DISCUSSION This trial will provide information about the feasibility of investigating how occupational therapy interventions in ICU influence longer term outcomes. It seeks to inform the design of a phase III multicentre trial of occupational therapy in critical care general medical intensive care units. TRIAL REGISTRATION Australia New Zealand Clinical Trials Registry (ANZCTR): ACTRN12618000374268 ; prospectively registered on 13 March 2018/ https://www.anzctr.org.au Trial funding: Metro South Health Research Support Scheme Postgraduate Scholarship.
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Affiliation(s)
- Andrea Rapolthy-Beck
- Logan Hospital, Brisbane, Queensland, Australia.
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia.
| | - Jennifer Fleming
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Merrill Turpin
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
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8
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Saueressig T, Owen PJ, Zebisch J, Herbst M, Belavy DL. Evaluation of Exercise Interventions and Outcomes After Hip Arthroplasty: A Systematic Review and Meta-analysis. JAMA Netw Open 2021; 4:e210254. [PMID: 33635329 PMCID: PMC7910817 DOI: 10.1001/jamanetworkopen.2021.0254] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
IMPORTANCE Preoperative and postoperative exercise interventions are commonly used in patients with total hip arthroplasty despite a lack of established efficacy. OBJECTIVE To explore clinical outcomes associated with exercise training before and after hip arthroplasty. DATA SOURCES PubMed, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, EMBASE, and Google Scholar were searched from their inception to March 2020. Reference lists of included trials and related reviews were also searched. STUDY SELECTION Randomized clinical trials of land-based exercise interventions before or after total hip arthroplasty were included. DATA EXTRACTION AND SYNTHESIS This systematic review and meta-analysis is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Data extraction was independently performed in duplicate. Random-effects meta-analyses with restricted maximum likelihood were performed for pooling the data. MAIN OUTCOMES AND MEASURES The primary prespecified outcome was self-reported physical function. Secondary prespecified outcomes were self-reported pain intensity, quality of life, gait speed, lower body muscle strength, lower body flexibility, anxiety, hospital length of stay, and adverse events. RESULTS A total of 32 randomized clinical trials with 1753 patients were included in the qualitative synthesis, and 26 studies with 1004 patients were included in the meta-analysis. Compared with usual care or no or minimal intervention, postoperative exercise training was not associated with improved self-reported physical function, with a moderate level of certainty, at 4 weeks (standardized mean difference [SMD], 0.01; 95% CI, -0.18 to 0.20), 12 weeks (SMD, -0.08; 95% CI, -0.23 to 0.07) and 26 weeks (SMD, -0.04; 95% CI, -0.31 to 0.24) postoperatively, and low level of certainty at 1 year after surgical treatment (SMD, 0.01; 95% CI, -0.09 to 0.12). For preoperative exercise interventions, there was no association of exercised training with self-reported physical function compared with the control at the 12-week (SMD, -0.14; 95% CI, -0.61 to 0.32) or 1-year follow-ups (SMD, 0.01; 95% CI, -0.37 to 0.40) with very low certainty, and no association with length of stay (mean difference, -0.21; 95% CI, -0.74 to 0.31) at moderate certainty. Results for postoperative hip muscle strength were rated at very low certainty, with no statistical significance. Meta-analysis could not be performed for other outcomes. CONCLUSIONS AND RELEVANCE This systematic review and meta-analysis found low- to moderate-quality evidence that postoperative exercise interventions were not associated with improved self-reported physical function compared with usual care or no or minimal intervention. Furthermore, there was very low-quality evidence that preoperative exercise programs were not associated with higher self-reported physical function and hospital length of stay compared with usual care or no or minimal intervention.
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Affiliation(s)
| | - Patrick J. Owen
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | | | | | - Daniel L. Belavy
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
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9
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Abstract
BACKGROUND Hip arthroplasty is considered the treatment of choice to improve the quality of life of patients affected by degenerative arthritis. The post-op rehabilitation regimen, however, is still a matter of debate. The goal of this study was to perform a systematic review of the available best evidence to provide recommendations for rehabilitation after hip arthroplasty. MATERIALS AND METHODS Biomedical databases were accessed to identify guidelines, systematic reviews and randomised controlled trials addressing rehabilitation after hip arthroplasty published between 2004 and 2019. Studies were selected and extracted by two independent evaluators with standardised tools. RESULTS 1 guideline, 8 systematic reviews and 5 randomised controlled trials were included. All included papers were organised according the available evidence of clinical course chronology both in pre- and post-operation rehabilitation up to 6 weeks and thereafter. Although the value of a rehabilitation program after hip arthroplasty is universally recognised, the exact timing and number of sessions is still unknown. A solid literature review allows us to partially answer to this question. CONCLUSIONS Evidence-based rehabilitation recommendations are proposed according to literature research findings. Clinical practice is still somewhat dependent on dogma and traditions, highlighting the need for additional high-quality clinical studies to address areas of uncertainty.
