Abstract
Introduction: Rehabilitation exercises are offered to patients after total hip arthroplasty (THA); however, the effectiveness and optimal type and dose of exercise remains unknown. The primary objective of this trial is to indicate the preliminary efficacy of home-based rehabilitation using elastic band exercise on performance-based function after THA, based on the relationship between the performed exercise dose and the change in performance-based function (gait speed) from 3 (start of intervention) to 10 weeks (end of intervention) after surgery. The secondary objective is to investigate if a dose-response relationship exists between the performed exercise dose and changes in: hip-related disability, lower-extremity functional performance, and hip muscle strength Methods: In this prospective cohort study, patients scheduled for THA will be consecutively included until 88 have completed the intervention period from 3 to 10 weeks postoperatively. Participants perform the standard rehabilitation program with elastic band exercises. Exercise dose (exposure) will be objectively quantified using a sensor attached to the elastic band. The primary outcome is gait speed measured by the 40-m fast-paced walk test. Secondary outcomes include: patient reported hip disability (Hip disability and Osteoarthritis Outcome Score (HOOS)), hip muscle strength (hand-held dynamometry) and lower extremity function (30-s chair stand test). Discussion: This trial will add knowledge concerning the relationship between performed exercise dose and post-operative outcomes after THA. The protocol paper describes the study design and methods in detail, including the statistical analysis plan. Trial registration: Pre-registered on March 27, 2017 at ClinicalTrails.gov (ID: NCT03109821).
Highlights
Rehabilitation exercises are offered to patients after total hip arthroplasty (THA); the effectiveness and optimal type and dose of exercise remains unknown
The primary objective is to indicate the preliminary efficacy of home-based rehabilitation using elastic band exercise on performance-based function after Total hip arthroplasty (THA), based on the relationship between the performed exercise dose and the change in performance-based function from 3 to 10 weeks after surgery
In the case that none of the models seem to fit the data, a linear regression model with a categorical variable based on intervals of the exercise dose variable will be fitted
Summary
Rehabilitation exercises are offered to patients after total hip arthroplasty (THA); the effectiveness and optimal type and dose of exercise remains unknown. Muscle strength and functional performance, such as walking ability, are substantially reduced early after THA2–5; this is why postoperative rehabilitation is offered throughout the municipalities in Denmark. In some municipalities, this is organized as outpatient supervised rehabilitation, whereas in other municipalities, patients receive an initial instruction and perform rehabilitation exercise in their own homes without supervision. There is, some evidence to indicate that rehabilitation exercise may be superior to no or very little rehabilitation exercise for selected muscle-strength, gait, and function outcomes after THA6,9,10 It suggests that a dose-response relationship exists for post-operative rehabilitation exercise and recovery after THA
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