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Wijnen A1,2, Bouma S1,3, Seeber G2, van der Woude L3, Bulstra S1, Lazovic D2, Stevens M1, van den Akker-Scheek I1
1Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, Netherlands, 2University Hospital of Orthopedics and Trauma Surgery Pius-Hospital, Medical Campus University of Oldenburg, Oldenburg, Germany, 3University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, Netherlands
Background: Several systematic reviews have been performed with respect to the effectiveness of physiotherapeutic exercise following Total Hip Arthroplasty (THA). These demonstrate that there is insufficient evidence to give a definitive answer with respect to effectiveness. As a result it has been recommended that reviews in addition to effectiveness should explicitly examine the therapeutic validity, which is defined as the potential effectiveness of a specific intervention given to a potential target group of patients.
Purpose: To assess the therapeutic validity and effectiveness of physiotherapeutic exercise interventions following THA for osteoarthritis.
Methods: Design: a systematic review.
Data sources: The databases Embase, MEDLINE, Cochrane Library, CINAHL and AMED were searched from inception up to February 2017.
Eligibility criteria: Articles reporting results of randomized controlled trials in which physiotherapeutic exercise was compared with usual care or with a different type of physiotherapeutic exercise were included, with the applied interventions starting within six months after THA. Only articles written in English, German or Dutch were included.
Study appraisal: Therapeutic validity was assessed using the CONTENT scale, consisting of five domains (patient eligibility, competences and setting, rationale, content, and adherence) with nine items in total. Risk of bias was assessed using the PEDro scale and Cochrane Collaboration´s tool. All were assessed independently by two researchers. Characteristics of the interventions and results about joint and muscle function, functional performance and self-reported outcomes were extracted.
Results: Of the 1124 unique records retrieved, twenty articles were included. Only one article was considered to be of high therapeutic validity. Description and adequacy of patient selection were the least reported items. The majority of articles was considered as having potentially high risk of bias, according to both assessment tools (PEDro scale 55%; Cochrane Collaboration´s tool 90%). The level of therapeutic validity did not correspond with the risk of bias scores. Because of the wide variety in characteristics of the exercises and control interventions, follow-up length and outcome measures, limited evidence was found on the effectiveness of physiotherapeutic exercise following THA.
Conclusion(s): The insufficient therapeutic validity and potentially high risk of bias in studies involving physiotherapeutic exercise interventions limit the ability to assess the effectiveness of these interventions following THA. Researchers are advised to take both aspects into account when developing and reporting studies involving physiotherapeutic exercise. In addition uniformity in intervention characteristics and outcome measures is necessary to enhance the comparability of clinical outcomes between trials.
Implications: When designing and describing studies in which a physiotherapeutic exercise intervention is applied, both therapeutic validity and risk of bias should be taken into account. The CONTENT scale should be used to describe the various aspects of therapeutic validity to increase the transparency of interventions applied in clinical trials. To gain complete insight into the effectiveness, future studies should include a spectrum of outcome measures for example as proposed by OARSI and appropriate patient selection criteria. A clear description of the control intervention should also be provided. Lastly, future studies should also include a long-term follow-up to assess whether any significant improvements after physiotherapeutic exercise interventions are lasting.
Keywords: Exercise, total hip replacement, rehabilitation
Funding acknowledgements: No funding was received for this study.
Purpose: To assess the therapeutic validity and effectiveness of physiotherapeutic exercise interventions following THA for osteoarthritis.
Methods: Design: a systematic review.
Data sources: The databases Embase, MEDLINE, Cochrane Library, CINAHL and AMED were searched from inception up to February 2017.
Eligibility criteria: Articles reporting results of randomized controlled trials in which physiotherapeutic exercise was compared with usual care or with a different type of physiotherapeutic exercise were included, with the applied interventions starting within six months after THA. Only articles written in English, German or Dutch were included.
Study appraisal: Therapeutic validity was assessed using the CONTENT scale, consisting of five domains (patient eligibility, competences and setting, rationale, content, and adherence) with nine items in total. Risk of bias was assessed using the PEDro scale and Cochrane Collaboration´s tool. All were assessed independently by two researchers. Characteristics of the interventions and results about joint and muscle function, functional performance and self-reported outcomes were extracted.
Results: Of the 1124 unique records retrieved, twenty articles were included. Only one article was considered to be of high therapeutic validity. Description and adequacy of patient selection were the least reported items. The majority of articles was considered as having potentially high risk of bias, according to both assessment tools (PEDro scale 55%; Cochrane Collaboration´s tool 90%). The level of therapeutic validity did not correspond with the risk of bias scores. Because of the wide variety in characteristics of the exercises and control interventions, follow-up length and outcome measures, limited evidence was found on the effectiveness of physiotherapeutic exercise following THA.
Conclusion(s): The insufficient therapeutic validity and potentially high risk of bias in studies involving physiotherapeutic exercise interventions limit the ability to assess the effectiveness of these interventions following THA. Researchers are advised to take both aspects into account when developing and reporting studies involving physiotherapeutic exercise. In addition uniformity in intervention characteristics and outcome measures is necessary to enhance the comparability of clinical outcomes between trials.
Implications: When designing and describing studies in which a physiotherapeutic exercise intervention is applied, both therapeutic validity and risk of bias should be taken into account. The CONTENT scale should be used to describe the various aspects of therapeutic validity to increase the transparency of interventions applied in clinical trials. To gain complete insight into the effectiveness, future studies should include a spectrum of outcome measures for example as proposed by OARSI and appropriate patient selection criteria. A clear description of the control intervention should also be provided. Lastly, future studies should also include a long-term follow-up to assess whether any significant improvements after physiotherapeutic exercise interventions are lasting.
Keywords: Exercise, total hip replacement, rehabilitation
Funding acknowledgements: No funding was received for this study.
Topic: Orthopaedics
Ethics approval required: No
Institution: N/A
Ethics committee: N/A
Reason not required: Since this was a systematic review no research has been done on humans or animals. No ethical approval was necessary.
All authors, affiliations and abstracts have been published as submitted.
