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Supervised or Unsupervised Rehabilitation After Total Hip Replacement Provides Similar Improvements for Patients: A Randomized Controlled Trial

      Highlights

      • A randomized controlled trial comparing home- versus group-based rehabilitation after total hip replacement is presented.
      • There were no differences in outcomes between the groups at any time point up to 26 weeks.
      • For most patients well enough to be discharged from the hospital within a week of surgery, independent (home-based) rehabilitation is a viable option.
      • Longitudinal examination of group differences may provide further insights into the benefits of group-based rehabilitation.

      Abstract

      Objective

      To determine whether patients do better with unsupervised (home-based) physiotherapy or in an outpatient setting.

      Setting

      Acute care public hospital in the region, supporting a population of ∼540,000.

      Design

      Single-blind randomized controlled trial.

      Participants

      Adult patients (N=98) after unilateral elective total hip replacement (THR) were randomly assigned to a supervised (center-based) exercise (n=56) or a unsupervised (home-based) exercise (n=42) program and followed for 6 months postsurgery.

      Interventions

      The supervised group attended a 4-week outpatient rehabilitation program supervised by a physiotherapist. The unsupervised group was given written and pictorial instructions to perform rehabilitation independently at home.

      Main Outcome Measures

      Western Ontario and McMaster Universities Osteoarthritis Index; Short-Form 36-item Health Questionnaire (SF-36) mental and physical component summary measures; University of California, Los Angeles activity scale; and timed Up and Go test.

      Results

      There were no differences between the groups for any measure. The overall differences between the adjusted means were as follows: Western Ontario and McMaster Universities Osteoarthritis Index, 0.50 (95% confidence interval [CI], −6.8 to 5.7); SF-36 physical component summary, 0.8 (95% CI, −6.5 to 8.1); SF-36 mental component summary, 1.7 (95% CI, −4.1 to 7.4); University of California, Los Angeles activity scale, 0.3 (95% CI, 5.2 to 6.1); and timed Up and Go test, 0 seconds (95% CI, −1.4 to 1.3s).

      Conclusions

      The results demonstrated that outcomes in response to rehabilitation after THR are clinically and statistically similar whether the program was supervised or not. The results suggest that early rehabilitation programs can be effectively delivered unsupervised in the home to low-risk patients discharged home after THR. However, the relative effect of late-stage rehabilitation was not tested.

      Keywords

      List of abbreviations:

      CI (confidence interval), MCID (minimal clinically important difference), MCS (mental component summary), PCS (physical component summary), RCT (randomized controlled trial), SF-36 (Short-Form 36-item Health Questionnaire), THR (total hip replacement), TUG (timed Up and Go test), UCLA (University of California, Los Angeles), WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index)
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