title: Early, intensified home-based exercise after total hip replacement--a pilot study.
abstract: OBJECTIVE
  Despite a successful surgical procedure, deficits in muscle strength and physical function are documented 1-2 years after total hip replacement (THR). There is a lack of evidence concerning which rehabilitation strategy is the most effective after THR. The purpose of this pilot study was to investigate the feasibility of an early-initiated intensified, home-based training regime and to form the basis of future studies with regard to exercises, outcome measures and power calculations.
  
  
  METHODS
  The trial is a single-blinded, cluster-randomized controlled trial performed at an orthopaedic physiotherapy department in a public hospital in Denmark. A consecutive sample of 46 patients undergoing primary THR surgery for osteoarthritis between September 2008 and January 2009 was included. Forty-four patients completed the trial (96% follow-up). Participants were randomly assigned to an intervention group (IG, n = 23) receiving 12 weeks of intensified exercises (e.g. rubber band resistance) or a control group (CG, n = 21) receiving standard rehabilitation exercises without external resistance. The outcome measurements were maximal gait speed, isometric hip abductor muscle strength, one-legged stance, health-related quality of life (EuroQol-5 Dimensions), patient satisfaction, and patient-evaluated function, stiffness and pain (Western and Ontario McMasters University Osteoarthritis Index).
  
  
  RESULTS
  There were significant increases in both groups in all the measurements during the 12 weeks of exercises. All participants in the IG were satisfied or very satisfied with the exercises compared with 85% in the CG (P = 0.095). In the IG, four participants (17.4%) had difficulties when performing the intensified exercises at home. Hip abduction strength was significantly weaker in the leg operated compared with the leg not operated on after the intervention in both groups (P < 0.01).
  
  
  CONCLUSIONS
  This pilot study indicates that the majority of THR patients tolerated early-initiated intensified exercises without additional pain and with high patient satisfaction. It seems that some of the patients need supervision to perform intensified exercises.
authors.affiliation: Department of Physiotherapy, Silkeborg Regional Hospital, Denmark. lonemike@rm.dk
authors.forename: Lone R
authors.initials: LR
authors.lastname: Mikkelsen
authors.forename: Søren S
authors.initials: SS
authors.lastname: Mikkelsen
authors.forename: Finn B
authors.initials: FB
authors.lastname: Christensen
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000534:rehabilitation*; D016000:Cluster Analysis; D005081:Exercise Therapy / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D005684:Gait; D006801:Humans; D008875:Middle Aged; D053580:Muscle Strength; D017060:Patient Satisfaction; D010865:Pilot Projects; D016037:Single-Blind Method; D016896:Treatment Outcome