Marco Monticone1, Emilia Ambrosini2, Barbara Rocca3, Chiara Lorenzon3, Simona Ferrante4, Giovanni Zatti5. 1. Physical Medicine and Rehabilitation Unit, Scientific Institute of Lissone Salvatore Maugeri Foundation IRCCS, Monza Brianza, Italy marco.monticone@fsm.it. 2. Physical Medicine and Rehabilitation Unit, Scientific Institute of Lissone Salvatore Maugeri Foundation IRCCS, Monza Brianza, Italy Neuroengineering and Medical Robotics Laboratory, Department of Electronics, Information, and Bioengineering Politecnico di Milano, Milan, Italy. 3. Physical Medicine and Rehabilitation Unit, Scientific Institute of Lissone Salvatore Maugeri Foundation IRCCS, Monza Brianza, Italy. 4. Neuroengineering and Medical Robotics Laboratory, Department of Electronics, Information, and Bioengineering Politecnico di Milano, Milan, Italy. 5. Bicocca University of Milan, Milan, Italy Orthopaedics Unit, San Gerardo Hospital, Monza Brianza, Italy.
Abstract
OBJECTIVE: To evaluate the efficacy of an in-hospital programme based on task-oriented exercises associated with early full weight-bearing in patients with multiple comorbidities undergoing total hip replacement. DESIGN: Randomized controlled trial. SETTING: Specialised rehabilitation centre. SUBJECTS: A total of 100 patients (mean age of 69 (8) years; 40 males, 60 females). INTERVENTIONS: The experimental group underwent task-oriented exercises and was encouraged to abandon any walking aids by the end of their in-hospital stay. The control group underwent open chain kinetic exercises, and was recommended to use partial weight-bearing and walking aids until three months after surgery. Both groups individually followed programmes of 90-minute sessions five times a week for three weeks. OUTCOME MEASURES: Western Ontario and McMaster Universities Osteoarthritis Index, Pain Numerical Rating Scale, Functional Independence Measure, and Short-Form Health Survey. The participants were evaluated before, after training, and after a further 12 months. RESULTS: There were no significant between-group differences at baseline. After training, a between-group difference of 12 points was found for the Western Ontario and McMaster Universities Osteoarthritis Index - functional subscale, indicating a clinically tangible treatment effect on disability. The Functional Independence Measure increased by 31 and 15 points in the experimental and control group, respectively. A linear mixed model revealed significant effects of time, group, and time by group interaction on disability, pain, activities of daily living, and most of the physical quality of life domains. CONCLUSION: Task-oriented exercises associated with early full weight-bearing improve disability, pain, activities of daily living, and quality of life after total hip replacement.
RCT Entities:
OBJECTIVE: To evaluate the efficacy of an in-hospital programme based on task-oriented exercises associated with early full weight-bearing in patients with multiple comorbidities undergoing total hip replacement. DESIGN: Randomized controlled trial. SETTING: Specialised rehabilitation centre. SUBJECTS: A total of 100 patients (mean age of 69 (8) years; 40 males, 60 females). INTERVENTIONS: The experimental group underwent task-oriented exercises and was encouraged to abandon any walking aids by the end of their in-hospital stay. The control group underwent open chain kinetic exercises, and was recommended to use partial weight-bearing and walking aids until three months after surgery. Both groups individually followed programmes of 90-minute sessions five times a week for three weeks. OUTCOME MEASURES: Western Ontario and McMaster Universities Osteoarthritis Index, Pain Numerical Rating Scale, Functional Independence Measure, and Short-Form Health Survey. The participants were evaluated before, after training, and after a further 12 months. RESULTS: There were no significant between-group differences at baseline. After training, a between-group difference of 12 points was found for the Western Ontario and McMaster Universities Osteoarthritis Index - functional subscale, indicating a clinically tangible treatment effect on disability. The Functional Independence Measure increased by 31 and 15 points in the experimental and control group, respectively. A linear mixed model revealed significant effects of time, group, and time by group interaction on disability, pain, activities of daily living, and most of the physical quality of life domains. CONCLUSION: Task-oriented exercises associated with early full weight-bearing improve disability, pain, activities of daily living, and quality of life after total hip replacement.
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