title: Randomised controlled trial to evaluate a physiotherapy-led functional exercise programme after total hip replacement.
abstract: BACKGROUND
  At present, there is an insufficient evidence base to evaluate the effectiveness of physiotherapy following total hip replacement (THR). This study evaluated the effectiveness of a physiotherapy-supervised functional exercise programme between 12 and 18 weeks following THR. These time-points coincide with increased functional demand in patients.
  
  
  METHODS
  Adequately powered assessor-blinded randomised controlled trial.
  
  
  METHODS
  Patients were recruited at a pre-operative assessment clinic and randomised following surgery.
  
  
  METHODS
  Sixty-three subjects were randomised to either the usual care group (control, n=31) or the functional exercise+usual care group (n=32).
  
  
  METHODS
  Patients in the functional exercise group attended a physiotherapy-supervised functional exercise class twice weekly from 12 to 18 weeks following THR. Patients in the control group followed the usual care protocol with no exercise intervention.
  
  
  METHODS
  The main outcome measurement tool was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire, and the secondary outcomes included walking speed, hip abduction dynamometry, Short Form 12 physical and mental health scores, and visual analogue pain scale score.
  
  
  RESULTS
  At 18 weeks post surgery, WOMAC function and walking speed improved significantly more in the functional exercise group [mean difference -4.0, 95% confidence interval (CI) -7.0 to 1.0 (P<0.01); mean difference 21.9m, 95% CI 0.60 to 43.3 (P<0.04)] than the control group, but there was no significant difference in hip abductor strength.
  
  
  CONCLUSIONS
  This study demonstrated that patients who undertake a physiotherapy-led functional exercise programme between 12 and 18 weeks after THR may gain significant functional improvement compared with patients receiving usual care. Clinical trial registration number NCT01683201.
authors.affiliation: Department of Physiotherapy, Our Lady's Hospital, Navan, Co Meath, Ireland. Electronic address: brenda.monaghan@hse.ie.
authors.forename: B
authors.initials: B
authors.lastname: Monaghan
authors.affiliation: Department of Radiology, Our Lady's Hospital, Navan, Co Meath, Ireland.
authors.forename: P
authors.initials: P
authors.lastname: Cunningham
authors.affiliation: Department of Orthopaedics, Our Lady's Hospital, Navan, Co Meath, Ireland.
authors.forename: P
authors.initials: P
authors.lastname: Harrington
authors.affiliation: Faculty of Health and Sciences and Medicine, Bond University, Robina, QLD, Australia.
authors.forename: W
authors.initials: W
authors.lastname: Hing
authors.affiliation: School of Public Health, Physiotherapy and Population Science, University College Dublin, Belfield, Dublin, Ireland.
authors.forename: C
authors.initials: C
authors.lastname: Blake
authors.affiliation: Department of Physiotherapy, Our Lady's Hospital, Navan, Co Meath, Ireland.
authors.forename: D
authors.initials: D
authors.lastname: O' Dohertya
authors.affiliation: School of Public Health, Physiotherapy and Population Science, University College Dublin, Belfield, Dublin, Ireland.
authors.forename: T
authors.initials: T
authors.lastname: Cusack
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000534:rehabilitation*; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D016037:Single-Blind Method
keywords: Late-stage functional exercise; Physiotherapy; Postoperative rehabilitation; Total hip replacement