Critically Appraised Topic
The patients who led us to investigate this question are those we treated in the acute setting post-op, and then saw a few days later in an outpatient clinic. A number of these patients experienced a decrease in their overall function and they had many limitations due to pain. Some patients improved and returned to function much quicker than others, and our question explores whether pre-operative rehabilitation training can affect the functional recovery of patients post total hip arthroplasty.
Do pre-operative exercises and/or education for patients undergoing a total hip arthroplasty improve recovery rates, improve function and decrease pain more than post-operative rehabilitation alone?
Clinical Bottom Line
Based on the results of the outcomes from Ferrara et al., Gocen et al., and Vukomanovic et al., preoperative physical therapy and intervention does not improve recovery rates, decrease pain or improve function as compared to post-operative physical therapy alone, in patients undergoing a total hip arthroplasty. However, preoperative physical therapy and education may be beneficial in promoting quicker returns to function immediately post-operation.
All groups receiving preoperative physical therapy were able to return to functional activity much quicker than groups receiving post-operative therapy alone. However, there were no long term differences in terms of hip function. Only one study, Ferrara et al. resulted in a significant decrease in pain for patients with preoperative therapy as measured by the VAS, as compared to the control group. The other two articles did not show a difference in pain scores. Regardless of the outcomes of these studies, further research is required to answer the question of whether preoperative therapy is truly beneficial. All three articles had relatively different treatment protocols, thus further research can be conducted to show which treatment protocol would be most beneficial. Another question that could be further researched, is: how long preoperative physical therapy should be conducted, prior to the operation.
Huffsmith, Shawnae and Liu, Evan, "The Effect of Pre-operative Exercises, Education and Pain Control for Patients Undergoing a Total Hip Arthroplasty" (2014). PT Critically Appraised Topics. 55.