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. 2013 Dec;59(4):219-26.
doi: 10.1016/S1836-9553(13)70198-X.

Physiotherapist-directed rehabilitation exercises in the outpatient or home setting improve strength, gait speed and cadence after elective total hip replacement: a systematic review

Corinne L Coulter  1 , Jennie M Scarvell, Teresa M Neeman, Paul N Smith
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Free article

Physiotherapist-directed rehabilitation exercises in the outpatient or home setting improve strength, gait speed and cadence after elective total hip replacement: a systematic review

Corinne L Coulter et al. J Physiother. 2013 Dec.
Free article

Abstract

Question: In people who have been discharged from hospital after a total hip replacement, do rehabilitation exercises directed by a physiotherapist improve strength, gait, function and quality of life? Are these exercises as effective in an unsupervised home-based setting as they are in a supervised outpatient setting?

Design: Systematic review with meta-analysis of randomised trials.

Participants: Adult patients after elective total hip replacement.

Intervention: Physiotherapist-directed rehabilitation exercises after discharge from hospital following total hip replacement.

Outcome measures: Hip and knee strength, gait parameters, functional measures, and quality of life.

Results: Five studies comprising 234 participants were included in the review. Sufficient data for meta-analysis were only obtained for hip and knee strength, gait speed and cadence. Physiotherapy rehabilitation improved hip abductor strength by a mean of 16Nm (95% CI 10 to 22), gait speed by 6 m/min (95% CI 1 to 11) and cadence by 20 steps/min (95% CI 8 to 32). Favourable but non-significant improvements in strength were noted for other muscle groups at the hip and knee. Function and quality of life could not be meta-analysed due to insufficient data and heterogeneity of measures, but functional measures tended to favour the physiotherapy rehabilitation group. Most outcomes were similar between outpatient and home-based exercise programs.

Conclusion: Physiotherapy rehabilitation improves hip abductor strength, gait speed and cadence in people who have been discharged from hospital after total hip replacement. Physiotherapist-directed rehabilitation exercises appear to be similarly effective whether they are performed unsupervised at home or supervised by a physiotherapist in an outpatient setting.

Keywords: Exercise; Physical therapy; Physiotherapy; Rehabilitation; Total hip replacement.

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