title: The Effectiveness of Specific Exercise Approach or Modifiable Heel Lift in the Treatment of Functional Leg Length Discrepancy in Early Post-surgery Inpatients after Total Hip Arthroplasty: A Randomized Controlled Trial with a PROBE design.
abstract: OBJECTIVE
  This study investigated the effectiveness of a specific exercise approach (SEA) or modifiable heel lift (MHL) to improve functional leg length discrepancy (LLD) after total hip arthroplasty (THA).
  
  
  METHODS
  The study was a randomized controlled trial with a PROBE (prospective, randomized, open, blinded-endpoint) design trial. Patients (n=33) with both functional and perceived LLDs, 1 week after THA, were randomized to the SEA, MHL, or control groups. Patients in the SEA group performed 2 weeks of exercises to improve hip contracture and lumbar scoliosis. Patients in the MHL group used an insole-type heel lift to correct functional LLD. The control group received normal postoperative care, comprising standard rehabilitation after THA. The primary outcomes were functional LLD, measured by a block test, and patient-perceived LLD at 3 weeks after the surgery. Secondary outcomes included the visual analog scale (VAS) for pain, the Timed Up and Go (TUG) test, and the Western Ontario and McMaster Universities Osteoarthritis index (WOMAC) at 3 weeks after the surgery.
  
  
  RESULTS
  The functional LLDs (mean ± SD) for the SEA (3.3 ± 3.1 mm) and MHL (2.2 ± 2.1 mm) groups were significantly smaller than for the control group (6.4 ± 4.0 mm). The degree of patient-perceived LLD differed significantly between the SEA and the control groups (p=.005).
  
  
  CONCLUSIONS
  SEA and MHL use, during early post-operative recovery, can produce relevant changes in functional LLD after THA.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine; Department of Physical Therapy, Yamagata Prefectural University of Health Sciences.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Nakanowatari
authors.affiliation: Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine.
authors.forename: Yoshimi
authors.initials: Y
authors.lastname: Suzukamo
authors.affiliation: Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine; Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Biomedical Engineering.
authors.forename: Shin-Ichi
authors.initials: SI
authors.lastname: Izumi
keywords: Functional leg length discrepancy; Heel lift; Randomized controlled trial; Total hip arthroplasty; therapeutic exercise