Translating Research into Clinical Practice: Functional Recovery Post Total Hip Arthroplasty Using Outcomes Gathered in the Usual Physical Therapy Practice Setting

Abstract

Purpose The purpose of this study is to determine the pattern of functional change after total hip arthroplasty (THA) in patients attending physical therapy (PT) in a usual care setting and to explore the effect of sex and time from surgery to the first physical therapy visit as potential prognostic factors influencing postoperative THA recovery. Study Design Adults with THA were retrospectively identified in an electronic medical record PT database (October 1, 2004-April 30, 2010). Hierarchical linear modeling was used to evaluate growth curves and individual variations in function using the Lower Extremity Function Scale (LEFS). Investigated predictors were: sex, age, start time, and PT visit. Results A total of 147 (81 female, 66 male) postoperative THA patients were included in the study; mean age was 62.7 years (SD 10.6, range 45-91 years). The majority (79%) of patients initiated PT <9 weeks postsurgery; predominately lower-functioning women started at ≥9 weeks. For patients initiating treatment at <9 weeks, the curvilinear slopes of recovery were similar between sexes, although the predicted levels of functional status were lower for females than for males ( P = .041). Conclusions This study of usual physical therapy practice supports the findings from controlled studies that post-THA women enter and are discharged from outpatient PT with lower functional status than men. New findings suggest that functional status for early start patients steadily improves over 26 weeks postsurgery. Modeling change in clinical practice using outcomes measures acquired through usual practice can feasibly and adequately serve to guide decisions in the management of THA rehabilitation.