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Affiliation(s)
| | | | | | - Emilio Romanini
- Centre for Hip and Knee Arthroplasty, Polo Sanitario San Feliciano, Rome, Italy.,GLOBE, Evidence Based Orthopedics Working Group, Rome, Italy
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10
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Fatoye F, Wright JM, Yeowell G, Gebrye T. Clinical and cost-effectiveness of physiotherapy interventions following total hip replacement: a systematic review and meta-analysis. Rheumatol Int 2020; 40:1385-1398. [PMID: 32451696 PMCID: PMC7371665 DOI: 10.1007/s00296-020-04597-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 05/04/2020] [Indexed: 12/22/2022]
Abstract
To examine the reported clinical and cost-effectiveness of physiotherapy interventions following total hip replacement (THR). A systematic review was completed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). MEDLINE, CINAHL, AMED, Scopus, DARE, HTA, and NHS EED databases were searched for studies on clinical and cost-effectiveness of physiotherapy in adults with THR published up to March 2020. Studies meeting the inclusion criteria were identified and key data were extracted. Risk of bias was assessed using the Cochrane Risk of Bias Tool and a Consolidated Health Economic Evaluation Reporting Standards (CHEERS). Data were summarised and combined using random-effect meta-analysis. A total of 1263 studies related to the aim of the review were identified, from which 20 studies met the inclusion criteria and were included in the review. These studies were conducted in Australia (n = 3), Brazil (n = 1), United States of America (USA) (n = 2), France (n = 2), Italy (n = 2), Germany (n = 3), Ireland (n = 1), Norway (n = 2), Canada (n = 1), Japan (n = 1), Denmark (n = 1), and United Kingdom (UK) (n = 1). The duration of follow-up of the included studies was ranged from 2 weeks to 12 months. Physiotherapy interventions were found to be clinically effective for functional performance, hip muscle strength, pain, and range of motion flexion. From the National Health Service perspective, an accelerated physiotherapy programme following THR was cost-effective. The findings of the review suggest that physiotherapy interventions were clinically effective for people with THR. However, questions remain on the pooled cost-effectiveness of physiotherapy interventions, and further research is required to examine this in patients with THR. Future studies are required to examine the cost-effectiveness of these interventions from patients, caregivers, and societal perspectives.Registration Prospero (ID: CRD42018096524).
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Affiliation(s)
- Francis Fatoye
- Department of Health Professions, Faculty of Health, Psychology, and Social Care, Manchester Metropolitan University, Brooks Building, 53 Bonsall Street, Manchester, M15 6GX, UK.
