Parameters of the Quality of Life of Women With Hip Arthroplasty in the Postpartum Period (Abdominal Delivery) as a Criterion for the Effectiveness of a Physical Therapy Program

Abstract

Abstract. Purpose: to determine the parameters of the quality of life of women with an endoprosthetic hip joint in the postpartum period as a criterion for the effectiveness of the physical therapy program.
 Methods. In the course of the study, 9 women aged 28.5±1.6 years were examined 1 month after childbirth, which took place by caesarean section. The developed program of physical therapy lasted 1 month (from the end of the first month after childbirth). In her process, therapeutic exercises for the trunk, upper and lower limbs were used; functional training to improve movements related to child care, Proprioceptive Neuromuscular Facilitation of lower limbs, back, trunk; massage of lower limbs, back. We took into account movement restrictions associated with an incompletely formed scar after cesarean section and with the presence of an endoprosthesis (excessive bending, rotation of the hip joint); accordingly, they created safe movement strategies related to child care (lifting, carrying) and transporting a baby carriage. Individual determination of short- and long-term goals of rehabilitation contributed to the improvement of psycho-emotional mood and increased compliance of women. The effectiveness of the tested program was evaluated using the standard SF-36 quality of life questionnaire («Medical outcomes study short form»).
 Results. During the initial examination, all women with hip arthroplasty in the postpartum period were found to have a deterioration in the quality of life according to the SF-36. Overloading of elements of the musculoskeletal system during pregnancy and changes in the biomechanics of a woman's body, which causes certain physical discomfort, is justified by hormonal and physical processes.During repeated testing, the effectiveness of the physical therapy program was confirmed by its positive impact on both scales - physical and mental functioning. The difference between the results of Physical health at the initial and repeated examination according to the Physical Functioning scale in the examined women was 41.9%, Role-Physical – 39.4%, Bodily Pain – 26.0%, General Health – 42.2%. Accordingly, for all subscales of Physical health, a statistically significant improvement in the condition of women was obtained compared to the initial parameters (р<0.05). The improvement of Mental health in comparison with the primary result on the Vitality scale in the examined women was 26.9%, Social Functioning - 60.3%, Role-Emotional - 32.5%; Mental Health - 49.9%. Therefore, a statistically significant improvement in the condition of women compared to the initial parameters was obtained for all subscales of Mental health (р<0.05).
 Conclusions. In women with an endoprosthetic hip joint in the postpartum period (abdominal delivery), a significant decrease in the physical and mental components of quality of life, determined by the SF-36 questionnaire, was found. The use of physical therapy (therapeutic exercises, functional training, massage taking into account the limitations of the abdominal wall scar and the functionality of the endoprosthesis) caused a statistically significant (p<0.05) improvement in the condition of the examined women in all subscales of SF-36 - physical and role functioning, pain intensity , general state of health, vitality, social functioning, influence of emotional state on role functioning; self-assessment of mental health.