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Published in: BMC Musculoskeletal Disorders 1/2015

Open Access 01-12-2015 | Research article

Agreements and disagreements in exercise therapy prescriptions after hip replacement among rehabilitation professionals: a multicenter survey

Authors: Christine Eulenburg, Anna-Lina Rahlf, Andrej Kutasow, Astrid Zech

Published in: BMC Musculoskeletal Disorders | Issue 1/2015

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Abstract

Background

Exercise therapy following total hip replacement (THR) is considered to be important during the initial postoperative care, but till date only a few evidence-based recommendations exist. The aim of this survey was to identify prescription standards among different rehabilitation professionals, for the exercise therapy management after THR in Germany.

Methods

The study was a cross-sectional survey. Standardized questionnaires were sent to 38 eligible rehabilitation facilities in Germany. Participating surgeons, orthopaedic physicians, physiotherapists and exercise therapists rated the optimal early weight-bearing, resistance training, key components and dose of exercise therapy, and the hip loading during exercising. The returned questionnaires were then analyzed for level of agreement (≥80 %) among respondents.

Results

313 rehabilitation professionals from 28 clinics returned completed questionnaires and were considered eligible for analysis. Out of total respondents, 53.9 % (cemented THR) and 18.2 % (uncemented THR) recommended full weight-bearing within five days after surgery. Commencement of resistance training later than three weeks after surgery is recommended by 20.6 % (36 %) for cemented (uncemented) prosthesis. Feedback varied significantly amongst the professions. Regarding the overall objectives of rehabilitation after hip replacement, respondents agree in six out of eight requested items. Agreement concerning priorities of specific exercises was achieved in three out of twelve items. The recommended exercise therapy dose varied significantly with working experience (p = 0.02).

