In persons who have been discharged from hospital after a total hip replacement, do rehabilitation exercises guided by a physiotherapist improve strength, gait, function and quality of life? Are these exercises as effective in an unsupervised home-based setting as they are in a supervised outpatient setting? A systematic review with meta-analysis of randomised trials of Adult patients after elective total hip replacement was conducted. Participants were given physiotherapist-directed rehabilitation exercises post discharge from hospital following total hip replacement. The outcome measures were hip and knee strength, gait parameters, functional measures, and quality of life. Five studies comprising 234 participants were included in the review. Sufficient data for meta-analysis were only obtained for hip and knee strength, gait speed and cadence. Physiotherapy rehabilitation improved hip abductor strength by a mean of 16Nm (95% CI 10 to 22), gait speed by 6 m/min (95% CI 1 to 11) and cadence by 20 steps/min (95% CI 8 to 32). Favourable but non-significant improvements in strength were noted for other muscle groups at the hip and knee. Meta-analysis could not be performed on function and quality of life due to a lack of data and heterogeneity of measures, but functional measures tended to favour the physiotherapy rehabilitation group. Most outcomes were similar between outpatient and home-based exercise programs.
It was concluded from the review that physiotherapy rehabilitation improves hip abductor strength, gait speed and cadence in people who have been discharged from hospital following total hip replacement. Physiotherapist-directed rehabilitation exercises appear to have a similar efficacy whether they are performed unsupervised at home or supervised by a physiotherapist in an outpatient setting.