QUESTION: In people who have been discharged from hospital after a total hip replacement, do rehabilitation exercises directed by a physiotherapist improve strength, gait, function and quality of life? Are these exercises as effective in an unsupervised home-based setting as they are in a supervised outpatient setting? DESIGN: Systematic review with meta-analysis of randomised trials. PARTICIPANTS: Adult patients after elective total hip replacement. INTERVENTION: Physiotherapist-directed rehabilitation exercises after discharge from hospital following total hip replacement. OUTCOME MEASURES: Hip and knee strength, gait parameters, functional measures, and quality of life. RESULTS: Five studies comprising 234 participants were included in the review. Sufficient data for meta-analysis were only obtained for hip and knee strength, gait speed and cadence. Physiotherapy rehabilitation improved hip abductor strength by a mean of 16Nm (95% CI 10 to 22), gait speed by 6 m/min (95% CI 1 to 11) and cadence by 20 steps/min (95% CI 8 to 32). Favourable but non-significant improvements in strength were noted for other muscle groups at the hip and knee. Function and quality of life could not be meta-analysed due to insufficient data and heterogeneity of measures, but functional measures tended to favour the physiotherapy rehabilitation group. Most outcomes were similar between outpatient and home-based exercise programs. CONCLUSION: Physiotherapy rehabilitation improves hip abductor strength, gait speed and cadence in people who have been discharged from hospital after total hip replacement. Physiotherapist-directed rehabilitation exercises appear to be similarly effective whether they are performed unsupervised at home or supervised by a physiotherapist in an outpatient setting.
QUESTION: In people who have been discharged from hospital after a total hip replacement, do rehabilitation exercises directed by a physiotherapist improve strength, gait, function and quality of life? Are these exercises as effective in an unsupervised home-based setting as they are in a supervised outpatient setting? DESIGN: Systematic review with meta-analysis of randomised trials. PARTICIPANTS: Adult patients after elective total hip replacement. INTERVENTION: Physiotherapist-directed rehabilitation exercises after discharge from hospital following total hip replacement. OUTCOME MEASURES: Hip and knee strength, gait parameters, functional measures, and quality of life. RESULTS: Five studies comprising 234 participants were included in the review. Sufficient data for meta-analysis were only obtained for hip and knee strength, gait speed and cadence. Physiotherapy rehabilitation improved hip abductor strength by a mean of 16Nm (95% CI 10 to 22), gait speed by 6 m/min (95% CI 1 to 11) and cadence by 20 steps/min (95% CI 8 to 32). Favourable but non-significant improvements in strength were noted for other muscle groups at the hip and knee. Function and quality of life could not be meta-analysed due to insufficient data and heterogeneity of measures, but functional measures tended to favour the physiotherapy rehabilitation group. Most outcomes were similar between outpatient and home-based exercise programs. CONCLUSION: Physiotherapy rehabilitation improves hip abductor strength, gait speed and cadence in people who have been discharged from hospital after total hip replacement. Physiotherapist-directed rehabilitation exercises appear to be similarly effective whether they are performed unsupervised at home or supervised by a physiotherapist in an outpatient setting.
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Authors: Annet Wijnen; Sjoukje E Bouma; Gesine H Seeber; Lucas H V van der Woude; Sjoerd K Bulstra; Djordje Lazovic; Martin Stevens; Inge van den Akker-Scheek Journal: PLoS One Date: 2018-03-16 Impact factor: 3.240