Clinical and cost-effectiveness of physiotherapy interventions following total hip replacement: a systematic review and meta-analysis

Abstract

To examine the reported clinical and cost-effectiveness of physiotherapy interventions following total hip replacement (THR). A systematic review was completed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). MEDLINE, CINAHL, AMED, Scopus, DARE, HTA, and NHS EED databases were searched for studies on clinical and cost-effectiveness of physiotherapy in adults with THR published up to March 2020. Studies meeting the inclusion criteria were identified and key data were extracted. Risk of bias was assessed using the Cochrane Risk of Bias Tool and a Consolidated Health Economic Evaluation Reporting Standards (CHEERS). Data were summarised and combined using random-effect meta-analysis. A total of 1263 studies related to the aim of the review were identified, from which 20 studies met the inclusion criteria and were included in the review. These studies were conducted in Australia ( n = 3), Brazil ( n = 1), United States of America (USA) ( n = 2), France ( n = 2), Italy ( n = 2), Germany ( n = 3), Ireland ( n = 1), Norway ( n = 2), Canada ( n = 1), Japan ( n = 1), Denmark ( n = 1), and United Kingdom (UK) ( n = 1). The duration of follow-up of the included studies was ranged from 2 weeks to 12 months. Physiotherapy interventions were found to be clinically effective for functional performance, hip muscle strength, pain, and range of motion flexion. From the National Health Service perspective, an accelerated physiotherapy programme following THR was cost-effective. The findings of the review suggest that physiotherapy interventions were clinically effective for people with THR. However, questions remain on the pooled cost-effectiveness of physiotherapy interventions, and further research is required to examine this in patients with THR. Future studies are required to examine the cost-effectiveness of these interventions from patients, caregivers, and societal perspectives. Registration Prospero (ID: CRD42018096524).

Mobile Robot-Based Gait Training after Total Hip Arthroplasty (THA) Improves Walking in Biomechanical Gait Analysis

“…While the benefits of physiotherapy after THA are generally acknowledged [ 1 ], and it frequently takes place in acute care clinics [ 17 , 18 ], there is a lack of consensus on the exact therapy program and only little evidence from controlled clinical trials, as a systematic review of the literature that appeared after 2008 [ 19 ] has shown. Other reviews and meta-analyses confirmed this view [ 19 , 20 , 21 ].…”

“…Regaining a mobility level post-surgery that comes close to the patients’ previous mobility as a baseline is the goal. It is commonly accepted that physiotherapy after THA has a positive impact on muscle strength, range of motion, pain, or gait which all impact patient mobility [ 1 ]. Physiotherapy starts shortly after operation, primarily as inpatient therapy in the hospital where surgery took place [ 2 , 3 ].…”

Incidence of postoperative complications and non- periprosthetic fractures after total hip arthroplasty: A more than 10-year follow-up retrospective cohort study

“…Therefore, surgeons and physical therapists should consider assessing the risk of falls and fallinduced fractures after THA, especially in patients aged 65 years, as well as improving muscle strength and functional performance. Recently, Fatoye et al 17 ) have shown that 2-12 weeks of physiotherapy interventions might lead to improvements in hip muscle strength and functional performance in patients after THA. In addition, several studies reported that 4-10 weeks of home-based exercises showed similar functional improvements to outpatient physiotherapy interventions 18,19) .…”

<p>Comparison of a Novel Muscle Training Device with Conventional Rehabilitation Training in Motor Dysfunction of Lower Limb Patients: A Pilot Study</p>

“…It is believed that intense functional exercises require two weeks following hip and knee replacement, which results in skeletal muscle weakness. 34 Recent studies have shown that early postoperative hip and knee joint exercises should be carried out with proper intensity. The muscle training device used in this study forced the muscles to move around the ankle joint by means of equipment exercise and gradually restored the muscle strength through the ankle flexion and dorsiflexion exercises.…”