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Int J Sports Med 2011; 32(9): 725-732
DOI: 10.1055/s-0031-1271696
Clinical Sciences

© Georg Thieme Verlag KG Stuttgart · New York

Pre-Surgical Sensorimotor Training for Patients Undergoing Total Hip Replacement: A Randomised Controlled Trial

R. Bitterli1 , J. M. Sieben2 , M. Hartmann1 , E. D. de Bruin3
  • 1Kantonsspital Liestal, Switzerland
  • 2Department of Anatomy & Embryology, Maastricht University, Maastricht, The Netherlands
  • 3Institute of Human Movement Sciences and Sport, ETH Zurich, Switzerland
Further Information

Publication History

accepted after revision January 13, 2011

Publication Date:
31 May 2011 (online)

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Abstract

The aim of this study was to investigate whether pre-operative, sensorimotor training results in improved physical function, quality of life, sensorimotor function and reduced disability in total hip replacement patients. 80 subjects awaiting total hip replacement at a Swiss hospital were recruited for this randomised controlled trial. The intervention group participated in a pre-operative home exercise sensorimotor training programme; the control group received no therapy. Primary outcome measure was physical function, secondary outcome measures were quality of life, disability and sensorimotor function. Outcomes were measured using generic and disease-specific questionnaires as well as objectively assessed balance ability. Measurements were taken one day before surgery and 10 days, 4 and 12 months after surgery. The intervention showed improved quality of life and sensorimotor function before surgery. These effects were lost following surgery. The intervention group experienced more disability at 4 months than the control group. At one year follow-up group-membership influenced quality of life scores depending on the measurement-time-point. It can be concluded that no useful effect was identified for a pre-operative sensory-motor training-programme. The psychological aspects following total hip replacement need to be considered in order to facilitate coping-strategies, reduce unrealistic expectations and increase satisfaction.

Key words

total hip endoprosthesis - osteoarthritis - physical therapy - orthopaedics - rehabilitation