| | - J M Wright
- Department of Health Professions, Faculty of Health, Psychology, and Social Care, Manchester Metropolitan University, Brooks Building, 53 Bonsall Street, Manchester, M15 6GX, UK
| | - G Yeowell
- Department of Health Professions, Faculty of Health, Psychology, and Social Care, Manchester Metropolitan University, Brooks Building, 53 Bonsall Street, Manchester, M15 6GX, UK
| | - T Gebrye
- Department of Health Professions, Faculty of Health, Psychology, and Social Care, Manchester Metropolitan University, Brooks Building, 53 Bonsall Street, Manchester, M15 6GX, UK
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11
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Maranesi E, Riccardi GR, Lattanzio F, Di Rosa M, Luzi R, Casoni E, Rinaldi N, Baldoni R, Di Donna V, Bevilacqua R. Randomised controlled trial assessing the effect of a technology-assisted gait and balance training on mobility in older people after hip fracture: study protocol. BMJ Open 2020; 10:e035508. [PMID: 32546491 PMCID: PMC7299027 DOI: 10.1136/bmjopen-2019-035508] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Deficits in balance and walking ability are relevant risk factors for falls during ageing. Moreover, falls are a risk factor for future falls, strongly associated with adverse health outcomes, such as fear of falling or fractures, particularly, hip fracture. For this reason, the development of prevention tools and innovative rehabilitation strategies is one of the main objectives in geriatrics. Effective interventions to promote hip recovery after hip fracture are characterised by intensive and repetitive movements. One treatment approach is to increase the number of steps during the rehabilitation sessions and to improve the balance and the endurance of the patients in the use of technological devices. METHODS AND ANALYSIS This randomised controlled trial aimed to evaluate an innovative rehabilitation treatment of elderly patients with hip fractures. A total of 195 patients with hip fractures will be recruited and randomly divided into three groups: traditional rehabilitation programme, traditional rehabilitation programme plus TYMO system and traditional rehabilitation programme plus Walker View. Assessments will be performed at baseline, at the end of treatment, at 6 months, and at 1 and 2 years after the end of the treatment. Only subjects hospitalised 4 weeks prior to the beginning of the study will be taken into consideration. Twenty treatment sessions will be conducted, divided into three training sessions per week, for 7 weeks. The technological intervention group will carry out 30 min sessions of traditional therapy and 20 min of treatment with a technological device. The control group will perform traditional therapy sessions, each lasting 50 min. The primary outcomes are risk of falling, gait performance and fear of falling. ETHICS AND DISSEMINATION The study was approved by the Istituto di Ricerca e Cura a Carattere Scientifica, Istituto Nazionale Ricovero e Cura Anziani Ethics Committee, with identification code number 19 014. Trial results will be submitted for publication in journals and conferences. TRIAL REGISTRATION NUMBER NCT04095338.
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Affiliation(s)
| | | | | | - Mirko Di Rosa
- Unit of Geriatric Pharmacoepidemiology, IRCCS INRCA, Ancona, Italy
| | | | - Elisa Casoni
- Clinical Unit of Physical Rehabilitation, IRCCS INRCA, Ancona, Italy
| | - Nadia Rinaldi
- Clinical Unit of Physical Rehabilitation, IRCCS INRCA, Fermo, Italy
| | - Renato Baldoni
- Clinical Unit of Physical Rehabilitation, IRCCS INRCA, Ancona, Italy
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12
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Budib MB, Hashiguchi MM, Oliveira-Junior SAD, Martinez PF. Influência da reabilitação física sobre aspectos funcionais em indivíduos submetidos à artroplastia total de quadril: uma revisão sistemática. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2020. [DOI: 10.1590/1981-22562020023.190252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Objetivo: Avaliar, por meio de revisão sistemática, a influência do tratamento fisioterapêutico sobre a funcionalidade, amplitude de movimento articular e força muscular em pacientes submetidos à artroplastia total de quadril devido à osteoartrite. Métodos: A busca sistemática de ensaios clínicos randomizados e não randomizados foi conduzida utilizando os bancos de dados eletrônicos PubMed, Web of Science, PEDro, Cochrane, Clinical Trials e SciELO, com base nas estratégias de pesquisa recomendadas pelos itens de relatórios preferenciais para análises sistemáticas e metanálises (PRISMA). Resultados: Em geral, protocolos supervisionados por fisioterapeutas associados à realização de exercícios ativos da musculatura periarticular do quadril e de extensores de joelho têm propiciado importante prognóstico físico e funcional. Exercícios resistidos (dinâmicos e isométricos) de alta intensidade são mais eficazes para a funcionalidade. Para a força muscular e Amplitude de movimento (ADM), exercícios dinâmicos com 3 a 5 séries de 8 a 12 repetições com baixa e alta intensidade promoveram ganhos mais expressivos em relação a outras modalidades terapêuticas. Conclusões: As técnicas e os protocolos utilizados pela fisioterapia para o tratamento da ATQ são variados e possuem importante eficácia clínica comprovada na literatura.
