This study aimed to evaluate the efficacy of a prehabilitation program consisting of exercises and patient education (AktivA®) for adults 70 years or older awaiting THR on gait speed.
A two-arm randomized controlled trial was conducted with 98 participants 70 or older with a Harris Hip Score 60 awaiting elective THR. Participants were recruited from three hospitals in Norway between 2019 and 2022 and randomly assigned to prehabilitation (intervention) or usual care (control). The prehabilitation group underwent a tailored exercise program and patient education for 6-12 weeks (AktivA® program), delivered by an AktivA® physiotherapists in a primary healthcare setting. The primary outcome, gait speed, was measured using the 40m Fast-Paced Walk Test. Secondary outcomes included performance-based tests (Chair Stand Test, Timed Up & Go Test, 6-Minute Walk Test, Stair Climb Test) and patient-reported outcomes (Hip Disability and Osteoarthritis Outcome Score (HOOS) and EQ-5D). Outcomes were assessed at baseline, post-intervention, and postoperatively at 6 weeks, 3-, 6-, and 12 months.
For the primary outcome of gait speed, no significant between-group differences were found at the primary endpoint of 3 months post-surgery (mean difference 0.08 m/s, 95% CI -0.06 to 0.21), or at any other post-surgery assessments. However, after ended intervention (before surgery), a significant between-group difference in favor of prehabilitation group was observed for gait speed (0.15 m/s, 95% CI 0.021-0.28). Likewise, before surgery we observed a between-group difference for the secondary outcome HOOS quality of life subscale (11.93, 95% CI 3.38-20.48), but no between-group differences were noted for this outcome at any post-surgery assessments. For other secondary outcomes no between-group differences were found at any point of assessment. Significant within-groups improvements were seen for all outcomes 3-12 months post-surgery.
The AktivA® program used as a prehabilitation program before THR did not result in improved postoperative outcomes at 3 months compared to usual care. Thus, replacing painful hip joints through total joint replacement seems to outweigh the potential efficacy of a prehabilitation program. Study limitations included dropouts, missing data, and challenges with exercise progression.
Efficacy of prehabilitation was not seen in any post-surgery measurements in our study. Nevertheless, the impact of having a THR had an immense effect on all measured outcomes both for intervention and control participants, and both groups performed well against reference values on fast paced gait speed 12 months post-surgery. Thus, this old and frail population should be prioritized for early surgery and rehabilitation rather than spending time in prehabilitation.
prehabilitation
total hip replacement
