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Judd DL, Cheuy V, Peters A, Graber J, Hinrichs-Kinney L, Forster JE, Christiansen CL, Stevens-Lapsley JE. Incorporating Functional Strength Integration Techniques During Total Hip Arthroplasty Rehabilitation: A Randomized Controlled Trial. Phys Ther 2024; 104:pzad168. [PMID: 38102757 DOI: 10.1093/ptj/pzad168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/01/2023] [Accepted: 12/07/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVE Total hip arthroplasty (THA) is a common orthopedic procedure that alleviates pain for millions of individuals. Yet, persistent physical function deficits, perhaps associated with movement compensations, are observed after THA. These deficits negatively affect quality of life and health for many individuals. Functional strength integration (FSI) techniques combine muscle strength training with specific movement retraining to improve physical function. This study aimed to determine if FSI would improve functional performance through remediation of movement compensations for individuals after THA. METHODS A double-blind randomized controlled trial was conducted. Ninety-five participants were randomized to either the FSI or control (CON) group for an 8-week intervention. The FSI protocol included exercise to improve muscular control and stability around the hip to minimize movement compensation during daily activity. The CON protocol included low-load resistance exercise, range-of-motion activities, and patient education. Functional performance, muscle strength, and self-reported outcomes were measured preoperatively, midway and after intervention, and 6 months after THA. Change from preoperative assessment to each time point was measured, and between-group differences were assessed. RESULTS There were minimal differences in outcomes between groups at the first postoperative assessment. There were no statistically significant between-group differences in the later assessments, including the primary endpoint. Both groups improved functional outcomes throughout the study period. CONCLUSION The FSI intervention did not result in greater improvements in function after THA compared to the CON intervention. Future work should further investigate additional biomechanical outcomes, timing of the FSI protocol, effective dosing, and patient characteristics predictive of success with FSI. IMPACT Recovery after THA is complex, and individuals after THA are affected by persistent movement deficits that affect morbidity and quality of life. The present study suggests that either approach to THA rehabilitation could improve outcomes for patients, and that structured rehabilitation programs may benefit individuals after THA.
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Affiliation(s)
- Dana L Judd
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, Colorado, USA
| | - Victor Cheuy
- Department of Physical Therapy and Rehabilitation Science, University of California San Francisco, San Francisco, California, USA
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Amy Peters
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, Colorado, USA
| | - Jeremy Graber
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, Colorado, USA
| | - Lauren Hinrichs-Kinney
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, Colorado, USA
| | - Jeri E Forster
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- US Department of Veterans Affairs, Rocky Mountain Mental Illness, Research, Education and Clinical Center, Aurora, Colorado, USA
| | - Cory L Christiansen
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, Colorado, USA
| | - Jennifer E Stevens-Lapsley
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, Colorado, USA
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Gandolfi MG, Zamparini F, Spinelli A, Prati C. Āsana for Back, Hips and Legs to Prevent Musculoskeletal Disorders among Dental Professionals: In-Office Yóga Protocol. J Funct Morphol Kinesiol 2023; 9:6. [PMID: 38249083 PMCID: PMC10801568 DOI: 10.3390/jfmk9010006] [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] [Received: 10/10/2023] [Revised: 11/29/2023] [Accepted: 12/18/2023] [Indexed: 01/23/2024] Open
Abstract
Dental professionals are exposed to significant unavoidable physical stress, and theoretical ergonomic recommendations for a sitting workplace are inapplicable in many dental activities. Work-related musculoskeletal disorders (WMSDs) represent a serious health problem among dental professionals (prevalence: 64-93%), showing involvement of 34-60% for the low back and 15-25% for the hips. Muscle stress; prolonged sitting; forward bending and twisting of the torso and head; unbalanced working postures with asymmetrical weight on the hips and uneven shoulders; and others are inevitable for dental professionals. Therefore, the approach for the prevention and treatment of WMSDs must be therapeutic and compensatory. This project was conceived to provide a Yoga