Conclusion

Rehabilitation professionals mainly disagreed with the exercise therapy prescriptions following the total hip replacement during the initial postoperative care in Germany.
Appendix
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Literature
1.
go back to reference Waddell J, Johnson K, Hein W, Raabe J, FitzGerald G, Turibio F. Orthopaedic practice in total hip arthroplasty and total knee arthroplasty: results from the Global Orthopaedic Registry (GLORY). Am J Orthop (Belle Mead NJ). 2010;39:5–13. Waddell J, Johnson K, Hein W, Raabe J, FitzGerald G, Turibio F. Orthopaedic practice in total hip arthroplasty and total knee arthroplasty: results from the Global Orthopaedic Registry (GLORY). Am J Orthop (Belle Mead NJ). 2010;39:5–13.
3.
go back to reference Mariconda M, Galasso O, Costa GG, Recano P, Cerbasi S. Quality of life and functionality after total hip arthroplasty: a long-term follow-up study. BMC Musculoskelet Disord. 2011;12:222.CrossRefPubMedPubMedCentral Mariconda M, Galasso O, Costa GG, Recano P, Cerbasi S. Quality of life and functionality after total hip arthroplasty: a long-term follow-up study. BMC Musculoskelet Disord. 2011;12:222.CrossRefPubMedPubMedCentral
4.
go back to reference Robert Koch-Institut. Die 50 häufigsten Operationen der vollstationären Patientinnen und Patienten in Krankenhäusern (Rang, Anzahl, Anteil in Prozent). 2012. 8-4-2014. Ref Type: Report. Robert Koch-Institut. Die 50 häufigsten Operationen der vollstationären Patientinnen und Patienten in Krankenhäusern (Rang, Anzahl, Anteil in Prozent). 2012. 8-4-2014. Ref Type: Report.
5.
go back to reference Sicard-Rosenbaum L, Light KE, Behrman AL. Gait, lower extremity strength, and self-assessed mobility after hip arthroplasty. J Gerontol A Biol Sci Med Sci. 2002;57:M47–51.CrossRefPubMed Sicard-Rosenbaum L, Light KE, Behrman AL. Gait, lower extremity strength, and self-assessed mobility after hip arthroplasty. J Gerontol A Biol Sci Med Sci. 2002;57:M47–51.CrossRefPubMed
6.
go back to reference Judd DL, Dennis DA, Thomas AC, Wolfe P, Dayton MR, Stevens-Lapsley JE. Muscle strength and functional recovery during the first year after THA. Clin Orthop Relat Res. 2014;472:654–64.CrossRefPubMed Judd DL, Dennis DA, Thomas AC, Wolfe P, Dayton MR, Stevens-Lapsley JE. Muscle strength and functional recovery during the first year after THA. Clin Orthop Relat Res. 2014;472:654–64.CrossRefPubMed
7.
go back to reference Minns Lowe CJ, Barker KL, Dewey ME, Sackley CM. Effectiveness of physiotherapy exercise following hip arthroplasty for osteoarthritis: a systematic review of clinical trials. BMC Musculoskelet Disord. 2009;10:98.CrossRefPubMedPubMedCentral Minns Lowe CJ, Barker KL, Dewey ME, Sackley CM. Effectiveness of physiotherapy exercise following hip arthroplasty for osteoarthritis: a systematic review of clinical trials. BMC Musculoskelet Disord. 2009;10:98.CrossRefPubMedPubMedCentral
8.
go back to reference Westby MD, Carr S, Kennedy DM, Brander V, Bell M, Doyle-Waters M. Post-acute physiotherapy for primary total hip arthroplasty: a cochrane systematic review. Arthritis Rheum. 2009;60:424–5. Westby MD, Carr S, Kennedy DM, Brander V, Bell M, Doyle-Waters M. Post-acute physiotherapy for primary total hip arthroplasty: a cochrane systematic review. Arthritis Rheum. 2009;60:424–5.
9.
go back to reference Gilbey HJ, Ackland TR, Wang AW, Morton AR, Trouchet T, Tapper J. Exercise improves early functional recovery after total hip arthroplasty. Clin Orthop Relat Res 2003;408:193–200. Gilbey HJ, Ackland TR, Wang AW, Morton AR, Trouchet T, Tapper J. Exercise improves early functional recovery after total hip arthroplasty. Clin Orthop Relat Res 2003;408:193–200.
10.
go back to reference Coudeyre E, Jardin C, Givron P, Ribinik P, Revel M, Rannou F. Could preoperative rehabilitation modify postoperative outcomes after total hip and knee arthroplasty? Elaboration of French clinical practice guidelines. Ann Readapt Med Phys. 2007;50:189–97.CrossRefPubMed Coudeyre E, Jardin C, Givron P, Ribinik P, Revel M, Rannou F. Could preoperative rehabilitation modify postoperative outcomes after total hip and knee arthroplasty? Elaboration of French clinical practice guidelines. Ann Readapt Med Phys. 2007;50:189–97.CrossRefPubMed
11.
