Objective: To evaluate the feasibility and preliminary effectiveness of therapeutic exercise before total hip replacement in frail elderly.
Design: A single-blind, randomized clinical pilot trial.
Setting: Outpatient physiotherapy department.
Subjects: Frail elderly with hip osteoarthritis awaiting total hip replacement.
Interventions: A short (3—6 weeks) tailor-made, therapeutic exercise programme was compared with usual care.
Main measures: Feasibility was assessed through patient satisfaction, adherence, occurrence of adverse events and the number of eligible non-volunteers. Preliminary preoperative effectiveness was assessed with performance and self-reported measures of pain, functioning, physical activity and quality of life. Postoperatively we measured functional recovery and length of hospital stay.
Results: Sixty-two eligible patients were approached of whom 21 (mean age 76 years) agreed to participate. Exercisers (n = 10), rated the intervention as very good 8.9 (8—10) (10-point rating scale). No serious adverse events occurred. Forty-one (66%) eligible patients did not participate, mainly because of logistic considerations, resulting in selection bias. The intervention group (trainings sessions participated 91%) showed relevant preoperative improvements on the chair-rise time
(delta —2.9 seconds; 95% confidence interval (CI) —6.2 to 0.4) and timed-up-and-go (delta —4.4 seconds; 95% CI —9.3 to 0.5). Postoperatively, no significant differences were seen.
Conclusions: A short, tailor-made, exercise programme is well tolerated and appreciated in elderly patients awaiting total hip replacement. However, a larger randomized clinical trial in the same setting is not warranted, because of the high number of eligible non-volunteers.
Get full access to this article
View all access options for this article.
References
1.
Kurtz S., Ong K., Lau E., Mowat F., Halpern M.Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am2007; 89: 780-5.
2.
Hoogeboom TJ , van den Ende CH, van der Sluis G. et al. The impact of waiting for total joint replacement on pain and functional status: a systematic review. Osteoarthr Cartil2009; 17: 1420-7.
3.
Fortin PR, Clarke AE, Joseph L. et al. Outcomes of total hip and knee replacement: preoperative functional status predicts outcomes at six months after surgery. Arthritis Rheum1999; 42: 1722-8.
4.
Fortin PR, Penrod JR, Clarke AE et al. Timing of total joint replacement affects clinical outcomes among patients with osteoarthritis of the hip or knee. Arthritis Rheum2002; 46: 3327-30.
5.
Hajat S., Fitzpatrick R., Morris R. et al. Does waiting for total hip replacement matter? Prospective cohort study. J Health Serv Res Policy2002; 7: 19-5.
6.
Holtzman J., Saleh K., Kane R.Effect of baseline functional status and pain on outcomes of total hip arthroplasty . J Bone Joint Surg Am2002; 84-A: 1942-8.
7.
Gibala MJ, McGee SLMetabolic adaptations to short-term high-intensity interval training: a little pain for a lot of gain?Exerc Sport Sci Rev2008; 36: 58-63.
8.
Wisloff U., Stoylen A., Loennechen JP et al. Superior cardiovascular effect of aerobic interval training versus moderate continuous training in heart failure patients: a randomized study . Circulation2007; 115: 3086-94.
9.
Crowe J., Henderson J.Pre-arthroplasty rehabilitation is effective in reducing hospital stay. Can J Occup Ther2003; 70: 88-96.
10.
Gilbey HJ, Ackland TR, Wang AW, Morton AR, Trouchet T., Tapper J.Exercise improves early functional recovery after total hip arthroplasty. Clin Orthop Relat Res2003; (408): 193-200.
11.
Gocen Z., Sen A., Unver B., Karatosun V., Gunal I.The effect of preoperative physiotherapy and education on the outcome of total hip replacement: a prospective randomized controlled trial. Clin Rehabil2004; 18: 353-8.
12.
Rooks DS, Huang J., Bierbaum BE et al. Effect of preoperative exercise on measures of functional status in men and women undergoing total hip and knee arthroplasty. Arthritis Rheum2006; 55: 700-8.
13.
Wijgman AJ, Dekkers GH, Waltje E., Krekels T., Arens HJ[No positive effect of preoperative exercise therapy and teaching in patients to be subjected to hip arthroplasty]. Ned Tijdschr Geneeskd1994; 138: 949-52.
14.
Ferrara PE, Rabini A., Maggi L. et al. Effect of pre-operative physiotherapy in patients with end-stage osteoarthritis undergoing hip arthroplasty. Clin Rehabil2008; 22: 977-86.
15.
Ackerman IN , Bennell KLDoes pre-operative physiotherapy improve outcomes from lower limb joint replacement surgery? A systematic review. Aust J Physiother2004; 50: 25-30.
16.
Coudeyre E. , Jardin C., Givron P., Ribinik P., Revel M., Rannou F.Could preoperative rehabilitation modify postoperative outcomes after total hip and knee arthroplasty? Elaboration of French clinical practice guidelines. Ann Readapt Med Phys2007; 50: 189-97.
17.
Craig P., Dieppe P., Macintyre S., Michie S., Nazareth I., Petticrew M.Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ2008; 337: a1655.
18.
Glasziou P. , Irwig L., Mant D.Monitoring in chronic disease: a rational approach. BMJ2005; 330: 644-8.
19.