protocol for dental professionals to prevent or treat WMSDs from a preventive medicine perspective, and it would represent a Yoga-based guideline for the self-cure and prevention of musculoskeletal problems. METHODS Specific Yoga positions (āsana, such as Virāsana, Virabhadrāsana, Garudāsana, Utkatāsana, Trikonāsana, Anuvittāsana, Chakrāsana, Uttanāsana, Pashimottanāsana) have been selected, elaborated on and adapted to be practiced in a dental office using a dental stool or the dental office walls or a dental unit chair. The protocol is specifically devised for dental professionals (dentists, dental hygienists and dental assistants) and targeted for the low back, hips and legs (including knees and ankles). The protocol includes Visranta Karaka Sthiti (supported positions) in sitting (Upavistha Sthiti) and standing (Utthistha Sthiti) positions, twisting/torsions (Parivrtta), flexions/forward bend positions (Pashima) and extensions/arching (Purva) for musculo-articular system decompression and mobilization. RESULTS Over 60 Yogāsana-specifically ideated for back detensioning and mobilization, lumbar lordosis restoration, trunk side elongation, hip release and leg stretches and decontraction-are shown and described. The paper provides a meticulous description for each position, including the detailed movement, recommendations and mistakes to avoid, and the breathing pattern (breath control) in all the breath-driven movements (āsana in vinyāsa). An exhaustive analysis of posture-related disorders affecting the lower body among dental professionals is reported, including low-back pain, hip pain and disorders, piriformis syndrome and quadratus femoris dysfunction (gluteal pain), iliopsoas syndrome, multifidus disorders, femoroacetabular and ischiofemoral impingement, spinopelvic mobility, lumbopelvic rhythm, impairment syndromes, lower crossed syndrome, leg pain, knee pain and ankle disorders. CONCLUSIONS A detailed guideline of āsana for low-back decompression, hip joint destress, piriformis and gluteal muscle release, lumbar lordosis recovery and a spinopelvic mobility increase has been elaborated on. The designed Yogāsana protocol represents a powerful tool for dental professionals to provide relief to retracted stiff muscles and unbalanced musculoskeletal structures in the lower body.
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Affiliation(s)
- Maria Giovanna Gandolfi
- Program in Ergonomics, Posturology and Yoga Therapy for the Degree in Dentistry and for the Degree in Dental Hygiene, School of Medicine, University of Bologna, 40125 Bologna, Italy
- Program in Yoga Therapy for the Specialization Course in Sports Medicine, School of Medicine, University of Bologna, 40125 Bologna, Italy
- Dental School, Department of Biomedical and Neuromotor Sciences, University of Bologna, 40125 Bologna, Italy (A.S.); (C.P.)
| | - Fausto Zamparini
- Dental School, Department of Biomedical and Neuromotor Sciences, University of Bologna, 40125 Bologna, Italy (A.S.); (C.P.)
| | - Andrea Spinelli
- Dental School, Department of Biomedical and Neuromotor Sciences, University of Bologna, 40125 Bologna, Italy (A.S.); (C.P.)
| | - Carlo Prati
- Dental School, Department of Biomedical and Neuromotor Sciences, University of Bologna, 40125 Bologna, Italy (A.S.); (C.P.)
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Park SJ, Kim BG. Effects of exercise therapy on the balance and gait after total hip arthroplasty: a systematic review and meta-analysis. J Exerc Rehabil 2023; 19:190-197. [PMID: 37662528 PMCID: PMC10468294 DOI: 10.12965/jer.2346290.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 07/12/2023] [Indexed: 09/05/2023] Open
Abstract
The situation is such that there is a lack of research analyzing the effect of exercise therapy during the rehabilitation period of patients after total hip arthroplasty (THA). Therefore, the purpose of this systematic review and meta-analysis is to analyze the effects of exercise therapy on the balance and gait of patients after THA. The studies selected for this study were based on the PICO as follows: P (Patient)-patients after THA, I (Intervention)-exercise therapy, C (Comparison)-control and other therapy groups, O (Outcome)-balance and gait. Additional criteria for this study were study design (randomized controlled study), language (English), publication status (journal), and the year of publication were not limited. Eleven studies were included. The effects of exercise therapy on balance and gait in patients after THA were significantly different. Balance: standardized mean difference (SMD), 0.51; 95% confidence intervals (CI), 0.24-0.78; I2=22%. Gait: SMD, 0.39; 95% CI, 0.01-0.76; I2=66%. Rehabilitation specialists recommend that exercise therapy be included in rehabilitation programs to improve balance and gait in patients after THA. Further research is needed in the future, including more studies and a network meta-analysis that analyzes the effect size of each exercise therapy.
