title: Physiotherapist-directed rehabilitation exercises in the outpatient or home setting improve strength, gait speed and cadence after elective total hip replacement: a systematic review.
abstract: OBJECTIVE
  In people who have been discharged from hospital after a total hip replacement, do rehabilitation exercises directed by a physiotherapist improve strength, gait, function and quality of life? Are these exercises as effective in an unsupervised home-based setting as they are in a supervised outpatient setting?
  
  
  METHODS
  Systematic review with meta-analysis of randomised trials.
  
  
  METHODS
  Adult patients after elective total hip replacement.
  
  
  METHODS
  Physiotherapist-directed rehabilitation exercises after discharge from hospital following total hip replacement.
  
  
  METHODS
  Hip and knee strength, gait parameters, functional measures, and quality of life.
  
  
  RESULTS
  Five studies comprising 234 participants were included in the review. Sufficient data for meta-analysis were only obtained for hip and knee strength, gait speed and cadence. Physiotherapy rehabilitation improved hip abductor strength by a mean of 16Nm (95% CI 10 to 22), gait speed by 6 m/min (95% CI 1 to 11) and cadence by 20 steps/min (95% CI 8 to 32). Favourable but non-significant improvements in strength were noted for other muscle groups at the hip and knee. Function and quality of life could not be meta-analysed due to insufficient data and heterogeneity of measures, but functional measures tended to favour the physiotherapy rehabilitation group. Most outcomes were similar between outpatient and home-based exercise programs.
  
  
  CONCLUSIONS
  Physiotherapy rehabilitation improves hip abductor strength, gait speed and cadence in people who have been discharged from hospital after total hip replacement. Physiotherapist-directed rehabilitation exercises appear to be similarly effective whether they are performed unsupervised at home or supervised by a physiotherapist in an outpatient setting.
authors.affiliation: Australian National University Medical School, Australia; Physiotherapy Department, Canberra Hospital, Australia. Electronic address: corinne.coulter@act.gov.au.
authors.forename: Corinne L
authors.initials: CL
authors.lastname: Coulter
authors.forename: Jennie M
authors.initials: JM
authors.lastname: Scarvell
authors.forename: Teresa M
authors.initials: TM
authors.lastname: Neeman
authors.forename: Paul N
authors.initials: PN
authors.lastname: Smith
mesh_terms: D000328:Adult; D000553:Ambulatory Care; D019644:Arthroplasty, Replacement, Hip / Q000534:rehabilitation*; D005684:Gait; D006699:Home Care Services; D006801:Humans; D053580:Muscle Strength; D026741:Physical Therapy Modalities; D016896:Treatment Outcome
keywords: Exercise; Physical therapy; Physiotherapy; Rehabilitation; Total hip replacement