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Affiliation(s)
- Mariana Bogoni Budib
- Universidade Federal de Mato Grosso do Sul, Brasil; Universidade Federal de Mato Grosso do Sul, Brasil
| | | | | | - Paula Felippe Martinez
- Universidade Federal de Mato Grosso do Sul, Brasil; Universidade Federal de Mato Grosso do Sul, Brasil
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Tugni C, Sansoni J, Vanacore N, Valente D, Galeoto G. Rehabilitation effects in patients with total hip replacement: a systematic review and meta-analysis. ACTA ACUST UNITED AC 2019. [DOI: 10.23736/s0394-3410.19.03929-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Sconza C, Respizzi S, Grappiolo G, Monticone M. The Risk Assessment and Prediction Tool (RAPT) after Hip and Knee Replacement: A Systematic Review. JOINTS 2019; 7:41-45. [PMID: 31879730 PMCID: PMC6930846 DOI: 10.1055/s-0039-1693459] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 06/10/2019] [Indexed: 12/13/2022]
Abstract
Purpose
The Risk Assessment and Prediction Tool (RAPT) is an interesting instrument for predicting the discharge destination and length of stay (LOS) for patients after hip or knee arthroplasty. The aim of this review is to describe its predictive ability, current utilization, and future prospects through the analysis of scientific literature.
Methods
The databases of PubMed, Web of Sciences, Cochrane Library, and Pedro were searched for English studies on RAPT prediction capacity. Only original prospective or retrospective articles that analyze specifically the use of RAPT were included, whereas those concerned with other preoperative prediction tools or those only considering other aspects of recovery after joint replacements were excluded.
Results
A total of 27 references were retrieved, and 8 studies were selected. All analyzed studies demonstrated that RAPT could reduce LOS and accurately predict discharge disposition especially for high- and low-risk patients. In the intermediate risk category, a targeted intensive postoperative rehabilitation program has demonstrated good results in reducing the uncertain outcome.
Conclusion
Although contrarily to many of the other scores, the RAPT has been validated in multiple countries with relatively similar results between different institutions; however, its validity has yet to be tested and adapted in every nation context. Further studies confirming the predictive accuracy of RAPT at other institutions are needed as well as studies assessing the effect of using RAPT to identify patients for targeted interventions in terms of LOS, discharge disposition, clinical outcomes, and financial impact.
Level of Evidence
This is a level IV, systematic review of level III and IV study.
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Affiliation(s)
- Cristiano Sconza
- Department of Physical and Rehabilitation Medicine, Humanitas Clinical and Research Centre IRCSS, Rozzano, Milan, Italy
| | - Stefano Respizzi
- Department of Physical and Rehabilitation Medicine, Humanitas Clinical and Research Centre IRCSS, Rozzano, Milan, Italy
| | - Guido Grappiolo
- Hip Diseases and Joint Replacement Surgery Unit, Humanitas Clinical and Research Centre IRCSS, Rozzano, Milan, Italy
| | - Marco Monticone
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
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Incorporating hip abductor strengthening exercises into a rehabilitation program did not improve outcomes in people following total knee arthroplasty: a randomised trial. J Physiother 2019; 65:136-143. [PMID: 31208916 DOI: 10.1016/j.jphys.2019.05.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 05/16/2019] [Accepted: 05/24/2019] [Indexed: 12/22/2022] Open
Abstract
QUESTION In adults following primary total knee arthroplasty, does the incorporation of hip abductor strengthening exercises into a 6-week rehabilitation program improve muscle strength, functional performance and patient-reported outcomes at the end of rehabilitation and at 26 weeks? DESIGN Randomised controlled trial with concealed allocation, blinded assessors and intention-to-treat analysis. PARTICIPANTS One hundred and five adults admitted to an inpatient rehabilitation facility immediately following total knee arthroplasty. INTERVENTION Participants in both groups attended 12 days of inpatient physiotherapy followed by 6 weeks of outpatient physiotherapy, which aimed to improve knee range of movement, strength and mobility. The experimental group completed a standard rehabilitation protocol with the addition of hip abductor strengthening. The control group completed the same standard rehabilitation protocol, with the addition of 15 minutes of general functional exercises. OUTCOME MEASURES Primary outcomes were the Knee Injury and Osteoarthritis Outcome Score (KOOS) and isometric hip abductor muscle strength normalised to body mass index. Secondary outcome measures included the stair climb test, 6-minute walk test, Timed Up and Go test, 40-m fast-paced walk test, 30-second chair stand test, step test, isometric quadriceps muscle strength, Lower Extremity Functional Scale, and Short Form-12. RESULTS The experimental intervention did not result in significantly greater improvements in hip strength, KOOS or any of the secondary outcome measures than the control intervention at 6 weeks or 26 weeks. CONCLUSION Similar improvements in muscle strength, functional performance and patient-reported outcomes were observed whether specific hip-strengthening exercises were incorporated or general functional exercises were continued instead as part of a postoperative rehabilitation program for participants after total knee arthroplasty. REGISTRATION ANZCTR 12615000863538.