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Affiliation(s)
- Se-Ju Park
- Department of Rehabilitation, Songwon University, Gwangju,
Korea
| | - Byeong-Geun Kim
- Department of Rehabilitation, Songwon University, Gwangju,
Korea
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Dudoniene V, Adomaitytė A, Žlibinaitė L. Randomized controlled trial to compare conventional physiotherapy with task-oriented exercises after total hip replacement. J Back Musculoskelet Rehabil 2023:BMR220340. [PMID: 37248880 DOI: 10.3233/bmr-220340] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Different interventions are used during rehabilitation after hip replacement surgery, but it is unclear if task-oriented exercise is more effective than conventional physiotherapy. OBJECTIVE This study compared the effectiveness of conventional physiotherapy (CPT) programme with task-oriented exercise (TOE) on hip pain, function, static and dynamic balance during the early rehabilitation stage after total hip replacement. METHODS This randomized controlled parallel-group trial was executed in an inpatient physical medicine and rehabilitation centre. The study included 40 patients who were randomly classified into CPT and TOE groups (n= 20 in each). Hip pain (assessed by visual analogue scale), function in the operated leg (assessed by modified Harris Hip Score, mHHS), static balance (assessed by Abili Balance analyser system) and dynamic balance (assessed by Berg Balance Scale) were evaluated at baseline and after 18 days of rehabilitation. Cohen's effect size (d) was calculated. RESULTS Greater pain reduction (p< 0.05; d= 0.08) was observed after TOE (1.6 ± 0.68 scores) compared with the CPT programme (2.2 ± 0.83 scores). Hip function assessed by the modified mHHS improved more (p< 0.05; d= 0.30) in the TOE group (73.45 ± 6.23 scores) than in the CPT group (54.90 ± 6.28 scores). Static balance improved significantly in both groups after the interventions but did not differ significantly between the groups. The improvement in dynamic balance was significantly greater (p< 0.05; d= 0.45) after TOE (50.55 ± 1.57 scores) than after CPT (38.55 ± 3.43 scores). CONCLUSION Both interventions reduced pain and improved function of the operated leg and static and dynamic balance. The effect on hip function was superior for TOE compared with CPT.
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Chaudhry YP, Hayes H, Wells Z, Papadelis E, Arevalo A, Horan T, Khanuja HS, Deirmengian C. Unsupervised Home Exercises Versus Formal Physical Therapy After Primary Total Hip Arthroplasty: A Systematic Review. Cureus 2022; 14:e29322. [PMID: 36159349 PMCID: PMC9484297 DOI: 10.7759/cureus.29322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2022] [Indexed: 11/09/2022] Open
Abstract
Historically, postoperative exercise and physical therapy (PT) have been viewed as crucial to a successful outcome following primary total hip arthroplasty (THA). This systematic review and meta-analysis aimed to assess differences in both short- and long-term objective and self-reported measures between primary THA patients with formal supervised physical therapy versus unsupervised home exercises after discharge. A search was conducted of six electronic databases from inception to December 14, 2020, for randomized controlled trials (RCTs) comparing changes from baseline in lower extremity strength (LES), aerobic capacity, and self-reported physical function and quality of life (QoL) between supervised and unsupervised physical therapy/exercise regimens following primary THA. Outcomes were separated into short-term (<6 months from surgery, closest to 3 months) and long-term (≥6 months from surgery, closest to 12 months) measures. Meta-analyses were performed when possible and reported in standardized mean differences (SMDs) with 95% confidence intervals (CI). Seven studies (N=398) were included for review. No significant differences were observed with regard to lower extremity strength (p=0.85), aerobic capacity (p=0.98), or short-term quality of life scores (p=0.18). Although patients in supervised physical therapy demonstrated improved short-term self-reported outcomes compared to those performing unsupervised exercises, this was represented by a small effect size (SMD 0.23 [95% CI, 0.02-0.44]; p=0.04). No differences were observed between groups regarding long-term lower extremity strength (p=0.24), physical outcome scores (p=0.37), or quality of life (p=0.14). The routine use of supervised physical therapy may not provide any clinically significant benefit over unsupervised exercises following primary THA. These results suggest that providers should reconsider the routine use of supervised physical therapy after discharge.
