Daniel Belavy Profile picture
Professor of Physiotherapy @hsgesundheit - University of Applied Sciences. Associate Editor @jospt and @BMJOpenSEM.

Apr 20, 2021, 15 tweets

Is #exercise before or after hip joint replacement better than usual care or minimal treatment?

#Metaanalysis in @JAMANetworkOpen @JAMA_current

Led by Tobias, Jochen and Max from @PhysioMeScience

🙏for #collaboration!


#osteoarthritis is one of the leading causes of #pain, #disability and healthcare resource usage worldwide.

Total hip replacements (THA below) done per year are expected to grow to ~600k per year by 2030

Some guidelines (both from 2020) recommend exercises with hip replacement

@NICEComms nice.org.uk/guidance/ng157
-pre-op advice only
-post-op inpatient ex ✅, outpatient self-directed exercise only

Dutch doi.org/10.1002/msc.14…
-pre-op ex ✅for specific patients
-post-op ✅

The American Academy of Orthopaedic Surgeons @AAOS1 @APTAtweets guidelines (2017) for hip replacement and exercise:
-pre-op exercise ✅
-post-op exercise ✅


But: a #metaanalysis in 2015 concluded minimal effect of pre-op rehab after hip OR knee arthroplasty.


So we took a 🧐 at the current evidence for hip arthroplasty

> #systematicreview and #metaanalysis
> four databases and ref. lists of relevant papers
> RCTs examining exercise before/after hip replacement
> Random-effects meta-analyses

➡️ 32 RCTs included

Findings: compared to minimal/no treatment…

> Pre-op exercise: no/minimal benefit for self-reported physical function (GRADE: very low) or stay in hospital

Findings for doing post-op exercise (compared to minimal/no treatment)

> no/minimal benefit for self-reported physical function
(GRADE: low-to-moderate depending on time-point)

What does this mean?
➡️ SUPERVISED pre/post-op rehabilitation exercise don't appear to impact patient outcomes after hip replacement
➡️ home exercise program (advice) similar effect to supervised therapy
➡️ guidelines should be reconsidered

As a #physiotherapist, this finding may be disappointing, but we have to reconsider practice on basis of evidence.

Things to consider:
➡️ no study outcomes with a low of risk of bias: is difficult to blind patients with self-report outcomes

➡️ evidence quality is low-to-moderate. Findings conclusions may change with more high-quality RCTs

Things to consider:
➡️ quality of exercise implementation (e.g. how often, how “well” was the exercise done) is something that we couldn’t examine

Paths forward for the future:
➡️subgroups that may be more likely to benefit (e.g. Dutch guidelines)

➡️#exercise volumes / frequency?

➡️ #ehealth as a way to engage patients?

🙏 to the researchers who performed all the RCTs

And of course 🙏 to all the people who took part in the studies!!


Interested in a #phd or #postdoc in musculoskeletal health research in #Germany?

More details here

#AcademicTwitter #phdchat #phdlife #research

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