髋关节强化锻炼剂量与全髋关节置换术后的临床改善无关 - 一项前瞻性队列研究（PHETHAS-1 研究）。
Hip strengthening exercise dosage is not associated with clinical improvements after total hip arthroplasty - a prospective cohort study (the PHETHAS-1 study).
机构信息
Elective Surgery Centre, Silkeborg Regional Hospital, Silkeborg, Denmark.
Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark.
出版信息
BMC Musculoskelet Disord. 2024 Nov 19;25(1):928. doi: 10.1186/s12891-024-08057-x.
BACKGROUND
Postoperative rehabilitation exercise is commonly prescribed after total hip arthroplasty (THA), but its efficacy compared to no or minimal rehabilitation exercise has been questioned. Preliminary efficacy would be indicated if a dose-response relationship exists between performed exercise dose and degree of postoperative recovery. The objective was to evaluate the preliminary efficacy of home-based rehabilitation using elastic band exercise on performance-based function after THA, based on the association between performed exercise dose and change in performance-based function (gait speed) from 3 (start of intervention) to 10 weeks (end of intervention) after surgery.
METHODS
A prospective cohort study was conducted. Following primary THA, patients were prescribed home-based rehabilitation exercise using elastic bands. Performed exercise dose (repetitions/week) was objectively measured using attached sensor technology. Primary outcome was change in gait speed (40 m fast-paced walk test). Secondary outcomes included patient-reported hip disability. In the primary analysis, a linear regression model was used.
RESULTS
Ninety-four patients (39 women) with a median age of 66.5 years performed a median of 339 exercise repetitions/week (1st-3rd quartile: 209-549). Across outcomes, participants significantly improved from 3 to 10-week follow-up. The association between performed exercise dose and change in mean gait speed was 0.01 m/s [95% CI: -0.01; 0.02] per 100 repetitions.
CONCLUSIONS
We found no indication of preliminary efficacy of home-based rehabilitation exercise using elastic bands, as no significant and clinically relevant associations between performed exercise dose and changes in outcomes were present. Trials comparing postoperative rehabilitation exercise with no exercise early after THA are warranted.
TRIAL REGISTRATION
Pre-registered: ClinicalTrials.gov (Identifier: NCT03109821, 12/04/2017).
背景
全髋关节置换术（THA）后常规定期进行术后康复锻炼，但术后不进行或仅进行最低限度康复锻炼的效果也受到了质疑。如果所进行的锻炼剂量与术后恢复程度之间存在剂量-反应关系，则表明初步有效。本研究旨在评估基于弹性带的家庭康复锻炼对 THA 后基于表现的功能的初步疗效，评估指标为术后 3 周（干预开始时）至 10 周（干预结束时）基于表现的功能（步态速度）的变化与所进行的锻炼剂量之间的关联。
方法
本研究为前瞻性队列研究。初次 THA 后，患者被规定在家中进行弹性带康复锻炼。所进行的锻炼剂量（每周重复次数）通过附加传感器技术进行客观测量。主要结局为步态速度（40m 快走测试）的变化。次要结局包括患者报告的髋关节残疾。在主要分析中，使用线性回归模型。
结果
94 例患者（39 例女性），中位年龄为 66.5 岁，每周完成中位锻炼次数 339 次（1 四分位至 3 四分位：209-549 次）。所有结局指标均显示，从第 3 周到第 10 周随访时，患者均有显著改善。所进行的锻炼剂量与平均步态速度变化之间的关联为每增加 100 次重复 0.01m/s[95%置信区间：-0.01；0.02]。
结论
我们未发现使用弹性带进行家庭康复锻炼具有初步疗效的迹象，因为所进行的锻炼剂量与结局变化之间没有显著的、有临床意义的关联。因此，有必要开展比较 THA 后早期进行康复锻炼与不进行锻炼的术后康复锻炼效果的临床试验。
试验注册
预注册：ClinicalTrials.gov（注册号：NCT03109821，2017 年 12 月 4 日）。
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