Pragmatic Home-Based Exercise after Total Hip Arthroplasty - Silkeborg: Protocol for a prospective cohort study (PHETHAS-1)

Abstract

Introduction: Rehabilitation exercises are offered to patients after total hip arthroplasty (THA); however, the effectiveness and optimal type and dose of exercise remains unknown. The primary objective of this trial is to indicate the preliminary efficacy of home-based rehabilitation using elastic band exercise on performance-based function after THA, based on the relationship between the performed exercise dose and the change in performance-based function (gait speed) from 3 (start of intervention) to 10 weeks (end of intervention) after surgery. The secondary objective is to investigate if a dose-response relationship exists between the performed exercise dose and changes in: hip-related disability, lower-extremity functional performance, and hip muscle strength Methods: In this prospective cohort study, patients scheduled for THA will be consecutively included until 88 have completed the intervention period from 3 to 10 weeks postoperatively. Participants perform the standard rehabilitation program with elastic band exercises. Exercise dose (exposure) will be objectively quantified using a sensor attached to the elastic band. The primary outcome is gait speed measured by the 40-m fast-paced walk test. Secondary outcomes include: patient reported hip disability (Hip disability and Osteoarthritis Outcome Score (HOOS)), hip muscle strength (hand-held dynamometry) and lower extremity function (30-s chair stand test). Discussion: This trial will add knowledge concerning the relationship between performed exercise dose and post-operative outcomes after THA. The protocol paper describes the study design and methods in detail, including the statistical analysis plan. Trial registration: Pre-registered on March 27, 2017 at ClinicalTrails.gov (ID: NCT03109821).

Patient Perspectives on Home-Based Rehabilitation Exercise and General Physical Activity after Total Hip Arthroplasty: A qualitative study (PHETHAS-2)

“…The study was part of the trial: Pragmatic Home-based Exercise after Total Hip Arthroplasty -Silkeborg (PHETHAS-1), which investigated the preliminary efficacy of home-based rehabilitation using elastic band exercise on performance-based function after THA. 11 The results from PHETHAS-1, as well as the current qualitative study PHETHAS-2, will be used to inform a future large-scale trial on the effectiveness of rehabilitation exercise following THA compared to general physical activity.…”

“…The details of this HBRE have been published previously. 11 The different pathways for the P and the S group are illustrated in table 2. Table 2.…”

Patient perspectives on home-based rehabilitation exercise and general physical activity after total hip arthroplasty: A qualitative study (PHETHAS-2)

“…The strengthening exercises were hip abduction, hip flexion and hip extension with elastic band resistance plus sit-to-stand exercise. Details of this home-based rehabilitation exercise have previously been published, 12 see Figure 1 for an overview.…”

“…The PHETHAS studies were founded to support and optimize clinical pathways with patients rehabilitating at home after THA. PHETHAS-1 (ClinicalTrials.gov NCT03109821, April 12, 2017) quantitatively investigates the physical outcomes of performing a home-based rehabilitation exercise program, 12 while this study, PHETHAS-2, qualitatively investigates how patients perceive home-based rehabilitation exercise and general physical activity after THA, focusing on facilitators and barriers.…”

Measures of Physical Performance

“…Since 2013 (when the minimum core set of OARSI performance‐based tests for people with hip and/or knee OA recommended the use of the 40 m FPWT) (11), this test has been included as either a primary or secondary outcome in a number of clinical trials (15‐32) (Table 1).…”