Coulter Corinne, Perriman Diana M, Neeman Teresa M, Smith Paul N, Scarvell Jennifer M
Physiotherapy Department, Canberra Hospital, Canberra, Australia; Trauma and Orthopedic Research Unit, Australian National University Medical School, Canberra, Australia.
Trauma and Orthopedic Research Unit, Australian National University Medical School, Canberra, Australia.
Arch Phys Med Rehabil. 2017 Nov;98(11):2253-2264. doi: 10.1016/j.apmr.2017.03.032. Epub 2017 May 12.
To determine whether patients do better with unsupervised (home-based) physiotherapy or in an outpatient setting.
Acute care public hospital in the region, supporting a population of ∼540,000.
Single-blind randomized controlled trial.
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.
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.
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.
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).
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.
确定患者接受无监督（居家）物理治疗还是门诊治疗效果更好。
该地区的急性护理公立医院，服务人口约54万。
单盲随机对照试验。
98例单侧择期全髋关节置换术（THR）后的成年患者被随机分配至有监督（基于中心）的锻炼组（n = 56）或无监督（居家）的锻炼组（n = 42），并在术后随访6个月。
有监督组参加由物理治疗师监督的为期4周的门诊康复计划。无监督组收到书面和图片指导，以便在家中独立进行康复。
西安大略和麦克马斯特大学骨关节炎指数；36项简明健康调查问卷（SF - 36）心理和身体成分汇总指标；加利福尼亚大学洛杉矶分校活动量表；以及定时起立行走测试。
两组在任何测量指标上均无差异。调整后均值的总体差异如下：西安大略和麦克马斯特大学骨关节炎指数为0.50（95%置信区间[CI]，-6.8至5.7）；SF - 36身体成分汇总为0.8（95%CI，-6.5至8.1）；SF - 36心理成分汇总为1.7（95%CI，-4.1至7.4）；加利福尼亚大学洛杉矶分校活动量表为0.3（95%CI，5.2至6.1）；定时起立行走测试为0秒（95%CI，-1.4至1.3秒）。
结果表明，THR术后康复的效果，无论康复计划是否有监督，在临床和统计学上都是相似的。结果表明，早期康复计划可以有效地在无监督的情况下在家中为THR术后出院的低风险患者提供。然而，晚期康复的相对效果未进行测试。
