title: Preoperative home-based physical therapy versus usual care to improve functional health of frail older adults scheduled for elective total hip arthroplasty: a pilot randomized controlled trial.
abstract: OBJECTIVE
  To investigate the feasibility and preliminary effectiveness of a home-based intensive exercise program to improve physical health of frail elderly patients scheduled for elective total hip arthroplasty (THA).
  
  
  METHODS
  Single-blind pilot randomized controlled trial.
  
  
  METHODS
  Patients' homes and a general hospital in The Netherlands.
  
  
  METHODS
  Frail patients (N=30) older than 65 years.
  
  
  METHODS
  A preoperative, home-based program supervised by an experienced physical therapist to train functional activities and walking capacity. The control group received usual care consisting of 1 session of instructions.
  
  
  METHODS
  Feasibility was determined on the basis of adherence to treatment, patient satisfaction, adverse events, walking distance (measured with a pedometer), and intensity of exercise (evaluated with the Borg scale). Preliminary pre- and postoperative effectiveness was determined by the Timed Up & Go (TUG) test, 6-minute walk test (6MWT), Chair Rise Time, and self-reported measures of functions, activities, and participation.
  
  
  RESULTS
  Patient satisfaction and adherence to the training were good (median=5 on a 5-point Likert scale) and no serious adverse events occurred. The Borg score during training was 14 (range, 13-16). Preoperative clinical relevant differences on the TUG test (2.9 s; 95% confidence interval [CI], -0.9 to 6.6) and significant differences on the 6MWT (41 m; 95% CI, 8 to 74) were found between groups.
  
  
  CONCLUSIONS
  Intensive preoperative training at home is feasible for frail elderly patients waiting for THA and produces relevant changes in functional health. A larger multicenter randomized controlled trial is in progress to investigate the (cost-)effectiveness of preoperative training.
authors.affiliation: Department of Physiotherapy, Gelderse Vallei Hospital, Ede, The Netherlands. oostinge@zgv.nl
authors.forename: Ellen
authors.initials: E
authors.lastname: Oosting
authors.forename: Marielle P
authors.initials: MP
authors.lastname: Jans
authors.forename: Jaap J
authors.initials: JJ
authors.lastname: Dronkers
authors.forename: Roelfrieke H
authors.initials: RH
authors.lastname: Naber
authors.forename: Christa M
authors.initials: CM
authors.lastname: Dronkers-Landman
authors.forename: Suzan M
authors.initials: SM
authors.lastname: Appelman-de Vries
authors.forename: Nico L
authors.initials: NL
authors.lastname: van Meeteren
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip; D004185:Disability Evaluation; D005240:Feasibility Studies; D005260:Female; D016330:Frail Elderly; D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D016014:Linear Models; D008297:Male; D009042:Motivation; D010349:Patient Compliance; D017060:Patient Satisfaction; D026741:Physical Therapy Modalities; D010865:Pilot Projects; D011183:Postoperative Complications / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods*; D018709:Statistics, Nonparametric; D016896:Treatment Outcome