title: Stair negotiation as a rehabilitation intervention for enhancing recovery following total hip and knee replacement surgery.
abstract: BACKGROUND
  Total hip replacement (THR) and total knee replacement (TKR) are common orthopaedic procedures. However, an optimal programme for post-operative rehabilitation has yet to be established. Stair negotiation is a challenging, habitual task, regularly used as a post-operative functional outcome measure; yet as a physical rehabilitation intervention it appears to be rarely used.
  
  
  OBJECTIVE
  The review purpose was to investigate the effectiveness of stair climbing as a rehabilitation intervention for THR and TKR patients.
  
  
  METHODS
  MEDLINE, PsycINFO, Science Citation Index, CINAHL, SPORTDiscus and the Cochrane Database of Systematic Reviews were searched. The systematic review targeted studies using stair negotiation as a rehabilitation intervention. Randomised and non-randomised controlled trials, pilot studies, and case studies were included; systematic reviews and meta-analyses were excluded.
  
  
  RESULTS
  Of 650 articles identified, ten studies were eligible for review. A predefined data table to extract information from selected studies was used. Of the ten identified reports, two prehabilitation and eight rehabilitation studies included stair negotiation exercises as part of multi-modal physical interventions. Outcome measures were classified as: functional self-reported, perceptual, psychological and those relating to quality of life.
  
  
  CONCLUSIONS
  Studies were methodologically heterogeneous and typically lacked adequate control groups. It was not possible to determine the impact of stair negotiation exercise on the positive outcomes of interventions. Stair negotiation warrants further investigation as a rehabilitation activity.
authors.affiliation: Department of Sport and Physical Activity, Faculty of Management, Bournemouth University, Poole, UK. Electronic address: jgavin@bournemouth.ac.uk.
authors.forename: James P
authors.initials: JP
authors.lastname: Gavin
authors.affiliation: Orthopaedic Research Institute, Bournemouth University, Bournemouth, UK.
authors.forename: Tikki
authors.initials: T
authors.lastname: Immins
authors.affiliation: Orthopaedic Research Institute, Bournemouth University, Bournemouth, UK; Centre of Postgraduate Medicine, Research and Education, The School of Health and Social Care, Bournemouth University, Bournemouth, UK.
authors.forename: Thomas
authors.initials: T
authors.lastname: Wainwright
mesh_terms: D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D006801:Humans; D051346:Mobility Limitation; D015207:Osteoarthritis, Hip / Q000451:nursing / Q000534:rehabilitation* / Q000601:surgery; D020370:Osteoarthritis, Knee / Q000451:nursing / Q000534:rehabilitation* / Q000601:surgery; D016059:Range of Motion, Articular; D020127:Recovery of Function; D000072799:Stair Climbing
keywords: Hip arthroplasty; Knee arthroplasty; Physical function; Rehabilitation; Stair climbing