Background Whereas there is evidence for the effectiveness of postoperative physical therapy (PT), the delivery of preoperative PT in patients undergoing total hip (TH) or total knee (TK) replacement is not substantiated by the literature. Little is known on how many and which of these patients actually receive preoperative PT and if they do, what the characteristics of this treatment are.
Objectives To describe the extent and content of preoperative PT in TH and TK replacement surgery.
Methods In 4 Dutch hospitals a survey was sent by mail to 1005 consecutive patients who underwent TH or TK replacement surgery in the previous 6-21 months. Patients were asked if they received PT within 12 weeks before surgery, and if so, what its content, duration and frequency were. In addition, the survey comprised sociodemographic characteristics, BMI, co morbidity and an assessment of physical functioning (SF-36 Physical Component (PC) (score 0-100)). Comparisons between patients who did and did not receive PT and between TH and TK were made by means of Mann Whitney or Chi-square tests.
Results In total, 522 patients returned the survey (52%), 282 (54%) underwent TH and 240 (46%) TK surgery. 337 (65%) were women, the mean age was 70.0 years (SD 9.3) and mean postoperative SF-36 PC score 48.9 (SD 9.9) (all p-value TH versus TK >0.05). BMI was significantly higher in TK than in TH (29.8 (SD 4.6) versus 26.6 (SD 3.9)) and significantly more TK patients had co morbidities (TK 144/223, 65% and TH 134/267, 50%, p=0.004). 210 of the 522 patients (40%) had received PT within 3 months before surgery (118/282 (42%) in TH and 92/240 (38%) in TK). There were no differences in characteristics of patients receiving and not receiving PT, except for more females in patients receiving PT (148/210, 70%) than in non-receivers (189/312, 61%) (p=0.02). 65/210 (31%) were referred by the orthopedic surgeon, 66/210 (31%) by the general practitioner and 52/ 210 (25%) by self-referral (13% unknown). In TK, significantly more patients were referred by the orthopedic surgeon than in TH (40 versus 24%), P<0.001. The duration of PT was > 12 weeks in 88/198 (44%) patients and <12 weeks in 110/198 (56%) patients, and frequency of treatment was once a week in 129/208 (62%), twice a week in 76/208 (37%) patients (similar rates in TH and TK). Regarding the content of treatment the large majority received education about the operation and rehabilitation (193/210, 92%), with a large variety in content of provided education and other treatment modalities. In 90/210 (42.9%) patients passive ROM exercises were provided (similar rates in TH and TK). The delivery of active exercises was different between TH and TK (76/118, 64% versus 73/92, 79%) p=0.02).
Conclusions A considerable proportion of patients undergoing TH or TK replacement received preoperative PT, with significantly more women than men having this intervention. There was a large variety of education and PT treatment modalities being provided, with less patients with TH than with TK receiving active exercises. These results indicates that more research into the potential benefits for specific groups of patients undergoing TH or TK surgery and into effective treatment modalities is needed.
Disclosure of Interest None Declared
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