Mikkelsen Lone R, Mikkelsen Søren S, Christensen Finn B
Department of Physiotherapy, Silkeborg Regional Hospital, Denmark.
Physiother Res Int. 2012 Dec;17(4):214-26. doi: 10.1002/pri.1523. Epub 2012 Mar 26.
Despite a successful surgical procedure, deficits in muscle strength and physical function are documented 1-2 years after total hip replacement (THR). There is a lack of evidence concerning which rehabilitation strategy is the most effective after THR. The purpose of this pilot study was to investigate the feasibility of an early-initiated intensified, home-based training regime and to form the basis of future studies with regard to exercises, outcome measures and power calculations.
The trial is a single-blinded, cluster-randomized controlled trial performed at an orthopaedic physiotherapy department in a public hospital in Denmark. A consecutive sample of 46 patients undergoing primary THR surgery for osteoarthritis between September 2008 and January 2009 was included. Forty-four patients completed the trial (96% follow-up). Participants were randomly assigned to an intervention group (IG, n = 23) receiving 12 weeks of intensified exercises (e.g. rubber band resistance) or a control group (CG, n = 21) receiving standard rehabilitation exercises without external resistance. The outcome measurements were maximal gait speed, isometric hip abductor muscle strength, one-legged stance, health-related quality of life (EuroQol-5 Dimensions), patient satisfaction, and patient-evaluated function, stiffness and pain (Western and Ontario McMasters University Osteoarthritis Index).
There were significant increases in both groups in all the measurements during the 12 weeks of exercises. All participants in the IG were satisfied or very satisfied with the exercises compared with 85% in the CG (P = 0.095). In the IG, four participants (17.4%) had difficulties when performing the intensified exercises at home. Hip abduction strength was significantly weaker in the leg operated compared with the leg not operated on after the intervention in both groups (P < 0.01).
This pilot study indicates that the majority of THR patients tolerated early-initiated intensified exercises without additional pain and with high patient satisfaction. It seems that some of the patients need supervision to perform intensified exercises.
尽管全髋关节置换术（THR）手术成功，但术后1 - 2年仍有肌肉力量和身体功能缺陷的记录。关于THR后哪种康复策略最有效，目前缺乏证据。本试点研究的目的是调查早期启动的强化家庭训练方案的可行性，并为未来关于运动、结局指标和功效计算的研究奠定基础。
该试验是在丹麦一家公立医院的骨科理疗科进行的单盲、整群随机对照试验。纳入了2008年9月至2009年1月期间因骨关节炎接受初次THR手术的46例患者的连续样本。44例患者完成了试验（随访率96%）。参与者被随机分配到干预组（IG，n = 23），接受为期12周的强化运动（如弹力带抗阻运动），或对照组（CG，n = 21），接受无外部抗阻的标准康复运动。结局测量指标包括最大步速、等长髋关节外展肌力量、单腿站立、健康相关生活质量（欧洲五维健康量表）、患者满意度以及患者评估的功能、僵硬和疼痛（西安大略和麦克马斯特大学骨关节炎指数）。
在12周的运动期间，两组所有测量指标均有显著增加。与CG组的85%相比，IG组所有参与者对运动满意或非常满意（P = 0.095）。在IG组，4名参与者（17.4%）在家中进行强化运动时有困难。两组干预后，手术侧髋关节外展力量均显著弱于未手术侧（P < 0.01）。
本试点研究表明，大多数THR患者能够耐受早期启动的强化运动，且无额外疼痛，患者满意度高。似乎一些患者需要监督才能进行强化运动。
