Supervised or Unsupervised Rehabilitation After Total Hip Replacement Provides Similar Improvements for Patients: A Randomized Controlled Trial.

Corinne Coulter, Diana PERRIMAN, Terry Neeman, Paul Smith, Jennie SCARVELL

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Objective: To determine whether patients do better with unsupervised (home-based) physiotherapy or in an outpatient setting.
Setting: Acute care public hospital in the region, supporting a population of ∼540,000.
Design: Single-blind randomized controlled trial.
Participants: Adult patients (N=98) after unilateral elective total hip replacement (THR) were randomly assigned to a supervised (center-based) exercise (n=56) or a unsupervised (home-based) exercise (n=42) program and followed for 6 months postsurgery.
Interventions: The supervised group attended a 4-week outpatient rehabilitation program supervised by a physiotherapist. The unsupervised group was given written and pictorial instructions to perform rehabilitation independently at home.
Main Outcome Measures: Western Ontario and McMaster Universities Osteoarthritis Index; Short-Form 36-item Health Questionnaire (SF-36) mental and physical component summary measures; University of California, Los Angeles activity scale; and timed Up and Go test.
Results: There were no differences between the groups for any measure. The overall differences between the adjusted means were as follows: Western Ontario and McMaster Universities Osteoarthritis Index, 0.50 (95% confidence interval [CI], -6.8 to 5.7); SF-36 physical component summary, 0.8 (95% CI, -6.5 to 8.1); SF-36 mental component summary, 1.7 (95% CI, -4.1 to 7.4); University of California, Los Angeles activity scale, 0.3 (95% CI, 5.2 to 6.1); and timed Up and Go test, 0 seconds (95% CI, -1.4 to 1.3s).
Conclusions: The results demonstrated that outcomes in response to rehabilitation after THR are clinically and statistically similar whether the program was supervised or not. The results suggest that early rehabilitation programs can be effectively delivered unsupervised in the home to low-risk patients discharged home after THR. However, the relative effect of late-stage rehabilitation was not tested.
Original languageEnglish
Pages (from-to)2253-2264
Number of pages12
JournalArchives of Physical Medicine and Rehabilitation
Volume98
Issue number11
DOIs
Publication statusPublished - 1 Nov 2017

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Hip Replacement Arthroplasties
Rehabilitation
Randomized Controlled Trials
Confidence Intervals
Los Angeles
Ontario
Osteoarthritis
Outpatients
Exercise
Physical Therapists
Public Hospitals
Outcome Assessment (Health Care)
Health
Population

Cite this

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title = "Supervised or Unsupervised Rehabilitation After Total Hip Replacement Provides Similar Improvements for Patients: A Randomized Controlled Trial.",
abstract = "Objective: To determine whether patients do better with unsupervised (home-based) physiotherapy or in an outpatient setting.Setting: Acute care public hospital in the region, supporting a population of ∼540,000.Design: Single-blind randomized controlled trial.Participants: Adult patients (N=98) after unilateral elective total hip replacement (THR) were randomly assigned to a supervised (center-based) exercise (n=56) or a unsupervised (home-based) exercise (n=42) program and followed for 6 months postsurgery.Interventions: The supervised group attended a 4-week outpatient rehabilitation program supervised by a physiotherapist. The unsupervised group was given written and pictorial instructions to perform rehabilitation independently at home.Main Outcome Measures: Western Ontario and McMaster Universities Osteoarthritis Index; Short-Form 36-item Health Questionnaire (SF-36) mental and physical component summary measures; University of California, Los Angeles activity scale; and timed Up and Go test.Results: There were no differences between the groups for any measure. The overall differences between the adjusted means were as follows: Western Ontario and McMaster Universities Osteoarthritis Index, 0.50 (95{\%} confidence interval [CI], -6.8 to 5.7); SF-36 physical component summary, 0.8 (95{\%} CI, -6.5 to 8.1); SF-36 mental component summary, 1.7 (95{\%} CI, -4.1 to 7.4); University of California, Los Angeles activity scale, 0.3 (95{\%} CI, 5.2 to 6.1); and timed Up and Go test, 0 seconds (95{\%} CI, -1.4 to 1.3s).Conclusions: The results demonstrated that outcomes in response to rehabilitation after THR are clinically and statistically similar whether the program was supervised or not. The results suggest that early rehabilitation programs can be effectively delivered unsupervised in the home to low-risk patients discharged home after THR. However, the relative effect of late-stage rehabilitation was not tested.",
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Supervised or Unsupervised Rehabilitation After Total Hip Replacement Provides Similar Improvements for Patients: A Randomized Controlled Trial. / Coulter, Corinne; PERRIMAN, Diana; Neeman, Terry; Smith, Paul; SCARVELL, Jennie.

