LOGIN
Post-THA physical therapy exercises improve strength, gait speed and cadence
Read Full Publication
April 2014
Post-THA physical therapy exercises improve strength, gait speed and cadence
Study Type:Meta-analysis/Systematic Review
OE Level Evidence:1
Journal Level of Evidence:N/A
Physiotherapist-directed rehabilitation exercises in the outpatient or home setting improve strength, gait speed and cadence after elective total hip replacement: a systematic review
J Physiother. 2013 Dec;59(4):219-26. doi: 10.1016/S1836-9553(13)70198-XDid you know you're eligible to earn 0.5 CME credits for reading this report? Click Here
Synopsis
5 randomized trials evaluating the effect of post-discharge rehabilitation exercises following a total hip arthroplasty (THA) were included in this review. The purposes of this meta-analysis/systematic review were to (1) examine the effectiveness of physical therapy exercises following THA and (2) determine whether supervised and home-based exercise regimens are comparable with respect to strength, gait, function, and quality of life. Results indicated that the prescription of exercise following THA resulted in significantly better hip abductor strength, gait speed, and cadence, but not hip flexor, hip extensor, or knee extensor strength. There were no significant differences between supervised or home-based exercise interventions with respect to gait speed, cadence, and functional outcomes, except for the Timed Up and Go Test, which favoured the supervised group.
Publication Funding Details
+
Funding:
Non-Industry funded
Sponsor:
Trauma and Orthopaedic Research Unit, and Physiotherapy Department, Canberra Hospital
Conflicts:
None disclosed
Were the search methods used to find evidence (original research) on the primary question or questions stated?
Was the search for evidence reasonably comprehensive?
Were the criteria used for deciding which studies to include in the overview reported?
Was the bias in the selection of studies avoided?
Were the criteria used for assessing the validity of the included studies reported?
Was the validity of all of the studies referred to in the text assessed with use of appropriate criteria (either in selecting the studies for inclusion or in analyzing the studies that were cited)?
Were the methods used to combine the findings of the relevant studies (to reach a conclusion) reported?
Were the findings of the relevant studies combined appropriately relative to the primary question that the overview addresses?
Were the conclusions made by the author or authors supported by the data and or analysis reported in the overview?
How would you rate the scientific quality of this evidence?
Yes = 1
Uncertain = 0.5
Not Relevant = 0
No = 0
The Reporting Criteria Assessment evaluates the transparency with which authors report the methodological and trial characteristics of the trial within the publication. The assessment is divided into five categories which are presented below.
4/4
Introduction
3/4
Accessing Data
3/4
Analysing Data
3/4
Results
3/4
Discussion
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
The Fragility Index is a tool that aids in the interpretation of significant findings, providing a measure of strength for a result. The Fragility Index represents the number of consecutive events that need to be added to a dichotomous outcome to make the finding no longer significant. A small number represents a weaker finding and a large number represents a stronger finding.
Why was this study needed now?
As the population ages, the number of patients undergoing total hip arthroplasty (THA) is steadily increasing. Exercise prescription for rehabilitation following a THA is variable, and is based more so on clinical experience, rather than concrete, methodologically-sound evidence. One systematic review examining the effectiveness of physical therapy following THA concluded that, based on studies published in 2004 or earlier, there was insufficient evidence to provide solid recommendations on this topic. Therefore, this systematic review/meta-analysis was needed to summarize more recent research regarding the effectiveness of both physiotherapist-guided rehabilitation exercises and home-based exercises performed independently.
What was the principal research question?
Are physiotherapist-guided rehabilitation exercises effective in improving strength, gait, function and quality of life in patients who have undergone total hip arthroplasty, and how does this compare to the prescription of home-based exercises performed independently?
Study Characteristics
-
Data Source:
MEDLINE, CINAHL, EMBASE, PEDro, and the Cochrane Library were searched from inception to March 2012. Furthermore, reference lists of relevant studies were also searched.
Index Terms:
Search terms included terms for total hip replacement/arthroplasty, terms for physiotherapy, and terms related to patient discharge or home services. For a full list of specific index terms, please refer to the original publication.
Study Selection:
A title and abstract screen was performed by a single reviewer, while the resulting full texts were reviewed independently by two authors (CC and JS). Disagreements were resolved through discussion. To be included, studies were required to be (1) randomized, (2) published in the English language, (3) include patients who had undergone a total hip arthroplasty, (4) include post-discharge physiotherapist-directed rehabilitation exercises (outpatient or home-based) as an intervention, (5) include "no intervention" or "home-based rehabilitation exercises" as comparison groups, and (6) report one or more of the following outcomes: muscle strength, gait, function and quality of life. Exclusion criteria were interventions involving early rehabilitation during the hospital inpatient phase, post-acute inpatient rehabilitation, and rehabilitation in residential care.
