Hansen S1, Aaboe J2, Mechlenburg I3, Overgaard S4, Mikkelsen LR3,5
1University of Southern Denmark, Library, Slagelse, Denmark, 2Danish Health Authority, Copenhagen, Denmark, 3Aarhus University, Department of Clinical Medicine, Aarhus, Denmark, 4Odense University Hospital, Orthopaedic research unit, Department of Orthopaedic Surgery and Traumatology, Odense, Denmark, 5Silkeborg Regional Hospital, Elective Surgery Centre, Silkeborg, Denmark
Background: In practice, some patients with primary total hip replacement are offered home-based non-supervised exercises and others supervised exercise, however it remains unknown whether supervised exercise are more effective than non-supervised exercise.
Purpose: The purpose of the study was to compare the effectiveness of supervised exercise to non-supervised exercise after total hip replacement on patient-reported function, hip-pain, health-related quality of life and performance-based function.
Methods: A systematic review and meta-analysis was conducted according to the Cochrane Handbook for Systematic Reviews of Interventions, based on a pre-registered protocol (PROSPERO: CRD42017055604). A systematic literature search was performed in the Databases: Medline, Embase and CINAHL on March 14th 2018. Randomized controlled trials (RCTs) were included if they compared supervised (minimum two supervised sessions per week) to non-supervised rehabilitation (a maximum of two supervised sessions in total after hospital discharge). The exercise intervention should be initiated less than three months after a primary total hip replacement and continued for at least six weeks. The primary outcome was patient-reported function at end of treatment. Secondary outcomes were; hip-related pain, health-related quality of life and performance-based function at end of treatment and long-term patient-reported function (6-12 months). The methodological quality of the included studies was assessed using the Cochrane Risk of Bias tool. Data extraction was performed using a predefined data extraction form. Two reviewers independently screened studies at all stages, extracted data and assessed the methodological quality. Mean difference (MD) or standardized mean differences (SMD) with 95% confidence intervals were calculated and pooled using random effects models.
Results: Seven studies were included with a total of 389 participants. A small and non-significant difference in favour of the supervised groups was found in patient-reported function (SMD: −0.22 [−0.46 to 0.02]), hip-related pain (SMD: −0.03 [−0.27 to 0.21]), health-related quality of life (MD: −3.08 [−6.29 to 0.14]) and performance-based function (SMD: −0.26 [−0.68 to 0.17] at end of treatment and in patient reported function at the 6- to 12-month follow-up( MD: −1.31 [−3.79 to 1.16]).
Conclusion(s): In conclusion, there was a small non-significant effect of supervised exercise compared to non-supervised exercise on patient-reported function, pain, health-related quality of life and performance-based function after primary total hip replacement.
Implications: This systematic review and meta-analysis do not support a clinical routine use of supervised exercise after total hip replacement for all patients. However, it remains unknown whether supervised exercise is beneficial to sub-groups of patients, for example, patients who need to return to work, suffers from comorbidities or have no prior experience with exercise.
Keywords: Total hip replacement, Exercise, Supervision
Funding acknowledgements: This study was initiated by the Danish Health Authority. The authors participated in developing the national guideline concerning hip osteoarthritis.
Purpose: The purpose of the study was to compare the effectiveness of supervised exercise to non-supervised exercise after total hip replacement on patient-reported function, hip-pain, health-related quality of life and performance-based function.
Methods: A systematic review and meta-analysis was conducted according to the Cochrane Handbook for Systematic Reviews of Interventions, based on a pre-registered protocol (PROSPERO: CRD42017055604). A systematic literature search was performed in the Databases: Medline, Embase and CINAHL on March 14th 2018. Randomized controlled trials (RCTs) were included if they compared supervised (minimum two supervised sessions per week) to non-supervised rehabilitation (a maximum of two supervised sessions in total after hospital discharge). The exercise intervention should be initiated less than three months after a primary total hip replacement and continued for at least six weeks. The primary outcome was patient-reported function at end of treatment. Secondary outcomes were; hip-related pain, health-related quality of life and performance-based function at end of treatment and long-term patient-reported function (6-12 months). The methodological quality of the included studies was assessed using the Cochrane Risk of Bias tool. Data extraction was performed using a predefined data extraction form. Two reviewers independently screened studies at all stages, extracted data and assessed the methodological quality. Mean difference (MD) or standardized mean differences (SMD) with 95% confidence intervals were calculated and pooled using random effects models.
Results: Seven studies were included with a total of 389 participants. A small and non-significant difference in favour of the supervised groups was found in patient-reported function (SMD: −0.22 [−0.46 to 0.02]), hip-related pain (SMD: −0.03 [−0.27 to 0.21]), health-related quality of life (MD: −3.08 [−6.29 to 0.14]) and performance-based function (SMD: −0.26 [−0.68 to 0.17] at end of treatment and in patient reported function at the 6- to 12-month follow-up( MD: −1.31 [−3.79 to 1.16]).
Conclusion(s): In conclusion, there was a small non-significant effect of supervised exercise compared to non-supervised exercise on patient-reported function, pain, health-related quality of life and performance-based function after primary total hip replacement.
Implications: This systematic review and meta-analysis do not support a clinical routine use of supervised exercise after total hip replacement for all patients. However, it remains unknown whether supervised exercise is beneficial to sub-groups of patients, for example, patients who need to return to work, suffers from comorbidities or have no prior experience with exercise.
Keywords: Total hip replacement, Exercise, Supervision
Funding acknowledgements: This study was initiated by the Danish Health Authority. The authors participated in developing the national guideline concerning hip osteoarthritis.
Topic: Musculoskeletal
Ethics approval required: No
Institution: N/A
Ethics committee: N/A
Reason not required: No patients involved
All authors, affiliations and abstracts have been published as submitted.
