Madara Kathleen C, Marmon Adam, Aljehani Moiyad, Hunter-Giordano Airelle, Zeni Joseph, Raisis Leo
University of Delaware, Newark, DE, USA.
Kinesiology and Applied Physiology, Newark, DE, USA.
Int J Sports Phys Ther. 2019 Jul;14(4):564-581.
The incidence of total hip arthroplasty (THA) has increased, due in part to younger individuals undergoing the procedure. Surgical techniques and biomaterials have improved, but rehabilitation has not kept pace with the needs of a changing demographic.
HYPOTHESIS/PURPOSE: The purpose of this study was to evaluate the feasibility and preliminary effectiveness of a progressive strengthening and functional retraining intervention after THA.
Intervention study.
Twenty patients participated in the control group (n=10) or experimental group (n=10). The experimental intervention had few supervised sessions in the early phase after THA (weeks 0-12), followed by supervised, progressive, and high-level activity retraining in the later phase (weeks 12-16). Training in the experimental group was tailored to individual patient goals, which included a variety of vocational and recreational activities. The control group participated in usual rehabilitation care as prescribed by their surgeon. Therefore, the duration and content of rehabilitation of the control group therapy was not constrained. Testing included three-dimensional motion analysis of gait and a clinical evaluation prior to surgery and 16 weeks post-surgery. Change scores were calculated for pain, the Timed Up and Go (TUG), the Stair Climb Test (SCT), the Six-minute Walk Test (6MWT), the Thirty Second Chair Rise Test (30-CRT), strength, the Hip Outcome Scale (HOS), the Hip Dysfunction and Osteoarthritis Outcome Score for Joint Replacement (HOOS Jr), ground reaction force during stance, hip abduction moment, sit to stand ground reaction force, and symmetry between limbs during stance and sit to stand and compared between groups. Patient satisfaction and number of rehabilitation visits were also compared. Safety and feasibility were assessed using descriptive analysis of the number adverse events.
One patient dropped from the control group prior to rehabilitation. The intervention group had a significantly greater improvement for the 6MWT than the control group (p=0.011), functional questionnaires (p=0.034), hip abduction strength on the non-surgical side (p=0.01) and greater satisfaction (96 vs 84 out of 100; p=0.03) at the conclusion of the intervention. The intervention group demonstrated a significantly greater improvement in force symmetry during sit-to-stand (p=0.041) as compared to the control group. There were no other significant differences in change scores for functional measures or discrete biomechanical metrics.
This physical therapy protocol, which focused on reducing supervised visits early after THA and retraining higher level activities later in the course of recovery, had a positive effect on biomechanics and functional outcomes without compromising safety. The effect of the experimental intervention was most appreciable for the 6MWT, non-surgical hip strength, satisfaction, and movement symmetry.
2B.
全髋关节置换术（THA）的发病率有所上升，部分原因是接受该手术的患者年龄越来越小。手术技术和生物材料已有改进，但康复治疗并未跟上人口结构变化的需求。
假设/目的：本研究的目的是评估THA术后进行渐进性强化和功能再训练干预的可行性和初步效果。
干预性研究。
20例患者分为对照组（n = 10）和试验组（n = 10）。试验性干预在THA术后早期（0 - 12周）进行少量有监督的训练，随后在后期（12 - 16周）进行有监督的、渐进性的和高水平的活动再训练。试验组的训练根据患者个体目标进行调整，这些目标包括各种职业和娱乐活动。对照组按照外科医生的处方接受常规康复护理。因此，对照组治疗的康复持续时间和内容不受限制。测试包括术前和术后16周的步态三维运动分析和临床评估。计算疼痛、计时起立行走测试（TUG）、爬楼梯测试（SCT）、6分钟步行测试（6MWT）、30秒椅子起立测试（30 - CRT）、力量、髋关节结果量表（HOS）、关节置换的髋关节功能障碍和骨关节炎结果评分（HOOS Jr）、站立时的地面反作用力、髋关节外展力矩、从坐到站的地面反作用力以及站立和从坐到站时双下肢的对称性的变化分数，并在组间进行比较。还比较了患者满意度和康复就诊次数。使用不良事件数量的描述性分析评估安全性和可行性。
对照组有1例患者在康复前退出。干预组在干预结束时，6MWT的改善显著大于对照组（p = 0.011）、功能问卷（p = 0.034）、非手术侧髋关节外展力量（p = 0.01），且满意度更高（100分制中分别为96分和84分；p = 0.03）。与对照组相比，干预组在从坐到站过程中的力量对称性改善也显著更大（p = 0.041）。功能测量或离散生物力学指标的变化分数没有其他显著差异。
这种物理治疗方案，重点是在THA术后早期减少有监督的就诊次数，并在恢复后期对更高水平的活动进行再训练，对生物力学和功能结果有积极影响，且不影响安全性。试验性干预对6MWT、非手术侧髋关节力量、满意度和运动对称性的影响最为明显。
2B。