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Warren J, Sundaram K, Anis H, McLaughlin J, Patterson B, Higuera CA, Piuzzi NS. The association between weight-bearing status and early complications in hip fractures. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 29:1419-1427. [DOI: 10.1007/s00590-019-02453-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 05/20/2019] [Indexed: 01/30/2023]
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Wu JQ, Mao LB, Wu J. Efficacy of exercise for improving functional outcomes for patients undergoing total hip arthroplasty: A meta-analysis. Medicine (Baltimore) 2019; 98:e14591. [PMID: 30855443 PMCID: PMC6417520 DOI: 10.1097/md.0000000000014591] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The objective of this meta-analysis was aimed to illustrate the functional outcomes of exercise for total hip arthroplasty (THA) patients. METHODS In July, 2018, a systematic computer-based search was conducted in PubMed, EMBASE, Web of Science, Cochrane Database of Systematic Reviews, and Google database. Data on exercise for functional outcomes for THA patients were retrieved. The primary endpoint was walking speed. Other outcomes included physical activity scale, Harris hip score, pain scores, abduction strength, and the length of hospital stay. After testing for publication bias and heterogeneity between studies, data were aggregated for random-effects models when necessary. RESULTS Ten clinical studies with 441 patients were ultimately included in the meta-analysis. Compared with the control group, exercise was associated with an increase of the walking speed by 0.15 m/s than control group (weighted mean difference [WMD] 0.15; 95% confidence interval [CI] 0.08, 0.22; P = .000). Also, exercise group could also increase Harris hip score (WMD 8.49; 95% CI 5.19, 11.78; P = .000) and abduction strength than control group (WMD 9.75; 95% CI 5.33, 14.17; P = .000). What is more, exercise has a beneficial role in reducing the pain scores (WMD -1.32; 95% CI -2.07, -0.57; P = .001) and the length of hospital stay (WMD -0.68; 95% CI -1.07, -0.29; P = .001) than the control group. However, there was no significant difference between the physical activity scale (WMD -2.13; 95% CI -6.31, 2.05; P = .317). CONCLUSIONS Compared with control group in the management of THA, postoperative exercise has a better pain relief and clinical outcomes. Considering the beneficial of the postoperative exercise, we take a positive attitude toward use exercise for patients with THA.
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Affiliation(s)
| | | | - Jian Wu
- Institute Office, Jingjiang People's Hospital, Jingjiang, Taizhou, Jiangsu Province, China
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Wijnen A, Bouma SE, Seeber GH, van der Woude LHV, Bulstra SK, Lazovic D, Stevens M, van den Akker-Scheek I. The therapeutic validity and effectiveness of physiotherapeutic exercise following total hip arthroplasty for osteoarthritis: A systematic review. PLoS One 2018; 13:e0194517. [PMID: 29547670 PMCID: PMC5856403 DOI: 10.1371/journal.pone.0194517] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 03/05/2018] [Indexed: 01/08/2023] Open
Abstract
Objective To assess the therapeutic validity and effectiveness of physiotherapeutic exercise interventions following total hip arthroplasty (THA) for osteoarthritis. Data sources The databases Embase, MEDLINE, Cochrane Library, CINAHL and AMED were searched from inception up to February 2017. Eligibility criteria Articles reporting results of randomized controlled trials in which physiotherapeutic exercise was compared with usual care or with a different type of physiotherapeutic exercise were included, with the applied interventions starting within six months after THA. Only articles written in English, German or Dutch were included. Study appraisal Therapeutic validity (using the CONTENT scale) and risk of bias (using both the PEDro scale and the Cochrane Collaboration’s tool) were assessed by two researchers independently. Characteristics of the physiotherapeutic exercise interventions and results about joint and muscle function, functional performance and self-reported outcomes were extracted. Results Of the 1124 unique records retrieved, twenty articles were included. Only one article was considered to be of high therapeutic validity. Description and adequacy of patient selection were the least reported items. The majority of the articles was considered as having potentially high risk of bias, according to both assessment tools. The level of therapeutic validity did not correspond with the risk of bias scores. Because of the wide variety in characteristics of the physiotherapeutic exercise and control interventions, follow-up length and outcome measures, limited evidence was found on the effectiveness of physiotherapeutic exercise following THA. Conclusion The insufficient therapeutic validity and potentially high risk of bias in studies involving physiotherapeutic exercise interventions limit the ability to assess the effectiveness of these interventions following THA. Researchers are advised to take both quality scores into account when developing and reporting studies involving physiotherapeutic exercise. Uniformity in intervention characteristics and outcome measures is necessary to enhance the comparability of clinical outcomes between trials.
