Does reduced movement restrictions and use of assistive devices affect rehabilitation outcome after total hip replacement? A non-randomized, controlled study.
Does reduced movement restrictions and use of assistive devices affect rehabilitation outcome after total hip replacement? A non-randomized, controlled study.
复制标题
减少运动限制和使用辅助装置是否会影响全髋关节置换术后的康复结果？
DOI：
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复制
发表时间：
2014
影响因子：
4.5
通讯作者：
I. Mechlenburg
中科院分区：
文献类型：
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作者：
L. Mikkelsen;Petersen Mk;K. Søballe;Søren Mikkelsen;I. Mechlenburg
背景
手术技术的改进和股骨头大小的增加可能改变了全髋关节置换术(THR)后限制活动的理由。
目标
目的：评价快速通道人工全髋关节置换术后患者的运动限制和辅助装置对康复的影响。
设计
非随机对照研究。
设置
住院病人。
人口
连续纳入365例THR患者。
方法
研究最初3个月的患者接受了髋关节活动受限的康复治疗和标准的辅助装置包(限制组)。将这组患者与以下3个月的患者进行比较，这些患者髋关节活动受限较少，并根据个人需要使用辅助设备(非限制性组)。分别于手术前、手术后3周和6周进行功能、疼痛、生活质量(HOOS)、焦虑(HADS)、工作状态和患者满意度问卷调查。
结果
3个测量时间的HOOS功能评分为(Mean±SD)，非受限组为46±17~76±9~83±14，受限组为43±16~81±14~83±13，随时间变化受限组显著高于受限组(P=0.004)。术后6周，非限制性组重返工作岗位的比例为53%，限制性组为32%(P=0.045)。两组在疼痛、症状、生活质量、焦虑/抑郁、髋关节脱位和患者满意度方面没有显著差异。
结论
这项研究显示，在减少行动限制和使用辅助设备后，患者报告的功能恢复略慢，但这种差异在6周后消失。减少行动限制并不影响其他患者报告的结果，并导致更早恢复工作。
临床康复的影响
有可能大大减少行动限制和辅助设备的使用。要阐明无限制康复对髋关节脱位的影响还需要更多的安全问题研究。
BACKGROUND
Improvements in surgical techniques and increase of femoral head size might have changed the rationale for movement restrictions after total hip replacement (THR).
AIM
To evaluate the influence of movement restrictions and assistive devices on rehabilitation after fast track THR.
DESIGN
Non-randomized, controlled study.
SETTING
Inpatient.
POPULATION
365 consecutively included THR patients.
METHODS
Patients included the 3 initial month of the study underwent rehabilitation with restrictions in hip movement and a standard package of assistive devices (restricted group). This group was compared to patients included the following 3 months with less restricted hip movement and use of assistive devices according to individual needs (unrestricted group). Questionnaires on function, pain, quality of life (HOOS), anxiety (HADS), working status and patient satisfaction were completed before THR, 3 and 6 weeks after.
RESULTS
The HOOS function score at the 3 measurement times was (mean ± SD); unrestricted group: 46 ± 17 - 76 ± 9 - 83 ± 14 compared to restricted group: 43 ± 16 - 81 ± 14 - 83 ± 13. Changes over time was significantly higher in the restricted group (P=0.004). Return to work 6 weeks after THR for the unrestricted group compared to restricted group was: 53% versus 32% (P=0.045). No significant differences between groups in pain, symptoms, quality of life, anxiety/depression, hip dislocations and patient satisfaction.
CONCLUSION
This study showed slightly slower recovery in patient-reported function after reduction in movement restrictions and use of assistive devices, but the difference was eliminated after 6 weeks. Reduced movement restrictions did not affect the other patient-reported outcomes and led to earlier return to work.
CLINICAL REHABILITATION IMPACT
It is possible to reduce movement restrictions and use of assistive devices considerably. More research on safety issues is needed to elucidate the effect of unrestricted rehabilitation on hip dislocation.