Physical Functioning Comparable To Peers After Total Hip Replacement

Dr. Kristi Elisabeth Heiberg PhD Post.doc Department of Medical Research Baerum Hospital Vestre Viken Hospital TrustMedicalResearch.com Interview with:
Dr. Kristi Elisabeth Heiberg PhD Post.doc
Department of Medical Research
Baerum Hospital
Vestre Viken Hospital Trust

Medical Research: What is the background for this study?

Dr. Heiberg: This study is a long term follow-up of 60 patients who suffered from hip osteoarthritis and were treated with total hip arthroplasty (THA) approximately 5 years earlier. In a prior study, the patients participated in a RCT study, examining the effects of a supervised walking skill training program on physical functioning, pain and self-efficacy (1). The training program was performed between three and five months after surgery, and it was compared to a control group without supervised physiotherapy in the same time span. The results showed that immediately after the walking skill training intervention was completed, several outcome variables were statistically significant more improved in the training group than in the control group, and at one year after surgery the statistically significant effect on walking capacity (measured by the 6-min walk test) still sustained. Few long-term follow-up of RCTs regarding physical functioning in patients after total hip arthroplasty are previously published. Furthermore in another prior study, we examined the recovery of the total group of the same patients from preoperatively to one year after surgery (2). The results showed that the patients were statistically significant improved in all outcomes of physical functioning, pain and self-efficacy during the first year, but they still did not quite reach the level of healthy peers in walking capacity. In line with this, they also reported one year after surgery that they wanted to further improve their ability to walk and to participate in recreational activities (3). However, it seems that patients’ desires regarding physical activity are poorly understood and have received relatively little evaluation, although regular physical activity is considered to be one of the most important lifestyle behaviors affecting health. Only few prior studies have examined the long term recovery of physical functioning and the impact on physical activity.

Therefore, in this present 5-year follow-up study after total hip arthroplasty the aims were threefold.

  • First, to examine the long-term effect from the supervised walking skill training program on physical functioning, pain and self-efficacy;
  • Second, to examine the long-term recovery of physical functioning from one to five years; and
  • Third, to identify predictors of physical activity outcome five years after THA among personal and preoperative variables (4).

Medical Research:? What are the main findings?

Dr. Heiberg: Five years after total hip arthroplasty, the control group had caught up with and reached the level of the training group on outcomes of physical functioning, pain and self-efficacy, and the patients in both groups reported that they performed equal numbers of weekly training sessions. There were no adverse effects from the walking skill training program on pain and loosening of the prosthesis. In the total group from one to five years, there were no statistically significant differences in the outcome measures, except an increase in hip range of motion and a decline in stair climbing time that was statistically significant. Preoperative pain and function in sport (measured by the HOOS) could explain 26% of the variance in activity level, measured by the UCLA activity scale, five years after THA.

Medical Research: What should clinicians and patients take away from your report?

Dr. Heiberg: : This 5-year follow-up study showed that training in weight bearing walking activities is safe in the long term and can be recommended for clinical use. The study suggests that following total hip arthroplasty the patients may expect to recover approximately to the level of healthy peers in physical functioning and physical activity. Despite higher age and incidence of osteoarthritis in knees or contralateral hip, the outcomes in physical functioning from one year still sustained at five years, and the participants lead an active lifestyle. However, pain and impaired ability to participate in sport and recreational activities before surgery predict lower level of physical activity five years following THA, probably underpinning that lifestyle behaviors are difficult to change. This may have implications on the recommendations and therapy given before and after surgery, as well as on time for surgery.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Heiberg: In the future, I would recommend that measures of physical activity, both by questionnaire and by objective measure of physical activity, are included both in clinical practice and in research following total hip arthroplasty. Interventions focused mainly on physical activities that motivate the participants to adopt a more active lifestyle, rather than on exercises, could be a topic for further research.

Citation:

Arthritis Care Res (Hoboken). 2015 Aug 3. doi: 10.1002/acr.22679. [Epub ahead of print]

Physical functioning and prediction of physical activity after total hip arthroplasty. 5-year follow-up of a randomized controlled trial.

Heiberg KE1, Figved W2.

References:

  1. Heiberg KE, Bruun-Olsen V, Ekeland A, Mengshoel AM. Effect of a walking skill training program in patients who have undergone total hip arthroplasty: Followup one year after surgery. Arthritis Care Res (Hoboken). 2012;64(3):415-23.
  2. Heiberg KE, Ekeland A, Bruun-Olsen V, Mengshoel AM. Recovery and prediction of physical functioning outcomes during the first year after total hip arthroplasty. Arch Phys Med Rehabil. 2013;94(7):1352-9.
  3. Heiberg KE, Ekeland A, Mengshoel AM. Functional improvements desired by patients before and in the first year after total hip arthroplasty. BMC MusculoskeletDisord. 2013;14(1):243.
  4. Heiberg KE, Figved W. Physical functioning and prediction of physical activity after total hip arthroplasty. 5-year follow-up of a randomized controlled trial. Arthritis Care Res (Hoboken). 2015.

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Dr. Kristi Elisabeth Heiberg PhD (2015). Physical Functioning Comparable To Peers After Total Hip Replacement 

Last Updated on September 16, 2015 by Marie Benz MD FAAD