In: Archives of Physical Medicine and Rehabilitation, Vol. 98, No. 11, 01.11.2017, p. 2253-2264.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Supervised or Unsupervised Rehabilitation After Total Hip Replacement Provides Similar Improvements for Patients: A Randomized Controlled Trial.

AU - Coulter, Corinne

AU - PERRIMAN, Diana

AU - Neeman, Terry

AU - Smith, Paul

AU - SCARVELL, Jennie

PY - 2017/11/1

Y1 - 2017/11/1

N2 - Objective: To determine whether patients do better with unsupervised (home-based) physiotherapy or in an outpatient setting.Setting: Acute care public hospital in the region, supporting a population of ∼540,000.Design: Single-blind randomized controlled trial.Participants: Adult patients (N=98) after unilateral elective total hip replacement (THR) were randomly assigned to a supervised (center-based) exercise (n=56) or a unsupervised (home-based) exercise (n=42) program and followed for 6 months postsurgery.Interventions: The supervised group attended a 4-week outpatient rehabilitation program supervised by a physiotherapist. The unsupervised group was given written and pictorial instructions to perform rehabilitation independently at home.Main Outcome Measures: Western Ontario and McMaster Universities Osteoarthritis Index; Short-Form 36-item Health Questionnaire (SF-36) mental and physical component summary measures; University of California, Los Angeles activity scale; and timed Up and Go test.Results: There were no differences between the groups for any measure. The overall differences between the adjusted means were as follows: Western Ontario and McMaster Universities Osteoarthritis Index, 0.50 (95% confidence interval [CI], -6.8 to 5.7); SF-36 physical component summary, 0.8 (95% CI, -6.5 to 8.1); SF-36 mental component summary, 1.7 (95% CI, -4.1 to 7.4); University of California, Los Angeles activity scale, 0.3 (95% CI, 5.2 to 6.1); and timed Up and Go test, 0 seconds (95% CI, -1.4 to 1.3s).Conclusions: The results demonstrated that outcomes in response to rehabilitation after THR are clinically and statistically similar whether the program was supervised or not. The results suggest that early rehabilitation programs can be effectively delivered unsupervised in the home to low-risk patients discharged home after THR. However, the relative effect of late-stage rehabilitation was not tested.

AB - Objective: To determine whether patients do better with unsupervised (home-based) physiotherapy or in an outpatient setting.Setting: Acute care public hospital in the region, supporting a population of ∼540,000.Design: Single-blind randomized controlled trial.Participants: Adult patients (N=98) after unilateral elective total hip replacement (THR) were randomly assigned to a supervised (center-based) exercise (n=56) or a unsupervised (home-based) exercise (n=42) program and followed for 6 months postsurgery.Interventions: The supervised group attended a 4-week outpatient rehabilitation program supervised by a physiotherapist. The unsupervised group was given written and pictorial instructions to perform rehabilitation independently at home.Main Outcome Measures: Western Ontario and McMaster Universities Osteoarthritis Index; Short-Form 36-item Health Questionnaire (SF-36) mental and physical component summary measures; University of California, Los Angeles activity scale; and timed Up and Go test.Results: There were no differences between the groups for any measure. The overall differences between the adjusted means were as follows: Western Ontario and McMaster Universities Osteoarthritis Index, 0.50 (95% confidence interval [CI], -6.8 to 5.7); SF-36 physical component summary, 0.8 (95% CI, -6.5 to 8.1); SF-36 mental component summary, 1.7 (95% CI, -4.1 to 7.4); University of California, Los Angeles activity scale, 0.3 (95% CI, 5.2 to 6.1); and timed Up and Go test, 0 seconds (95% CI, -1.4 to 1.3s).Conclusions: The results demonstrated that outcomes in response to rehabilitation after THR are clinically and statistically similar whether the program was supervised or not. The results suggest that early rehabilitation programs can be effectively delivered unsupervised in the home to low-risk patients discharged home after THR. However, the relative effect of late-stage rehabilitation was not tested.

KW - Arthroplasty, Hip

KW - Rehabilitation exercise

KW - Orthopaedic surgery

KW - Exercise

KW - Orthopedics

KW - Arthroplasty

KW - Rehabilitation

KW - Hip

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