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Affiliation(s)
- Annet Wijnen
- University Hospital of Orthopedics and Trauma Surgery Pius-Hospital, Medical Campus University of Oldenburg, Oldenburg, Germany
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- * E-mail:
| | - Sjoukje E. Bouma
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands
| | - Gesine H. Seeber
- University Hospital of Orthopedics and Trauma Surgery Pius-Hospital, Medical Campus University of Oldenburg, Oldenburg, Germany
| | - Lucas H. V. van der Woude
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands
| | - Sjoerd K. Bulstra
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Djordje Lazovic
- University Hospital of Orthopedics and Trauma Surgery Pius-Hospital, Medical Campus University of Oldenburg, Oldenburg, Germany
| | - Martin Stevens
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Inge van den Akker-Scheek
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Monticone M, Ambrosini E, Brunati R, Capone A, Pagliari G, Secci C, Zatti G, Ferrante S. How balance task-specific training contributes to improving physical function in older subjects undergoing rehabilitation following hip fracture: a randomized controlled trial. Clin Rehabil 2018; 32:340-351. [PMID: 28805094 DOI: 10.1177/0269215517724851] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To evaluate the efficacy of a rehabilitation programme including balance task-specific training in improving physical function, pain, activities of daily living (ADL), balance and quality of life in subjects after a hip fracture. DESIGN Randomized controlled trial. SUBJECTS A total of 52 older subjects selected for internal fixation due to extra-capsular hip fracture were randomized to be included in an experimental ( n = 26) and control group ( n = 26). INTERVENTIONS The experimental group underwent a rehabilitation programme based on balance task-specific training. The control group underwent general physiotherapy, including open kinetic chain exercises and walking training. Both groups individually followed programmes of 90-minute sessions five times/week for three weeks. OUTCOME MEASURES The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), a Pain Numerical Rating Scale, the Berg Balance Scale, the Functional Independence Measure and the 36-item Short-Form Health Survey. The participants were evaluated before and after training, and after 12 months. RESULTS Significant effects of time, group and time × group were found for all outcome measures in favour of the experimental group. A clinically important between-group difference of 25 points was achieved after training and at follow-up in terms of the primary outcome (WOMAC function before treatment, after treatment and at follow-up was 84.8 (3.7), 39.8 (4.9) and 35.7 (6.2) for the experimental group and 80.9 (5.7), 65.2 (7.1) and 61.0 (11.1) for the control group). CONCLUSION An inpatient rehabilitation programme based on balance task-specific training is useful in improving physical function, pain, ADL and quality of life in older patients after hip fracture.