go back to reference Okoro T, Ramavath A, Howarth J, Jenkinson J, Maddison P, Andrew JG, et al. What does standard rehabilitation practice after total hip replacement in the UK entail? Results of a mixed methods study. BMC Musculoskelet Disord. 2013;14:91.CrossRefPubMedPubMedCentral Okoro T, Ramavath A, Howarth J, Jenkinson J, Maddison P, Andrew JG, et al. What does standard rehabilitation practice after total hip replacement in the UK entail? Results of a mixed methods study. BMC Musculoskelet Disord. 2013;14:91.CrossRefPubMedPubMedCentral
12.
go back to reference Di Monaco M, Vallero F, Tappero R, Cavanna A. Rehabilitation after total hip arthroplasty: a systematic review of controlled trials on physical exercise programs. Eur J Phys Rehabil Med. 2009;45:303–17.PubMed Di Monaco M, Vallero F, Tappero R, Cavanna A. Rehabilitation after total hip arthroplasty: a systematic review of controlled trials on physical exercise programs. Eur J Phys Rehabil Med. 2009;45:303–17.PubMed
13.
go back to reference Spieser A, Mittag O, Bruggemann S, Jackel WH. Acceptance and practicability of the rehab therapy standards for rehabilitation after total hip and knee arthroplasty - findings of a user survey of the pilot version. Rehabilitation (Stuttg). 2012;51:229–36.CrossRef Spieser A, Mittag O, Bruggemann S, Jackel WH. Acceptance and practicability of the rehab therapy standards for rehabilitation after total hip and knee arthroplasty - findings of a user survey of the pilot version. Rehabilitation (Stuttg). 2012;51:229–36.CrossRef
14.
go back to reference Peter WF, Nelissen RG, Vliet Vlieland TP. Guideline recommendations for post-acute postoperative physiotherapy in total hip and knee arthroplasty: are they used in daily clinical practice? Musculoskeletal Care. 2014;12(3):125–31.CrossRefPubMed Peter WF, Nelissen RG, Vliet Vlieland TP. Guideline recommendations for post-acute postoperative physiotherapy in total hip and knee arthroplasty: are they used in daily clinical practice? Musculoskeletal Care. 2014;12(3):125–31.CrossRefPubMed
15.
go back to reference Bandholm T, Kehlet H. Physiotherapy exercise after fast-track total hip and knee arthroplasty: time for reconsideration? Arch Phys Med Rehabil. 2012;93:1292–4.CrossRefPubMed Bandholm T, Kehlet H. Physiotherapy exercise after fast-track total hip and knee arthroplasty: time for reconsideration? Arch Phys Med Rehabil. 2012;93:1292–4.CrossRefPubMed
16.
go back to reference Westby M, Brittain A, Backman C. Expert consensus on best practices for post-acute rehabilitation after total hip and knee arthroplasty: a Canada and United States Delphi study. Arthritis Care Res (Hoboken). 2014;66:411–23.CrossRef Westby M, Brittain A, Backman C. Expert consensus on best practices for post-acute rehabilitation after total hip and knee arthroplasty: a Canada and United States Delphi study. Arthritis Care Res (Hoboken). 2014;66:411–23.CrossRef
18.
go back to reference Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc. 1982;14:377–81.PubMed Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc. 1982;14:377–81.PubMed
19.
go back to reference Marx RG, Jones EC, Angel M, Wickiewicz TL, Warren RF. Beliefs and attitudes of members of the American Academy of Orthopaedic Surgeons regarding the treatment of anterior cruciate ligament injury. Arthroscopy. 2003;19:762–70.CrossRefPubMed Marx RG, Jones EC, Angel M, Wickiewicz TL, Warren RF. Beliefs and attitudes of members of the American Academy of Orthopaedic Surgeons regarding the treatment of anterior cruciate ligament injury. Arthroscopy. 2003;19:762–70.CrossRefPubMed
20.
go back to reference Wright JG, Coyte P, Hawker G, Bombardier C, Cooke D, Heck D, et al. Variation in orthopedic surgeons’ perceptions of the indications for and outcomes of knee replacement. CMAJ. 1995;152:687–97.PubMedPubMedCentral Wright JG, Coyte P, Hawker G, Bombardier C, Cooke D, Heck D, et al. Variation in orthopedic surgeons’ perceptions of the indications for and outcomes of knee replacement. CMAJ. 1995;152:687–97.PubMedPubMedCentral
21.
go back to reference Mamlin LA, Melfi CA, Parchman ML, Gutierrez B, Allen DI, Katz BP, et al. Management of osteoarthritis of the knee by primary care physicians. Arch Fam Med. 1998;7:563–7.CrossRefPubMed Mamlin LA, Melfi CA, Parchman ML, Gutierrez B, Allen DI, Katz BP, et al. Management of osteoarthritis of the knee by primary care physicians. Arch Fam Med. 1998;7:563–7.CrossRefPubMed
22.
