Daniel Belavy Profile picture
Apr 20, 2021 15 tweets 10 min read Read on X
Is #exercise before or after hip joint replacement better than usual care or minimal treatment?

#Metaanalysis in @JAMANetworkOpen @JAMA_current
dx.doi.org/10.1001/jamane…

Led by Tobias, Jochen and Max from @PhysioMeScience

🙏for #collaboration!

Thread
👇👇👇👇
#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
doi.org/10.2106/jbjs.1…
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 ✅

www5.aaos.org/uploadedFiles/…
But: a #metaanalysis in 2015 concluded minimal effect of pre-op rehab after hip OR knee arthroplasty.
doi.org/10.1136/bmjope…

🤔

So we took a 🧐 at the current evidence for hip arthroplasty
Methods
> #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!!

➡️...STANDING ON THE SHOULDERS OF GIANTS... ⬅️
Interested in a #phd or #postdoc in musculoskeletal health research in #Germany?

More details here
👇👇👇👇👇



@AcademicChatter
#AcademicTwitter #phdchat #phdlife #research

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More from @belavyprof

May 13, 2022
What causes back pain?🤔
Specifically: how much do nervous system, spine tissue and psychosocial contribute to #backpain?

#systematicreview with multivariate #metaanalysis in European J Pain @EFIC_org

doi.org/10.1002/ejp.18…

Led by @ScottTags 🙏collaborators

Thread
👇 Image
Low #backpain is leading cause of disability worldwide… 90-95% of cases are considered 'non-specific'

Many factors can contribute

Image 👇from doi.org/10.2147/jpr.s1… @chadcookpt

But which ones and how much? Image
Individual meta-analyses + factors associated with back pain
➡️ pain processing doi.org/10.1097/j.pain…
➡️ disc degeneration doi.org/10.3174/ajnr.A…
➡️ muscle atrophy doi.org/10.2522/ptj.20…
➡️ depression / distress doi.org/10.1093/fampra…

But is one more important than other?
Read 13 tweets
Apr 9, 2021
Can #exercise “strengthen” the intervertebral disc?

A brief history of research from 2013 to 2020:

Review: dx.doi.org/10.1007/s40279…
Cross-section: dx.doi.org/10.1038/srep45…
RCT: dx.doi.org/10.1007/s00586…

🙏 collaborators

Thread 👇 👇 👇 👇
#backpain
First, we did a review of the literature (narrative, not a #systematicreview. This was back in my pre-systematic review days!) dx.doi.org/10.1007/s40279… in @SportsMedicineJ

🙏 @DieenJaap, Kirsten Albracht, Prof. Brüggemann, Dr. Vergroesen
It has been well established that exercise and loading can impact IVD height. E.g. doi.org/10.1097/000076… doi.org/10.1249/mss.0b…

So, exercise and movement protocols can at least ‘influence’ the IVD
Read 20 tweets

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