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Affiliation(s)
- Marco Monticone
- 1 Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
- 2 Physical Medicine and Rehabilitation Unit, Scientific Institute of Lissone, Clinical and Scientific Institutes Maugeri, Institute of Care and Research (IRCCS), Lissone, Italy
| | - Emilia Ambrosini
- 3 Neuroengineering and Medical Robotics Laboratory, Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Roberto Brunati
- 2 Physical Medicine and Rehabilitation Unit, Scientific Institute of Lissone, Clinical and Scientific Institutes Maugeri, Institute of Care and Research (IRCCS), Lissone, Italy
| | - Antonio Capone
- 4 Orthopaedic Unit, Department of Surgery, University of Cagliari, Cagliari, Italy
| | - Giulia Pagliari
- 2 Physical Medicine and Rehabilitation Unit, Scientific Institute of Lissone, Clinical and Scientific Institutes Maugeri, Institute of Care and Research (IRCCS), Lissone, Italy
| | - Claudio Secci
- 5 Physical Medicine and Rehabilitation School, University of Cagliari, Cagliari, Italy
| | - Giovanni Zatti
- 6 University of Milano-Bicocca, Milan, Italy
- 7 Orthopaedics Unit, San Gerardo Hospital, Monza, Italy
| | - Simona Ferrante
- 3 Neuroengineering and Medical Robotics Laboratory, Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
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Briggs RA, Houck JR, LaStayo PC, Fritz JM, Drummond MJ, Marcus RL. High-Intensity Multimodal Resistance Training Improves Muscle Function, Symmetry during a Sit-to-Stand Task, and Physical Function Following Hip Fracture. J Nutr Health Aging 2018; 22:431-438. [PMID: 29484358 DOI: 10.1007/s12603-017-0977-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Post rehabilitation, older adults with hip fracture display low vertical ground reaction force (vGRF) on the involved lower extremity during a sit-to-stand task and low physical function. The purpose of this study was to test whether muscle performance, involved side vGRF during a sit-to-stand task, and physical function improved following multimodal high-intensity resistance training, when initiated after usual care (2 to 6 months after hip fracture). DESIGN Case series study, 12 weeks extended high-intensity strength training intervention following hip fracture. SETTING University hospital outpatient facility. PARTICIPANTS Twenty-four community-dwelling older adults (mean age 78.4 years (SD 10.4), 16 female/8 male), 3.6 (SD 1.2) months post-hip fracture and discharged from physical therapy participated. Intervention/Measurement: All participants performed sit-to-stand tasks, muscle performance tests, and modified physical performance test (mPPT) before and after 12 weeks (3x/wk) of training. Variables were compared using paired t-tests. RESULTS The vGRF rate of force development (RFD) and magnitude of discrepancy between limb loading during rising phase of sit-to-stand task (AREA) variables improved post-training (RFD ratio = Pre: 0.78 - Post: 0.82, AREA ratio = Pre: 0.79 - Post: 0.86). Surgical leg extension power gains were large (~65%) while strength gains were moderate (~34%); yielding improved symmetry in both strength (Pre: 0.74 - Post: 0.88) and power (Pre: 0.75 - Post: 0.82). Physical function improved pre-training 25 (SD 5.2) to post training 30 (SD 4.3), (p < 0.001). CONCLUSION Unique to this study, participants recovering from hip fracture demonstrated improved symmetry in sit-to-stand vGRFs, muscle function, and physical function after training. However, a high percentage of patients continued to experience persistently low vGRF of the involved side compared to previous studies of healthy elderly controls. Developing alternative strategies to improve involved side vGRF may be warranted.
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Affiliation(s)
- R A Briggs
- Robert A. Briggs PT PhD, Physical Therapy, David Grant Medical Center, 60th Medical Group, 101 Bodin Circle, Travis AFB, CA 94535, USA;
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Responsiveness and Minimal Important Changes of the Western Ontario and McMaster Universities Osteoarthritis Index in Subjects Undergoing Rehabilitation Following Hip Fracture. Am J Phys Med Rehabil 2017; 96:321-326. [DOI: 10.1097/phm.0000000000000609] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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L Snell D, Hipango J, Sinnott KA, Dunn JA, Rothwell A, Hsieh CJ, DeJong G, Hooper G. Rehabilitation after total joint replacement: a scoping study. Disabil Rehabil 2017; 40:1718-1731. [PMID: 28330380 DOI: 10.1080/09638288.2017.1300947] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE The evidence supporting rehabilitation after joint replacement, while vast, is of variable quality making it difficult for clinicians to apply the best evidence to their practice. We aimed to map key issues for rehabilitation following joint replacement, highlighting potential avenues for new research. MATERIALS AND METHODS We conducted a scoping study including research published between January 2013 and December 2016, evaluating effectiveness of rehabilitation following hip and knee total joint replacement. We reviewed this work in the context of outcomes described from previously published research. RESULTS Thirty individual studies and seven systematic reviews were included, with most research examining the effectiveness of physiotherapy-based exercise rehabilitation after total knee replacement using randomized control trial methods. Rehabilitation after hip and knee replacement whether carried out at the clinic or monitored at home, appears beneficial but type, intensity and duration of interventions were not consistently associated with outcomes. The burden of comorbidities rather than specific rehabilitation approach may better predict rehabilitation outcome. Monitoring of recovery and therapeutic attention appear important but little is known about optimal levels and methods required to maximize outcomes. CONCLUSIONS More work exploring the role of comorbidities and key components of therapeutic attention and the therapy relationship, using a wider range of study methods may help to advance the field. Implications for Rehabilitation Physiotherapy-based exercise rehabilitation after total hip replacement and total knee replacement, whether carried out at the clinic or monitored at home, appears beneficial. Type, intensity, and duration of interventions do not appear consistently associated with outcomes. Monitoring a patient's recovery appears to be an important component. The available research provides limited guidance regarding optimal levels of monitoring needed to achieve gains following hip and knee replacement and more work is required to clarify these aspects. The burden of comorbidities appears to better predict outcomes regardless of rehabilitation approach.
