Effectiveness of physiotherapy exercise following hip arthroplasty for osteoarthritis: a systematic review of clinical trials.
BACKGROUND
Physiotherapy has long been a routine component of patient rehabilitation following hip joint replacement. The purpose of this systematic review was to evaluate the effectiveness of physiotherapy exercise after discharge from hospital on function, walking, range of motion, quality of life and muscle strength, for osteoarthritic patients following elective primary total hip arthroplasty.


METHODS



METHODS
Systematic review, using the Cochrane Collaboration Handbook for Systematic Reviews of Interventions and the Quorom Statement. Database searches: AMED, CINAHL, EMBASE, KingsFund, MEDLINE, Cochrane library (Cochrane reviews, Cochrane Central Register of Controlled Trials, DARE), PEDro, The Department of Health National Research Register. Handsearches: Physiotherapy, Physical Therapy, Journal of Bone and Joint Surgery (Britain) Conference Proceedings. No language restrictions were applied.


METHODS
Trials comparing physiotherapy exercise versus usual/standard care, or comparing two types of relevant exercise physiotherapy, following discharge from hospital after elective primary total hip replacement for osteoarthritis were reviewed.


RESULTS
Functional activities of daily living, walking, quality of life, muscle strength and range of hip joint motion. Trial quality was extensively evaluated. Narrative synthesis plus meta-analytic summaries were performed to summarise the data.


RESULTS
8 trials were identified. Trial quality was mixed. Generally poor trial quality, quantity and diversity prevented explanatory meta-analyses. The results were synthesised and meta-analytic summaries were used where possible to provide a formal summary of results. Results indicate that physiotherapy exercise after discharge following total hip replacement has the potential to benefit patients.


CONCLUSIONS
Insufficient evidence exists to establish the effectiveness of physiotherapy exercise following primary hip replacement for osteoarthritis. Further well designed trials are required to determine the value of post discharge exercise following this increasingly common surgical procedure.
Minns Lowe
Catherine J
CJ
Department of Primary Care Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, UK. catherine.minnslowe@noc.anglox.nhs.uk
Barker
Karen L
KL
Dewey
Michael E
ME
Sackley
Catherine M
CM
D000203:Activities of Daily Living; D019644:Arthroplasty, Replacement, Hip; D002986:Clinical Trials as Topic; D019317:Evidence-Based Medicine; D005081:Exercise Therapy; D006621:Hip Joint / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D053580:Muscle Strength; D015207:Osteoarthritis, Hip / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D010351:Patient Discharge; D011788:Quality of Life; D016059:Range of Motion, Articular; D020127:Recovery of Function; D016896:Treatment Outcome; D016138:Walking