Disantis Ashley E, Ruh Ethan, Martin RobRoy, Enseki Keelan, McClincy Michael
Adolescent and Young Adult Hip Preservation Program, UPMC Children's Hospital of Pittsburgh; Department of Physical Therapy, Rangos School of Health Sciences, Duquesne University.
Department of Orthopedic Surgery, UPMC Children's Hospital of Pittsburgh.
Int J Sports Phys Ther. 2022 Oct 2;17(6):1002-1015. doi: 10.26603/001c.38043. eCollection 2022.
Treatment of acetabular dysplasia with a periacetabular osteotomy (PAO) has been shown to improve long term outcomes and is considered the gold standard in the setting of symptomatic hip dysplasia in patients younger than 35 years of age. Post-operative rehabilitation following a PAO plays an important role in helping patients return to their prior level of function and reduce the impact of strength deficits that may persist. Currently, there is a paucity of research supporting post-operative rehabilitation guidelines. The purpose of this study is to present expert-driven rehabilitation guidelines to reduce practice variation following a PAO.
A panel of 16 physiotherapists from across the United States and Canada who were identified as experts in PAO rehabilitation by high-volume hip preservation surgeons participated in this Delphi study. Panelists were presented with 11 questions pertaining to rehabilitation guidelines following a PAO. Three iterative survey rounds were presented to the panelists based on responses to these questions. This three-step Delphi method was utilized to establish consensus on post-operative rehabilitation guidelines following a PAO.
Total (100%) participation was achieved for all three survey rounds. Consensus (>75%) was reached for 11/11 questions pertaining to the following areas: 1) weight-bearing and range of motion (ROM) precautions, 2) therapeutic exercise prescription including neuromuscular control, cardiovascular exercise, and flexibility, and 3) objective measures for return to straight line running and return to full participation in sports.
This Delphi study established expert-driven rehabilitation guidelines for use following a PAO. The standardization of rehabilitative care following PAO is essential for achieving optimal outcomes despite other factors such as geographical location and socioeconomic status. Further research on patient-reported outcomes is necessary to confirm successful rehabilitation following the guidelines outlined in this study.
髋臼周围截骨术（PAO）治疗髋臼发育不良已被证明可改善长期疗效，被认为是35岁以下有症状髋关节发育不良患者的金标准。PAO术后康复在帮助患者恢复到术前功能水平以及减少可能持续存在的力量缺陷影响方面发挥着重要作用。目前，支持术后康复指南的研究较少。本研究的目的是提出专家主导的康复指南，以减少PAO术后的实践差异。
来自美国和加拿大的16名物理治疗师组成的小组参与了这项德尔菲研究，这些物理治疗师被大量进行髋关节保留手术的外科医生认定为PAO康复专家。向小组成员提出了11个与PAO术后康复指南相关的问题。根据对这些问题的回答，向小组成员进行了三轮迭代调查。采用这种三步德尔菲法就PAO术后康复指南达成共识。
三轮调查的总参与率均达到100%。对于以下11个问题中的11个（100%）达成了共识（>75%）：1）负重和活动范围（ROM）注意事项，2）治疗性运动处方，包括神经肌肉控制、心血管运动和灵活性，3）恢复直线跑步和完全恢复运动参与的客观指标。
这项德尔菲研究建立了专家主导的PAO术后康复指南。PAO术后康复护理的标准化对于实现最佳疗效至关重要，无论地理位置和社会经济地位等其他因素如何。有必要对患者报告的结果进行进一步研究以确认遵循本研究中概述的指南进行康复是否成功。
