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EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
Rivista di Medicina Fisica e Riabilitativa dopo Eventi Patologici
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Indexed/Abstracted in: CINAHL, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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European Journal of Physical and Rehabilitation Medicine 2014 August;50(4):383-93
Does reduced movement restrictions and use of assistive devices affect rehabilitation outcome after total hip replacement? A non-randomized, controlled study
Mikkelsen L. R. 1, Petersen M. K. 2, Søballe K. 3, Mikkelsen S. 1, Mechlenburg I. 3 ✉
1 Elective Surgery Centre, Silkeborg Regional Hospital, Silkeborg, Denmark;
2 Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital/Institute of Public Health, Aarhus University, Aarhus, Denmark;
3 Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus, Denmark
BACKGROUND: Improvements in surgical techniques and increase of femoral head size might have changed the rationale for movement restrictions after total hip replacement (THR).
AIM: To evaluate the influence of movement restrictions and assistive devices on rehabilitation after fast track THR.
DESIGN: Non-randomized, controlled study.
POPULATION: 365 consecutively included THR patients.
METHODS: Patients included the 3 initial month of the study underwent rehabilitation with restrictions in hip movement and a standard package of assistive devices (restricted group). This group was compared to patients included the following 3 months with less restricted hip movement and use of assistive devices according to individual needs (unrestricted group). Questionnaires on function, pain, quality of life (HOOS), anxiety (HADS), working status and patient satisfaction were completed before THR, 3 and 6 weeks after.
RESULTS: The HOOS function score at the 3 measurement times was (mean±SD); unrestricted group: 46±17 - 76±9 - 83±14 compared to restricted group: 43±16 - 81±14 - 83±13. Changes over time was significantly higher in the restricted group (P=0.004). Return to work 6 weeks after THR for the unrestricted group compared to restricted group was: 53% versus 32% (P=0.045). No significant differences between groups in pain, symptoms, quality of life, anxiety/depression, hip dislocations and patient satisfaction.
CONCLUSION: This study showed slightly slower recovery in patient-reported function after reduction in movement restrictions and use of assistive devices, but the difference was eliminated after 6 weeks. Reduced movement restrictions did not affect the other patient-reported outcomes and led to earlier return to work.
CLINICAL REHABILILTATION IMPACT: It is possible to reduce movement restrictions and use of assistive devices considerably. More research on safety issues is needed to elucidate the effect of unrestricted rehabilitation on hip dislocation.