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Affiliation(s)
- Yash P Chaudhry
- Orthopaedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, USA
| | - Hunter Hayes
- Orthopaedics, Philadelphia College of Osteopathic Medicine, Philadelphia, USA
| | - Zachary Wells
- Orthopaedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, USA
| | - Efstratios Papadelis
- Orthopaedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, USA
| | - Alfonso Arevalo
- Orthopaedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, USA
| | | | - Harpal S Khanuja
- Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Carl Deirmengian
- Orthopaedic Surgery, The Rothman Orthopaedic Institute, Philadelphia, USA
- Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, USA
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Total Joint Arthroplasty Training (Prehabilitation and Rehabilitation) in Lower Extremity Arthroplasty. J Am Acad Orthop Surg 2022; 30:e799-e807. [PMID: 35594512 DOI: 10.5435/jaaos-d-21-00247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 02/14/2022] [Indexed: 02/01/2023] Open
Abstract
Lower extremity total joint arthroplasty (TJA) has an established track record of success and a subset of patients who fail to experience desired improvements. Current TJA success can be attributed to refined surgical techniques, improved preparation of patients for surgery, and enhanced postoperative recovery protocols. One aspect of preoperative patient preparation and enhanced postoperative recovery includes training regimens intended to prepare patients for TJA and facilitate TJA functional recovery (often referred to as using the jargon prehabilitation and rehabilitation). The importance of prehabilitation and rehabilitation is open to debate because of historically insufficient and inconsistent evidence. This review aims to provide direction for future investigative efforts by presenting an overview of current preoperative and postoperative TJA training/exercise programs within the framework of utility, timing, form, setting, and cost.
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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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The Unknown Prevalence of Postrandomization Bias in 15 Physical Therapy Journals: A Methods Review. J Orthop Sports Phys Ther 2021; 51:542-550. [PMID: 34546817 DOI: 10.2519/jospt.2021.10491] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To determine the prevalence of prospective clinical trial registration and postrandomization bias in published musculoskeletal physical therapy randomized clinical trials (RCTs). DESIGN A methods review. LITERATURE SEARCH Articles indexed in MEDLINE and published between January 2016 and July 2020 were included. STUDY SELECTION CRITERIA Two independent blinded reviewers identified the RCTs using Covidence. We included RCTs related to musculoskeletal interventions that were published in International Society of Physiotherapy Journal Editors member journals. DATA SYNTHESIS Data were extracted independently for the variables of interest from the identified RCTs by 2 blinded reviewers. The data were presented descriptively or in frequency tables. RESULTS One hundred thirty-eight RCTs were identified. One third of RCTs were consistent with their prospectively registered intent (49/138); consistency with prospectively registered intent could not be determined for two thirds (89/138) of the RCTs. Four RCTs (8%)reported inconsistent results with the primary aims and 7 (14%) with the outcomes from the prospective clinical trial registry, despite high methodological quality (Physiotherapy Evidence Database [PEDro] scale score). Differences between prospectively registered and non-prospectively registered RCTs for PEDro scale scores had a medium effect size (r = 0.30). Two of 15 journals followed their clinical trial registration policy 100% of the time; in 1 journal, the published RCTs were consistent with the clinical trial registration. CONCLUSION Postrandomization bias in musculoskeletal physical therapy RCTs could not be ruled out, due to the lack of prospective clinical trial registration and detailed data analysis plans. J Orthop Sports Phys Ther 2021;51(11):542-550. Epub 21 Sep 2021. doi:10.2519/jospt.2021.10491.
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Röhner E, Mayfarth A, Sternitzke C, Layher F, Scheidig A, Groß HM, Matziolis G, Böhle S, Sander K. Mobile Robot-Based Gait Training after Total Hip Arthroplasty (THA) Improves Walking in Biomechanical Gait Analysis. J Clin Med 2021; 10:jcm10112416. [PMID: 34072524 PMCID: PMC8198188 DOI: 10.3390/jcm10112416] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 05/27/2021] [Indexed: 12/15/2022] Open
Abstract
There are multiple attempts to decrease costs in the healthcare system while maintaining a high treatment quality. Digital therapies receive increasing attention in clinical practice, mainly relating to home-based exercises supported by mobile devices, eventually in combination with wearable sensors. The aim of this study was to determine if patients following total hip arthroplasty (THA) could benefit from gait training on crutches conducted by a mobile robot in a clinical setting. METHOD This clinical trial was conducted with 30 patients following total hip arthroplasty. Fifteen patients received the conventional physiotherapy program in the clinic (including 5 min of gait training supported by a physiotherapist). The intervention group of 15 patients passed the same standard physiotherapy program, but the 5-min gait training supported by a physiotherapist was replaced by 2 × 5 min of gait training conducted by the robot. Length of stay of the patients was set to five days. Biomechanical gait parameters of the patients were assessed pre-surgery and upon patient discharge. RESULTS While before surgery no significant difference in gait parameters was existent, patients from the intervention group showed a significant higher absolute walking speed (0.83 vs. 0.65 m/s, p = 0.029), higher relative walking speed (0.2 vs. 0.16 m/s, p = 0.043) or shorter relative cycle time (3.35 vs. 3.68 s, p = 0.041) than the patients from the control group. CONCLUSION The significant higher walking speed of patients indicates that such robot-based gait training on crutches may shorten length of stay (LOS) in acute clinics. However, the number of patients involved was rather small, thus calling for further studies.
