Surgery rates are increasing, while recommendations for physical therapy are decreasing
Hip osteoarthritis is a condition in which cartilage that normally protects bones gradually wears away, which eventually leads to these bones rubbing against one another. Patients go on to experience pain, weakness and difficulty walking, which can make their daily lives difficult. Although non-surgical treatments like physical therapy are recommended at first, some patients with hip osteoarthritis don't improve and decide to have a surgical procedure called total hip replacement (THR) to treat it. The rates of THR are increasing on an international level, and even though most patients experience a positive result from it, some are not satisfied and continue to have issues in the future. This is why physical therapy is considered an important component of the rehabilitation process that will help patients get back to full strength. Despite this, less patients are being instructed to have physical therapy after surgery, and some studies have suggested that it may not be as effective as some believe.
For this reason, a randomized-controlled trial (RCT) was conducted on this topic. An RCT is a powerful study that randomly divides patients into separate treatment groups to determine which is more effective. In this case, the question was whether having physical therapy within 18 weeks after THR can lead to better outcomes for patients than the usual, standard treatment.
Patients have 12 physical therapy sessions over six weeks
Patients aged 50 or older who had a THR for hip osteoarthritis were invited to participate in the RCT, and this process led to a group of 63 participants. This group was randomly and evenly split into two smaller groups: one that received physical therapy and the other that received usual treatment. Twelve weeks after surgery, patients in the physical therapy group attended two sessions per week over six weeks, for a total of 12 physical therapy sessions. Each session lasted 35 minutes and consisted of seven different exercises to strengthen the hips and legs, such as heel raises, knee bends and knee raises. Patients in the usual treatment group, or control group, received a booklet with some exercises to perform while still in the hospital but did not attend any specific exercise sessions. All patients were instructed to walk with their crutches every day and to gradually increase their distance walked, but no other instructions were given to either group. The main outcomes that were analyzed were pain, stiffness and function, and measurements taken before (12 weeks after surgery) and immediately after physical therapy was given (18 weeks after surgery).
Physical therapy seems to improve overall status of patients
Results of this RCT showed that patients who received physical therapy improved significantly more in walking speed and overall daily function than patients who received usual treatment. Aside from this, no major differences were found between these patients groups in the other measurements taken. Nonetheless, this study shows that a physical therapy program given after hip surgery can lead to significant improvements for patients. These positive findings make this study the first to show that physical therapy can in fact be beneficial for patients during the recovery process. For this reason, additional studies should be conducted to investigate this matter in greater detail. They should also be sure to look into the long-term effects of physical therapy, which was not explored in this current RCT. More evidence that supports physical therapy will help to change the trend and make it offered to a greater number of patients after hip surgery.
-Summarized by Greg Gargiulo.
As reported in the February ’16 issue of Physiotherapy