Kennedy DM, Stratford PW, Wessel J., Gollish JD, Penney D.Assessing stability and change of four performance measures: a longitudinal study evaluating outcome following total hip and knee arthroplasty. BMC Musculoskelet Disord2005; 6: 3.
20.
Portney L., Watkins M.The research question. Foundations of clinical research. New York: Prentice-Hall, 2000.
21.
Rockwood K. , Song X., MacKnight C. et al. A global clinical measure of fitness and frailty in elderly people. CMAJ2005; 173: 489-95.
22.
American College of Sports Medicine Position Stand.Exercise and physical activity for older adults. Med Sci Sports Exerc1998; 30: 992-1008.
23.
Mazzeo RS, Tanaka H.Exercise prescription for the elderly: current recommendations. Sports Med2001; 31: 809-18.
24.
Sevick MA, Dunn AL, Morrow MS, Marcus BH, Chen GJ, Blair SNCost-effectiveness of lifestyle and structured exercise interventions in sedentary adults: results of project ACTIVE. Am J Prev Med2000; 19: 1-8.
25.
de Vreede PL , Samson MM, van Meeteren NL, Duursma SA, Verhaar HJFunctional-task exercise versus resistance strength exercise to improve daily function in older women: a randomized, controlled trial. J Am Geriatr Soc2005; 53: 2-10.
26.
de Vreede PL , Samson MM, van Meeteren NL, van der Bom JG, Duursma SA, Verhaar HJFunctional tasks exercise versus resistance exercise to improve daily function in older women: a feasibility study. Arch Phys Med Rehabil2004; 85: 1952-61.
27.
Robertson RJ , Goss FL, Rutkowski J. et al. Concurrent validation of the OMNI perceived exertion scale for resistance exercise. Med Sci Sports Exerc2003; 35: 333-41.
28.
Lagally KM, Robertson RJ, Gallagher KI, Gearhart R., Goss FLRatings of perceived exertion during low- and high-intensity resistance exercise by young adults. Percept Mot Skills2002; 94: 723-31.
29.
Hoeksma HL, Dekker J., Ronday HK et al. Comparison of manual therapy and exercise therapy in osteoarthritis of the hip: a randomized clinical trial. Arthritis Rheum2004; 51: 722-9.
30.
Talbot LA, Gaines JM, Huynh TN, Metter EJA home-based pedometer-driven walking program to increase physical activity in older adults with osteoarthritis of the knee: a preliminary study. J Am Geriatr Soc2003; 51: 387-92.
31.
Kerr A., Syddall HE, Cooper C., Turner GF, Briggs RS, Sayer AADoes admission grip strength predict length of stay in hospitalised older patients?Age Ageing2006; 35: 82-4.
32.
Gill TM, Williams CS, Tinetti MEAssessing risk for the onset of functional dependence among older adults: the role of physical performance. J Am Geriatr Soc1995; 43: 603-9.
33.
Klassbo M., Larsson E., Mannevik E.Hip disability and osteoarthritis outcome score. An extension of the Western Ontario and McMaster Universities Osteoarthritis Index. Scand J Rheumatol2003; 32: 46-51.
34.
de Groot I. , Reijman M., Terwee CB et al. Validation of the Dutch version of the Hip disability and Osteoarthritis Outcome Score. Osteoarthritis Cartilage2007; 15: 104-9.
35.
Stel VS, Smit JH, Pluijm SM, Visser M., Deeg DJ, Lips P.Comparison of the LASA Physical Activity Questionnaire with a 7-day diary and pedometer. J Clin Epidemiol2004; 57: 252-8.
36.
Beurskens AJ , de Vet HC, Koke AJ et al. A patient-specific approach for measuring functional status in low back pain. J Manip Physiol Ther1999; 22: 144-8.
37.
Withers RT, Davies GJ, Crouch RGA comparison of three W170 protocols. Eur J Appl Physiol Occup Physiol1977; 37: 123-8.
38.
Podsiadlo D. , Richardson S.The timed ‘Up & Go’: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc1991; 39: 142-8.
39.
Shields RK, Enloe LJ, Evans RE, Smith KB, Steckel SDReliability, validity, and responsiveness of functional tests in patients with total joint replacement. Phys Ther1995 ; 75: 169-76.
40.
Oldmeadow LB , McBurney H., Robertson VJHospital stay and discharge outcomes after knee arthroplasty: implications for physiotherapy practice. Aust J Physiother2002; 48: 117-21.
41.
Jesudason C. , Stiller K.Are bed exercises necessary following hip arthroplasty?Aust J Physiother2002; 48: 73-81.
42.
Vickers AJ, Altman DGStatistics notes: Analysing controlled trials with baseline and follow up measurements. BMJ2001; 323: 1123-4.
43.
Matthews JN , Altman DG, Campbell MJ, Royston P.Analysis of serial measurements in medical research. BMJ1990; 300: 230-5.
44.
Forster A., Lambley R., Hardy J. et al. Rehabilitation for older people in long-term care. Cochrane Database Syst Rev2009; (1): CD004294.
45.
McGinn TG, Guyatt GH, Wyer PC, Naylor CD, Stiell IG, Richardson WSUsers’ guides to the medical literature: XXII: how to use articles about clinical decision rules. Evidence-Based Medicine Working Group. JAMA2000; 284: 79-84.