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Affiliation(s)
- Eric Röhner
- Orthopaedic Professorship of the University Hospital Jena, Orthopedic Department of the Waldkliniken Eisenberg, 07607 Eisenberg, Germany; (F.L.); (G.M.); (S.B.); (K.S.)
- Correspondence: ; Tel.: +49-36691-8-1254; Fax: +49-36691-8-1807
| | - Anke Mayfarth
- Tediro GmbH, Ehrenbergstr. 11, 98693 Ilmenau, Germany; (A.M.); (C.S.)
| | | | - Frank Layher
- Orthopaedic Professorship of the University Hospital Jena, Orthopedic Department of the Waldkliniken Eisenberg, 07607 Eisenberg, Germany; (F.L.); (G.M.); (S.B.); (K.S.)
| | - Andrea Scheidig
- TU Ilmenau, Neuroinformatics and Cognitive Robotics Lab, PF 100565, 98684 Ilmenau, Germany; (A.S.); (H.-M.G.)
| | - Horst-Michael Groß
- TU Ilmenau, Neuroinformatics and Cognitive Robotics Lab, PF 100565, 98684 Ilmenau, Germany; (A.S.); (H.-M.G.)
| | - Georg Matziolis
- Orthopaedic Professorship of the University Hospital Jena, Orthopedic Department of the Waldkliniken Eisenberg, 07607 Eisenberg, Germany; (F.L.); (G.M.); (S.B.); (K.S.)
| | - Sabrina Böhle
- Orthopaedic Professorship of the University Hospital Jena, Orthopedic Department of the Waldkliniken Eisenberg, 07607 Eisenberg, Germany; (F.L.); (G.M.); (S.B.); (K.S.)
| | - Klaus Sander
- Orthopaedic Professorship of the University Hospital Jena, Orthopedic Department of the Waldkliniken Eisenberg, 07607 Eisenberg, Germany; (F.L.); (G.M.); (S.B.); (K.S.)
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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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11
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Power Training in Older Adults With Hip Osteoarthritis and Total Hip Arthroplasty. TOPICS IN GERIATRIC REHABILITATION 2021. [DOI: 10.1097/tgr.0000000000000300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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12
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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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13
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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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14
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Chen J, Zhu X, Jiang J, Qi Y, Shi Y. Needs of Chinese patients undergoing home-based rehabilitation after hip replacement: A qualitative study. PLoS One 2019; 14:e0220304. [PMID: 31348814 PMCID: PMC6660078 DOI: 10.1371/journal.pone.0220304] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 07/13/2019] [Indexed: 02/06/2023] Open
Abstract
Background The needs of Chinese patients undergoing home-based rehabilitation after hip replacement surgery remain unclear. In this study, we qualitatively investigated the needs of Chinese patients undergoing home-based rehabilitation after hip replacement surgery. Methods A total of 21 participants undergoing home-based rehabilitation after hip replacement surgery were included in this study. Individual semi-structured interviews involving all participants were performed to determine the needs and experiences of this patient population during home-based rehabilitation. Data were subjected to qualitative content analysis. Results The patients had numerous needs during rehabilitation. Three substantive themes, namely, the need to obtain health-related knowledge, the need to obtain care and support, and the needs of those who cannot perform self-care, were identified from the qualitative data. The participants shared valuable insights into their needs during home-based rehabilitation after hip replacement and provided potential suggestions. Conclusions Patients undergoing home-based rehabilitation after hip replacement have several strong needs and lack proper guidance. The initial and continuous engagement of rehabilitation professionals and the establishment of related policies based on patient’s needs are potential approaches for improving the effectiveness of home-based rehabilitation after hip replacement.