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Affiliation(s)
- Deborah L Snell
- a Department of Orthopaedic Surgery and Musculoskeletal Medicine , University of Otago Christchurch , Christchurch, New Zealand.,b Burwood Academy of Independent Living (BAIL), Burwood Hospital , Christchurch , New Zealand
| | - Julia Hipango
- a Department of Orthopaedic Surgery and Musculoskeletal Medicine , University of Otago Christchurch , Christchurch, New Zealand
| | - K Anne Sinnott
- b Burwood Academy of Independent Living (BAIL), Burwood Hospital , Christchurch , New Zealand
| | - Jennifer A Dunn
- a Department of Orthopaedic Surgery and Musculoskeletal Medicine , University of Otago Christchurch , Christchurch, New Zealand
| | - Alastair Rothwell
- a Department of Orthopaedic Surgery and Musculoskeletal Medicine , University of Otago Christchurch , Christchurch, New Zealand
| | - C Jean Hsieh
- c MedStar Health Research Institute , Washington , DC , USA.,d MedStar National Rehabilitation Hospital , Washington , DC , USA
| | - Gerben DeJong
- d MedStar National Rehabilitation Hospital , Washington , DC , USA.,e Department of Rehabilitation Medicine , Georgetown University School of Medicine , Washington , DC , USA
| | - Gary Hooper
- a Department of Orthopaedic Surgery and Musculoskeletal Medicine , University of Otago Christchurch , Christchurch, New Zealand
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Jepson P, Sands G, Beswick AD, Davis ET, Blom AW, Sackley CM. A feasibility randomised controlled trial of pre-operative occupational therapy to optimise recovery for patients undergoing primary total hip replacement for osteoarthritis (PROOF-THR). Clin Rehabil 2015; 30:156-66. [PMID: 25795459 DOI: 10.1177/0269215515576811] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 02/18/2015] [Indexed: 01/24/2023]
Abstract
Objective: To assess the feasibility of a pre-operative occupational therapy intervention for patients undergoing primary total hip replacement. Design: Single blinded feasibility randomised controlled trial, with data collection prior to the intervention, and at 4, 12, and 26 weeks following surgery. Setting: Recruitment from two NHS orthopaedic outpatient centres in the West Midlands, UK. Subjects: Patients awaiting primary total hip replacement due to osteoarthritis were recruited. Following pre-operative assessment, patients were individually randomised to intervention or control by a computer-generated block randomisation algorithm stratified by age and centre. Interventions: The intervention group received a pre-surgery home visit by an occupational therapist who discussed expectations, assessed home safety, and provided appropriate adaptive equipment. The control group received treatment as usual. Outcomes: The study assessed the feasibility of recruitment procedures, delivery of the intervention, appropriateness of outcome measures and data collection methods. Health related quality of life and resource use were recorded at 4, 12 and 26 weeks. Results: Forty-four participants were recruited, 21 were randomised to the occupational therapy intervention and 23 to usual care. Analysis of 26 week data included 18 participants in the intervention group and 21 in the control. The intervention was delivered successfully with no withdrawals or crossovers; 5/44 were lost to follow-up with further missing data for participation and resource use. Conclusions: The feasibility study provided the information required to conduct a definitive trial. Burden of assessment would need to be addressed. A total of 219 patients would be required in an efficacy trial.
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Affiliation(s)
- Paul Jepson
- School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, UK
| | - Gina Sands
- CLAHRC-EM, School of Medicine, University of Nottingham, UK
| | - Andrew D Beswick
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, UK
| | - Edward T Davis
- The Royal Orthopaedic Hospital, NHS Foundation Trust, Birmingham, UK
| | - Ashley W Blom
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, UK
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