References

  • 1 Bundesamt für Statistik (BFS) .Krankenhausbehandlung – Detaillierte Daten. 2008. Neuchatel, Switzerland; http://www.bfs.admin.ch/bfs/portal/de/index/themen/14/04/01/data/01.html
    Google Scholar
  • 2 Ackerman IN, Bennell KL. Does pre-operative physiotherapy improve outcomes from lower limb joint replacement surgery? A systematic review.  Aust J Physiother. 2004;  50 25-30
    CrossrefPubMedGoogle Scholar
  • 3 Angst F, Aeschlimann A, Stucki G. Smallest detectable and minimal clinically important differences of rehabilitation intervention with their implications for required sample sizes using WOMAC and SF-36 quality of life measurement instruments in patients with osteoarthritis of the lower extremities.  Arthritis Rheum. 2001;  45 384-391
    CrossrefPubMedGoogle Scholar
  • 4 Arnold BL, Schmitz RJ. Examination of balance measures produced by the biodex stability system.  J Athl Train. 1998;  33 323-327
    PubMedGoogle Scholar
  • 5 Bachmeier CJ, March LM, Cross MJ, Lapsley HM, Tribe KL, Courtenay BG, Brooks PM. A comparison of outcomes in osteoarthritis patients undergoing total hip and knee replacement surgery.  Osteoarthritis Cartilage. 2001;  9 137-146
    CrossrefPubMedGoogle Scholar
  • 6 Boardman DL, Dorey F, Thomas BJ, Lieberman JR. The accuracy of assessing total hip arthroplasty outcomes: a prospective correlation study of walking ability and 2 validated measurement devices.  J Arthroplasty. 2000;  15 200-204
    CrossrefPubMedGoogle Scholar
  • 7 Bullinger M, Kirchberger I. SF-36 Fragebogen zum Gesundheitszustand Handanweisung. Götingen: Hogrefe Verlag für Psychologie; 1998
    Google Scholar
  • 8 Butler GS, Hurley CA, Buchanan KL, Smith-VanHorne J. Prehospital education: effectiveness with total hip replacement surgery patients.  Patient Educ Couns. 1996;  29 189-197
    CrossrefPubMedGoogle Scholar
  • 9 Cohen J. Statistical Power Analysis for the Behavioral Sciences. 2nd edition Hillsdale, NJ: Lawrence Erlbaum Associates; 1988
    Google Scholar
  • 10 Crowe J, Henderson J. Pre-arthroplasty rehabilitation is effective in reducing hospital stay.  Can J Occup Ther. 2003;  70 88-96
    PubMedGoogle Scholar
  • 11 Fagerson T. The Hip Handbook. Boston: Butterworth-Heinemann; 1998
    Google Scholar
  • 12 Finch E, Brooks D, Stratford P, Mayo N. Physical Rehabilitation Outcome Measures – A Guide to Enhanced Clinical Decision Making. (2nd edition) Hamilton: BC Decker Inc.; 2002
    Google Scholar
  • 13 Finn J, Alvarez M, Jett R, Axtell R, Kemler D. Stability performance assessment among subjects of disparate balancing abilities.  Med Sci Sports Exerc. 1999;  31 S252
    PubMedGoogle Scholar
  • 14 Fisher R, Yates F. Statistical Tables for Biological, Agricultural and Medical Research. Darien: Hafner Publishing Company; 1970
    Google Scholar
  • 15 Gammon J, Mulholland CW. Effect of preparatory information prior to elective total hip replacement on post-operative physical coping outcomes.  Int J Nurs Stud. 1996;  33 589-604
    CrossrefPubMedGoogle Scholar
  • 16 Gammon J, Mulholland CW. Effect of preparatory information prior to elective total hip replacement on psychological coping outcomes.  J Adv Nurs. 1996;  24 303-308
    CrossrefPubMedGoogle Scholar
  • 17 Gilbey HJ, Ackland TR, Wang AW, Morton AR, Trouchet T, Tapper J. Exercise improves early functional recovery after total hip arthroplasty.  Clin Orthop. 2003;  193-200
    PubMedGoogle Scholar
  • 18 Gocen Z, Sen A, Unver B, Karatosun V, Gunal I. The effect of preoperative physiotherapy and education on the outcome of total hip replacement: a prospective randomized controlled trial.  Clin Rehabil. 2004;  18 353-358
    CrossrefPubMedGoogle Scholar
  • 19 Granacher U, Gollhofer A. Neuromuskuläre Leistungsfähigkeit im Alter – Ein Überblick.  Zeitschrift für Physiotherapeuten. 2005;  57 1316-1328
    PubMedGoogle Scholar
  • 20 Harriss DJ, Atkinson G. International Journal of Sports Medicine – Ethical Standards in Sport and Exercise Science Research.  Int J Sports Med. 2009;  30 701-702
    Google Scholar
  • 21 Hinman M. Factors affecting reliability of the Biodex Balance System: a summary of four studies.  J Sport Rehabil. 2000;  9 240-252
    PubMedGoogle Scholar
  • 22 Illyés À, Holnapy G, Szendröï M, Kiss R. Importance of proprioception after total hip replacement. In: Austria: International Association of Science and Technology for Development; 2006: 379-383
    Google Scholar
