Preoperative therapeutic exercise in frail elderly scheduled for total hip replacement: a randomized pilot trial.
OBJECTIVE
To evaluate the feasibility and preliminary effectiveness of therapeutic exercise before total hip replacement in frail elderly.


METHODS
A single-blind, randomized clinical pilot trial.


METHODS
Outpatient physiotherapy department.


METHODS
Frail elderly with hip osteoarthritis awaiting total hip replacement.


METHODS
A short (3-6 weeks) tailor-made, therapeutic exercise programme was compared with usual care.


METHODS
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.
Hoogeboom
Thomas J
TJ
Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands. t.hoogeboom@maartenskliniek.nl
Dronkers
Jaap J
JJ
van den Ende
Cornelia H M
CH
Oosting
Ellen
E
van Meeteren
Nico L U
NL
D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000379:methods* / Q000534:rehabilitation; D005081:Exercise Therapy / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D016330:Frail Elderly; D006801:Humans; D007902:Length of Stay; D008297:Male; D015207:Osteoarthritis, Hip / Q000534:rehabilitation / Q000601:surgery*; D010349:Patient Compliance; D017060:Patient Satisfaction; D010865:Pilot Projects; D011300:Preoperative Care / Q000379:methods; D020127:Recovery of Function; D016037:Single-Blind Method