Supervised or unsupervised rehabilitation after total hip replacement provides similar improvements for patients: a randomised controlled trial

Publication date: Available online 12 May 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Corinne Coulter, Diana M. Perriman, Teresa M. Neeman, Paul N. Smith, Jennifer M. Scarvell
ObjectiveTo determine do patients do better with unsupervised home PT or in an outpatient setting Are the outcomes after a supervised (centre-based) and an independent (home-based) physical rehabilitation program delivered in the early post-discharge phase (<8weeks) equivalent in an adult THR population.SettingAcute care public hospital in the region, supporting a population of almost 540,000.DesignSingle blinded randomised controlled trial.ParticipantsAdult patients (n=98) after unilateral elective total hip replacement (THR) were randomly assigned to supervised/centre-based exercise (n=56) or unsupervised/home exercise (n=42) and followed 6 months post-surgery.InterventionThe supervised group attended a 4 week outpatient rehabilitation program supervised by a physiotherapist. The unsupervised group was given written and pictorial instructions to perform rehabilitation independently at home.Outcome measuresThe WOMAC, SF-36 mental and physical component scores(MCS and PCS) questionnaires, the UCLA activity rating and the Timed up and Go test (TUG).ResultsThere were no differences between groups for any measure. Overall differences between the adjusted means were: WOMAC 0.5 [-6.75, 5.73], SF-36 PCS 0.8 [-6.5 - 8.1], SF-36 MCS 1.7 [-4.1 - 7.4], UCLA 0.3 [5.19, 6.10] and TUG 0 secs [-1.4 - 1.3].ConclusionResults demonstrated that outcomes in response to rehabilitation after THR are clinically and statistically similar whether the program was supervised or not. The results suggest that early rehabilitation programs can be effectively delivered unsupervised in the home to low-risk patients discharged home after THR. However, the relative effect of late stage rehabilitation was not tested.



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