Functional exercise after total hip replacement (FEATHER)

Abstract

Background: Total hip replacement is a successful surgical procedure carried out for end stage arthritis worldwide. Recently there has been a consistent move towards reduced length of stay in hospital for patients in hospital post arthroplasty. This trend has led to the emergence of programmes to actively manage length of stay and have caused a shift in rehabilitation from the inpatient setting to a community based outpatient service. A number of studies have reported functional problems for patients post operatively up to one year following surgery. Traditionally physical therapy has been a routine part of patient rehabilitation particularly in those with reduced levels of function in the post- operative period yet a number of systematic reviews have failed to establish the effectiveness of physical therapy. Purpose: This randomised controlled trial was designed to evaluate the efficacy of a functional exercise programme post total hip replacement. The study compared patients randomised to usual care with patients randomised to usual care plus a functional exercise programme undertaken between 12 and 18 weeks post total hip replacement. Methods: Patients were recruited at the pre-assessment clinic of the elective orthopaedic unit. For those randomised to the functional exercise group follow up rehabilitation was carried out at one of three outlying community hospital sites. Informed consent was obtained from 72 patients and nine patients withdrew having already consented to participate. Inclusion and exclusion criteria have been previously published. Patients randomised to the exercise group were contacted directly on discharge by the pre-identified physiotherapists responsible for conducting the exercise classes. All outcome measurements were recorded for all subjects by the principal investigator who was blinded to group allocation. Outcomes measurements were recorded at week 12 pre-intervention and repeated at week 18 for all subjects post either the intervention or the control group period. Three experienced physical therapists supervised the functional exercise classes at each of the three clinical sites. Outcomes of interest were function, walking speed and hip abductor strength. Results: The functional exercise group scored significantly better for change in function as measured by the Western Ontario and McMaster universities osteoarthritis index questionnaire (WOMAC) (p < .009) and walking speed as measured by the Six Minute Walking Test (p < .04) at eighteen weeks post- surgery. There was no significant difference between groups found for hip abductor strength. Conclusion(s): This study demonstrates that patients who undertake a physical therapy led functional exercise programme between 12 and 18 weeks post total hip replacement may gain significant functional improvement. Implications: This study was an adequately powered randomised control study. All patients received the same in-patient hospital care focused on early functional mobility and early discharge. For the first time the results of this study provide important evidence that patients benefit functionally from attending a programme of functional exercise rehabilitation from week 12 to week 18 post total hip replacement surgery. As patient rating of outcome is becoming increasingly relevant to post- operative satisfaction this study provides evidence to support a physical therapy led functional exercise.