go back to reference IBM Corp. IBM SPSS Statistics for Windows. [21.0]. Armonk, NY: IBM Corp; 2012. Ref Type: Computer Program. IBM Corp. IBM SPSS Statistics for Windows. [21.0]. Armonk, NY: IBM Corp; 2012. Ref Type: Computer Program.
23.
go back to reference Kishida Y, Sugano N, Sakai T, Nishii T, Haraguchi K, Ohzono K, et al. Full weight-bearing after cementless total hip arthroplasty. Int Orthop. 2001;25:25–8.CrossRefPubMedPubMedCentral Kishida Y, Sugano N, Sakai T, Nishii T, Haraguchi K, Ohzono K, et al. Full weight-bearing after cementless total hip arthroplasty. Int Orthop. 2001;25:25–8.CrossRefPubMedPubMedCentral
24.
go back to reference Markmiller M, Weiss T, Kreuz P, Ruter A, Konrad G. Partial weightbearing is not necessary after cementless total hip arthroplasty: a two-year prospective randomized study on 100 patients. Int Orthop. 2011;35:1139–43.CrossRefPubMed Markmiller M, Weiss T, Kreuz P, Ruter A, Konrad G. Partial weightbearing is not necessary after cementless total hip arthroplasty: a two-year prospective randomized study on 100 patients. Int Orthop. 2011;35:1139–43.CrossRefPubMed
25.
go back to reference Berger RA, Jacobs JJ, Meneghini RM, Della VC, Paprosky W, Rosenberg AG. Rapid rehabilitation and recovery with minimally invasive total hip arthroplasty. Clin Orthop Relat Res 2004;429:239–247. Berger RA, Jacobs JJ, Meneghini RM, Della VC, Paprosky W, Rosenberg AG. Rapid rehabilitation and recovery with minimally invasive total hip arthroplasty. Clin Orthop Relat Res 2004;429:239–247.
26.
go back to reference Hol AM, van Grinsven S, Lucas C, van Susante JL, van Loon CJ. Partial versus unrestricted weight bearing after an uncemented femoral stem in total hip arthroplasty: recommendation of a concise rehabilitation protocol from a systematic review of the literature. Arch Orthop Trauma Surg. 2010;130:547–55.CrossRefPubMed Hol AM, van Grinsven S, Lucas C, van Susante JL, van Loon CJ. Partial versus unrestricted weight bearing after an uncemented femoral stem in total hip arthroplasty: recommendation of a concise rehabilitation protocol from a systematic review of the literature. Arch Orthop Trauma Surg. 2010;130:547–55.CrossRefPubMed
27.
go back to reference Buehler KO, D’Lima DD, Petersilge WJ, Colwell CW, Jr., Walker RH. Late deep venous thrombosis and delayed weightbearing after total hip arthroplasty. Clin Orthop Relat Res. 1999;361:123–130. Buehler KO, D’Lima DD, Petersilge WJ, Colwell CW, Jr., Walker RH. Late deep venous thrombosis and delayed weightbearing after total hip arthroplasty. Clin Orthop Relat Res. 1999;361:123–130.
28.
go back to reference Radl R, Aigner C, Hungerford M, Pascher A, Windhager R. Proximal femoral bone loss and increased rate of fracture with a proximally hydroxyapatite-coated femoral component. J Bone Joint Surg Br. 2000;82:1151–5.CrossRefPubMed Radl R, Aigner C, Hungerford M, Pascher A, Windhager R. Proximal femoral bone loss and increased rate of fracture with a proximally hydroxyapatite-coated femoral component. J Bone Joint Surg Br. 2000;82:1151–5.CrossRefPubMed
29.
go back to reference Husby VS, Helgerud J, Bjorgen S, Husby OS, Benum P, Hoff J. Early postoperative maximal strength training improves work efficiency 6–12 months after osteoarthritis-induced total hip arthroplasty in patients younger than 60 years. Am J Phys Med Rehabil. 2010;89:304–14.CrossRefPubMed Husby VS, Helgerud J, Bjorgen S, Husby OS, Benum P, Hoff J. Early postoperative maximal strength training improves work efficiency 6–12 months after osteoarthritis-induced total hip arthroplasty in patients younger than 60 years. Am J Phys Med Rehabil. 2010;89:304–14.CrossRefPubMed
30.
go back to reference Hesse S, Werner C, Seibel H, von Frankenberg S, Kappel EM, Kirker S, et al. Treadmill training with partial body-weight support after total hip arthroplasty: a randomized controlled trial. Arch Phys Med Rehabil. 2003;84:1767–73.CrossRefPubMed Hesse S, Werner C, Seibel H, von Frankenberg S, Kappel EM, Kirker S, et al. Treadmill training with partial body-weight support after total hip arthroplasty: a randomized controlled trial. Arch Phys Med Rehabil. 2003;84:1767–73.CrossRefPubMed
31.
