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

-pre-op advice only
-post-op inpatient ex ✅, outpatient self-directed exercise only

-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

• • •

Missing some Tweet in this thread? You can try to force a refresh

Keep Current with Daniel Belavy

Daniel Belavy Profile picture

Stay in touch and get notified when new unrolls are available from this author!

Read all threads

This Thread may be Removed Anytime!


Twitter may remove this content at anytime! Save it as PDF for later use!

Try unrolling a thread yourself!

how to unroll video
  1. Follow @ThreadReaderApp to mention us!

  2. From a Twitter thread mention us with a keyword "unroll"
@threadreaderapp unroll

Practice here first or read more on our help page!

More from @BelavySpine

9 Apr
Can #exercise “strengthen” the intervertebral disc?

A brief history of research from 2013 to 2020:


🙏 collaborators

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

🙏 @DieenJaap, Kirsten Albracht, Prof. Brüggemann, Dr. Vergroesen
It has been well established that exercise and loading can impact IVD height. E.g.……

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

Did Thread Reader help you today?

Support us! We are indie developers!

This site is made by just two indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3/month or $30/year) and get exclusive features!

Become Premium

Too expensive? Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal Become our Patreon

Thank you for your support!

Follow Us on Twitter!