  • 23 Ishii Y, Tojo T, Terajima K, Terashima S, Bechtold JE. Intracapsular components do not change hip proprioception.  J Bone Joint Surg Br. 1999;  81 345-348
    CrossrefPubMedGoogle Scholar
  • 24 Lephart S, Fu F. Proprioception and Neuromuscular Control in Joint Stability. Leeds: Human Kinetics; 2000
    Google Scholar
  • 25 Lieberman JR, Dorey F, Shekelle P, Schumacher L, Thomas BJ, Kilgus DJ, Finerman GA. Differences between patients’ and physicians’ evaluations of outcome after total hip arthroplasty.  J Bone Joint Surg Am. 1996;  78 835-838
    PubMedGoogle Scholar
  • 26 Mancuso CA, Salvati EA, Johanson NA, Peterson MG, Charlson ME. Patients’ expectations and satisfaction with total hip arthroplasty.  J Arthroplasty. 1997;  12 387-396
    CrossrefPubMedGoogle Scholar
  • 27 Mancuso CA, Sculco TP, Salvati EA. Patients with poor preoperative functional status have high expectations of total hip arthroplasty.  J Arthroplasty. 2003;  18 872-878
    CrossrefPubMedGoogle Scholar
  • 28 McGrath RE, Meyer GJ. When effect sizes disagree: the case of r and d.  Psychol Methods. 2006;  11 386-401
    CrossrefPubMedGoogle Scholar
  • 29 Moseley GL. Do training diaries affect and reflect adherence to home programs?.  Arthritis Rheum. 2006;  55 662-664
    CrossrefPubMedGoogle Scholar
  • 30 Nakagawa S, Cuthill IC. Effect size, confidence interval and statistical significance: a practical guide for biologists.  Biol Rev Camb Philos Soc. 2007;  82 591-605
    PubMedGoogle Scholar
  • 31 Nallegowda M, Singh U, Bhan S, Wadhwa S, Handa G, Dwivedi SN. Balance and gait in total hip replacement: a pilot study.  Am J Phys Med Rehabil. 2003;  82 669-677
    CrossrefPubMedGoogle Scholar
  • 32 Nilsdotter AK, Roos EM, Westerlund JP, Roos HP, Lohmander LS. Comparative responsiveness of measures of pain and function after total hip replacement.  Arthritis Rheum. 2001;  45 258-262
    CrossrefPubMedGoogle Scholar
  • 33 Pincivero D, Lephart S, Henry T. Learning effects and reliability of the Biodex Stability System.  J Athl Train. 1995;  30 S48
    PubMedGoogle Scholar
  • 34 Rooks DS, Huang J, Bierbaum BE, Bolus SA, Rubano J, Connolly CE, Alpert S, Iversen MD, Katz JN. Effect of preoperative exercise on measures of functional status in men and women undergoing total hip and knee arthroplasty.  Arthritis Rheum. 2006;  55 700-708
    CrossrefPubMedGoogle Scholar
  • 35 Schmitz R, Arnold B. Intertester and intratester reliability of a dynamic balance protocol using the Biodex Stability System.  J Sport Rehabil. 1998;  7 95-101
    PubMedGoogle Scholar
  • 36 Siggeirsdottir K, Olafsson O, Jonsson H, Iwarsson S, Gudnason V, Jonsson BY. Short hospital stay augmented with education and home-based rehabilitation improves function and quality of life after hip replacement: randomized study of 50 patients with 6 months of follow-up.  Acta Orthop. 2005;  76 555-562
    CrossrefPubMedGoogle Scholar
  • 37 Soderman P, Malchau H, Herberts P. Outcome of total hip replacement: a comparison of different measurement methods.  Clin Orthop. 2001;  163-172
    PubMedGoogle Scholar
  • 38 Stucki G, Meier D, Stucki S, Michel BA, Tyndall AG, Dick W, Theiler R. Evaluation einer deutschen Version des WOMAC (Western Ontario und McMaster Universities) Arthroseindex.  Z Rheumatol. 1996;  55 40-49
    PubMedGoogle Scholar
  • 39 van Baar ME, Dekker J, Oostendorp RA, Bijl D, Voorn TB, Lemmens JA, Bijlsma JW. The effectiveness of exercise therapy in patients with osteoarthritis of the hip or knee: a randomized clinical trial.  J Rheumatol. 1998;  25 2432-2439
    PubMedGoogle Scholar
  • 40 Wang AW, Gilbey HJ, Ackland TR. Perioperative exercise programs improve early return of ambulatory function after total hip arthroplasty: a randomized, controlled trial.  Am J Phys Med Rehabil. 2002;  81 801-806
    CrossrefPubMedGoogle Scholar
  • 41 Weineck J. Sportbiologie. Balingen: Spitta Verlag GmbH; 2000
    Google Scholar
  • 42 Weitbrecht WU, Rice C, Schafer W. Phantomsensationen und peripher induzierter Neglect nach Hufttotalendoprothese.  Fortschr Neurol Psychiatr. 2004;  72 93-97
    Article in Thieme ConnectPubMedGoogle Scholar

Correspondence

Dr. Judith M. SiebenPhD 

Department of Anatomy &

Embryology

Maastricht University

P.O. Box 616

6200 MD Maastricht

The Netherlands

Phone: +31/433/88 1056

Fax: +31/433/88 4134

Email: j.sieben@maastrichtuniversity.nl

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