go back to reference Rahmann AE, Brauer SG, Nitz JC. A specific inpatient aquatic physiotherapy program improves strength after total hip or knee replacement surgery: a randomized controlled trial. Arch Phys Med Rehabil. 2009;90:745–55.CrossRefPubMed Rahmann AE, Brauer SG, Nitz JC. A specific inpatient aquatic physiotherapy program improves strength after total hip or knee replacement surgery: a randomized controlled trial. Arch Phys Med Rehabil. 2009;90:745–55.CrossRefPubMed
32.
go back to reference Suetta C, Magnusson SP, Rosted A, Aagaard P, Jakobsen AK, Larsen LH, et al. Resistance training in the early postoperative phase reduces hospitalization and leads to muscle hypertrophy in elderly hip surgery patients--a controlled, randomized study. J Am Geriatr Soc. 2004;52:2016–22.CrossRefPubMed Suetta C, Magnusson SP, Rosted A, Aagaard P, Jakobsen AK, Larsen LH, et al. Resistance training in the early postoperative phase reduces hospitalization and leads to muscle hypertrophy in elderly hip surgery patients--a controlled, randomized study. J Am Geriatr Soc. 2004;52:2016–22.CrossRefPubMed
33.
go back to reference Garber CE, Blissmer B, Deschenes MR, Franklin BA, Lamonte MJ, Lee IM, et al. American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc. 2011;43:1334–59.CrossRefPubMed Garber CE, Blissmer B, Deschenes MR, Franklin BA, Lamonte MJ, Lee IM, et al. American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc. 2011;43:1334–59.CrossRefPubMed
34.
go back to reference Scherr J, Wolfarth B, Christle JW, Pressler A, Wagenpfeil S, Halle M. Associations between Borg’s rating of perceived exertion and physiological measures of exercise intensity. Eur J Appl Physiol. 2013;113:147–55.CrossRefPubMed Scherr J, Wolfarth B, Christle JW, Pressler A, Wagenpfeil S, Halle M. Associations between Borg’s rating of perceived exertion and physiological measures of exercise intensity. Eur J Appl Physiol. 2013;113:147–55.CrossRefPubMed
35.
go back to reference Bergmann G, Deuretzbacher G, Heller M, Graichen F, Rohlmann A, Strauss J, et al. Hip contact forces and gait patterns from routine activities. J Biomech. 2001;34:859–71.CrossRefPubMed Bergmann G, Deuretzbacher G, Heller M, Graichen F, Rohlmann A, Strauss J, et al. Hip contact forces and gait patterns from routine activities. J Biomech. 2001;34:859–71.CrossRefPubMed
36.
go back to reference Schwachmeyer V, Damm P, Bender A, Dymke J, Graichen F, Bergmann G. In vivo hip joint loading during post-operative physiotherapeutic exercises. PLoS One. 2013;8:e77807.CrossRefPubMedPubMedCentral Schwachmeyer V, Damm P, Bender A, Dymke J, Graichen F, Bergmann G. In vivo hip joint loading during post-operative physiotherapeutic exercises. PLoS One. 2013;8:e77807.CrossRefPubMedPubMedCentral
37.
go back to reference Davy DT, Kotzar GM, Brown RH, Heiple KG, Goldberg VM, Heiple Jr KG, et al. Telemetric force measurements across the hip after total arthroplasty. J Bone Joint Surg Am. 1988;70:45–50.PubMed Davy DT, Kotzar GM, Brown RH, Heiple KG, Goldberg VM, Heiple Jr KG, et al. Telemetric force measurements across the hip after total arthroplasty. J Bone Joint Surg Am. 1988;70:45–50.PubMed
38.
go back to reference Hashimoto N, Ando M, Yayama T, Uchida K, Kobayashi S, Negoro K, et al. Dynamic analysis of the resultant force acting on the hip joint during level walking. Artif Organs. 2005;29:387–92.CrossRefPubMed Hashimoto N, Ando M, Yayama T, Uchida K, Kobayashi S, Negoro K, et al. Dynamic analysis of the resultant force acting on the hip joint during level walking. Artif Organs. 2005;29:387–92.CrossRefPubMed
39.
go back to reference Geissler A, Scheller-Kreinsen D, Quentin W. Do diagnosis-related groups appropriately explain variations in costs and length of stay of hip replacement? A comparative assessment of DRG systems across 10 European countries. Health Econ. 2012;21 Suppl 2:103–15.CrossRefPubMed Geissler A, Scheller-Kreinsen D, Quentin W. Do diagnosis-related groups appropriately explain variations in costs and length of stay of hip replacement? A comparative assessment of DRG systems across 10 European countries. Health Econ. 2012;21 Suppl 2:103–15.CrossRefPubMed
Metadata
Title
Agreements and disagreements in exercise therapy prescriptions after hip replacement among rehabilitation professionals: a multicenter survey
Authors
Christine Eulenburg
Anna-Lina Rahlf
Andrej Kutasow
Astrid Zech
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2015
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-015-0646-7

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