Data Extraction:
The manner in which data was extracted was not reported. Extracted outcomes included muscle strength, gait, function and quality of life.
Data Synthesis:
Data synthesis was performed using Review Manager 5.1. Heterogeneity was assessed both visually (by examining forest plots) and statistically (by computing the I-squared statistic). When the I-squared statistic was greater than 50%, significant heterogeneity was present among studies and the data was pooled using a random-effects model. Conversely, when the I-squared statistic was less than 50%, heterogeneity was not significant, and data was pooled using a fixed-effects model.
What were the important findings?
- 5 randomized trials were included in this review. Three compared an experimental group to a control group, one compared two experimental groups, and one compared two experimental groups with a control group.
- A meta-analysis of 4 studies (n=137) concluded that rehabilitation exercises after discharge significantly improved hip abductor strength (MD: 16 Nm; 95% CI 10 to 22; p<0.05). Separate analyses found no significant effect of post-discharge exercises on hip flexor strength (3 studies; n=111; MD: 6 Nm; 95% CI -2 to 13), hip extensor strength (3 studies; n=111; MD: 21 Nm; 95% CI -2 to 44), or knee extensor strength (2 studies; n=58; MD: 42 Nm; 95% CI -4 to 89) (all p>0.05).
- Post-discharge exercises significantly improved gait speed (2 studies; n=79; MD: 6 m/min; 95% CI 1 to 11) and cadence (1 study; MD: 20 steps/min; 95% CI 8 to 32) (both p<0.05).
- 2 studies assessed function as an outcome; however, the scale on which function was measured varied between these studies. One study, reporting Harris Hip Scores, found exercise to have a significantly beneficial effect on function; however, the mean between-group estimate was only 0.9 points (95% CI 0.2 to 1.6). Significantly better functional outcomes with post-discharge exercises were also observed in the second study (which used the 12-item Hip Questionnaire) (MD in medians 1.5 points; p=0.01).
- One study compared hip abduction strength between home-based exercises and supervised exercises. This study found that the supervised group improved significantly more (by 5.4 Nm); however, differences in baseline measurements may have influenced this result.
- Pooled results from two studies (n=40) revealed no significant differences in gait speed (MD: 8 m/min; 95% CI -9 to 24) or cadence (MD: 2 steps/min; 95% CI -4 to 8) whether the exercise intervention was supervised or home-based (p>0.05).
- One study compared functional outcomes (both objective and patient-reported) between supervised and home-based exercise interventions. This study found no significant difference in patient-reported function (measured on the WOMAC scale), or in the time to ascend four stairs, lower limb power and the 6-minute walk test (all objective measures) (p>0.05). For the Timed Up and Go Test, significantly better results were observed in the supervised group (MD: 1.8 seconds; 95% CI 0.1 to 3.5).
- Results from one study found that quality of life (measured on the Assessment of Quality of Life questionnaire) was similar between exercises that were supervised or home-based (MD: 0.05; 95% CI -0.15 to 0.25).
What should I remember most?
Post-discharge rehabilitation exercises following total hip arthroplasty (THA) resulted in significantly better hip abductor strength, gait speed, and cadence, but not hip flexor, hip extensor, or knee extensor strength. Two studies evaluating functional outcomes on two separate scales both revealed significant improvements in function with post-discharge rehabilitation exercises compared to no intervention. There were no significant differences between supervised or home-based exercise interventions with respect to gait speed, cadence, and most functional outcomes (except the Timed Up and Go Test, which favoured the supervised group). The effect of post-discharge exercise on quality of life, as well as the effect of supervised versus home-based exercises on strength and quality of life, remain unknown.
How will this affect the care of my patients?
Results from this meta-analysis and systematic review suggest that post-discharge rehabilitation exercises may improve gait and strength in patients who have undergone a total hip arthroplasty (THA). Additional high-quality studies, examining the effect of post-discharge exercise on quality of life, as well as the effect of supervised versus home-based exercises on strength and quality of life, are needed.
Learn about our AI Driven
High Impact Search Feature
Our AI driven High Impact metric calculates the impact an article will have by considering both the publishing journal and the content of the article itself. Built using the latest advances in natural language processing, OE High Impact predicts an article’s future number of citations better than impact factor alone.
Continue
Join the Conversation
Please Login or Join to leave comments.