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Affiliation(s)
- Jing Chen
- Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Xiaoping Zhu
- Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jinxia Jiang
- Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yan Qi
- Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yan Shi
- Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
- * E-mail:
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15
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Cinnamon CC, Longworth JA, Brunner JH, Chau VK, Ryan CA, Dapiton KR, Chmell SJ, Foucher KC. Static and dynamic abductor function are both associated with physical function 1 to 5 years after total hip arthroplasty. Clin Biomech (Bristol, Avon) 2019; 67:127-133. [PMID: 31103962 DOI: 10.1016/j.clinbiomech.2019.05.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 04/06/2019] [Accepted: 05/08/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND A subset of total hip arthroplasty patients experience functional impairments past the first postoperative year. Poor hip abductor function is common before and in the early postoperative period. It is not known if abductor impairment is associated with long-term functional impairment. This study evaluated the relationships between static and dynamic abductor function and performance-based and self-reported function >1 year post-total hip arthroplasty. METHODS Eighteen adults 1-5 years post-total hip arthroplasty participated. Static and dynamic abductor function were assessed through dynamometry and gait analysis, respectively. Subjects completed four physical performance tests and two self-report instruments. FINDINGS Higher peak isometric abductor strength was associated with better performance-based function (P ≤ 0.001-0.030) and with self-reported function (P ≤ 0.001-0.012). Higher peak external adduction moment was associated with better results on 3 of 4 performance tests (P = 0.007-0.026). Together, static and dynamic abductor function predicted 35-77% of the variation in physical function. Abductor strength best predicted walking test results and self-reported function, while dynamic abductor function best predicted tests involving sit-to-stand INTERPRETATION: Static and dynamic abductor function were associated with physical function 1-5 years after total hip arthroplasty. These results support further investigation of interventions targeting abductor function for persons experiencing persistent impairments.
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Affiliation(s)
- Christopher C Cinnamon
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA
| | - Jessica A Longworth
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA
| | - J Heather Brunner
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, USA
| | - Vivian K Chau
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA; Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, USA
| | - Colleen A Ryan
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA; School of Nursing, DePaul University, Chicago, Illinois, Chicago, IL, USA
| | - Kris R Dapiton
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA; Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, USA
| | - Samuel J Chmell
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, IL, USA
| | - Kharma C Foucher
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA.
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16
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Hansen S, Aaboe J, Mechlenburg I, Overgaard S, Mikkelsen LR. Effects of supervised exercise compared to non-supervised exercise early after total hip replacement on patient-reported function, pain, health-related quality of life and performance-based function – a systematic review and meta-analysis of randomized controlled trials. Clin Rehabil 2018; 33:13-23. [DOI: 10.1177/0269215518791213] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background: The rehabilitation after a total hip replacement varies in degree of supervision; however, it remains unknown whether supervised programmes are more effective than non-supervised. Objective: This study compared the effectiveness of supervised exercise compared to non-supervised home-based exercise after total hip replacement on patient-reported function, hip-pain, health-related quality of life and performance-based function. Methods: A systematic review and meta-analysis of randomized controlled trials investigating the effect of supervised exercise compared to non-supervised home-based exercise. An electronic search was performed in Medline, Embase and CINAHL on 14 March 2018. The methodological quality was assessed using the Cochrane Risk of Bias tool. Results: Seven studies were included with a total of 389 participants. A small and non-significant difference in favour of the supervised groups was found in patient-reported function (standardized mean difference (SMD) −0.22 (95% confidence interval (CI) −0.46 to 0.02)), hip-related pain (SMD −0.03 (95% CI −0.27 to 0.21)), health-related quality of life (mean difference (MD) −3.08 (95% CI −6.29 to 0.14)) and performance-based function (SMD −0.26 (95% CI −0.68 to 0.17)) at end of treatment and in patient-reported function (MD −1.31 (95% CI −3.79 to 1.16)) at the 6- to 12-month follow-up. Limitations: The literature search was systematic, but limited to three databases. The overall quality of evidence was downgraded to moderate due to lack of blinding in included studies. Conclusion: Supervised exercise was not significantly effective compared to non-supervised home-based exercise on patient-reported function, pain, health-related quality of life and performance-based function after primary total hip replacement. Others: PROSPERO registration number: CRD42017055604.
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Affiliation(s)
- Sebrina Hansen
- Center of Rehabilitation, Municipality of Slagelse, Slagelse, Denmark
| | - Jens Aaboe
- National Clinical Guidelines, Danish Health Authority, Copenhagen, Denmark
| | - Inger Mechlenburg
- Centre of Research in Rehabilitation (CORIR), Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Søren Overgaard
- The Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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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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Coulter C, Perriman DM, Neeman TM, Smith PN, Scarvell JM. Supervised or Unsupervised Rehabilitation After Total Hip Replacement Provides Similar Improvements for Patients: A Randomized Controlled Trial. Arch Phys Med Rehabil 2017; 98:2253-2264. [DOI: 10.1016/j.apmr.2017.03.032] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 02/24/2017] [Accepted: 03/10/2017] [Indexed: 10/19/2022]
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