title: Is there a difference in physical activity levels in patients before and up to one year after unilateral total hip replacement? A systematic review and meta-analysis.
abstract: OBJECTIVE
  To determine the difference in physical activity levels before and up to one year after unilateral primary total hip replacement.
  
  
  METHODS
  A search was performed on 13 July 2016. Studies were eligible for inclusion if they presented preoperative and up to one year postoperative measures of physical activity for patients who had undergone unilateral primary total hip replacement.
  
  
  METHODS
  Any article that used a measure of physical activity pre and up to one year post-unilateral primary total hip replacement. Data was synthesised using a meta-analysis with 95% confidence intervals (CI), if appropriate. The Critical Appraisal Skills Programme cohort study checklist was used to assess the quality of evidence.
  
  
  RESULTS
  From 6024 citations, 17 studies were selected: Nine studies were analysed in a meta-analysis and eight studies were analysed qualitatively. The quality of the evidence was 'low' to 'moderate'. There was no statistically significant difference in physical activity pre- to post-total hip replacement when assessed using: movement-related activity (mean difference (MD): -0.08; 95% CI: 1.60, 1.44; I2= 0%; n = 77), percentage of 24-hours spent walking (MD: -0.21; 95% CI: -1.36, 0.93; I2= 12%; n = 65), 6-minute walk test (MD: -60.85; 95% CI: -122.41, 0.72; I2= 84%; n = 113) or the cardiopulmonary exercise test (MD: -0.24; 95% CI: -1.36, 0.87; I2= 0%; n = 76).
  
  
  CONCLUSIONS
  There is no statistically significant difference in physical activity levels before and up to one year after unilateral primary total hip replacement. However, the low to moderate methodological quality of the included articles should be taken into consideration when drawing conclusions.
authors: 1 School of Health Sciences, University of East Anglia, Norwich, UK.
authors: Thomas M
authors: TM
authors: Withers
authors: 2 Department of Physiotherapy, Norfolk and Norwich University Hospital, Norwich, UK.
authors: Sarah
authors: S
authors: Lister
authors: 3 Department of Physiotherapy, Kings College London, London, UK.
authors: Catherine
authors: C
authors: Sackley
authors: 4 Norwich Medical School, University of East Anglia, Norwich, UK.
authors: Allan
authors: A
authors: Clark
authors: 1 School of Health Sciences, University of East Anglia, Norwich, UK.
authors: Toby O
authors: TO
authors: Smith
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000534:rehabilitation*; D015444:Exercise; D006801:Humans; D015207:Osteoarthritis, Hip / Q000503:physiopathology* / Q000601:surgery; D011184:Postoperative Period; D057234:Preoperative Period
keywords: Total hip replacement; exercise; physical activity; recovery