Improving Rehabilitation Outcomes After Total Hip Arthroplasty

改善全髋关节置换术后的康复效果

• 批准号: 10230982
• 负责人: Jennifer E. Stevens-Lapsley
• 金额: --
• 依托单位: VA EASTERN COLORADO HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-11-01 至 2021-10-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10230982
• 关键词: Activities of Daily Living; Athletic; Biological Markers; Biomechanics; Caring; Chronic; Clinical; Degenerative polyarthritis; Elderly; Equilibrium; Failure; Financial compensation; Gait; Goals; High Prevalence; Hip Joint; Hip Osteoarthritis; Hip region structure; Intervention; Investigation; Limb structure; Measures; Movement; Muscle; Muscle function; Operative Surgical Procedures; Orthopedic Surgery; Outcome; Pain; Participant; Patient Self-Report; Patients; Pelvis; Performance; Physical Function; Population; Postoperative Period; Quality of life; Randomized Controlled Trials; Recovery; Recovery of Function; Rehabilitation Outcome; Rehabilitation therapy; Reporting; Standardization; Surveys; Techniques; Testing; Time; United States; Veterans; Walking; Western Ontario and McMaster Universities Arthritis Index; anterior cruciate ligament reconstruction; base; disability; functional decline; group intervention; health related quality of life; hip replacement arthroplasty; improved; improved functioning; indexing; innovation; meter; muscle strength; physical conditioning; primary endpoint; primary outcome; programs; recruit; rehabilitation paradigm; rehabilitation strategy; rehabilitative care; stem; treatment as usual

Currently, over 230,000 total hip arthroplasties (THA) are performed each year in the United States to alleviate pain and disability associated with osteoarthritis (OA). However, full recovery of muscle strength and function after hip arthroplasty remains a major challenge. A major factor influencing full recovery of physical function is the presence of chronic movement compensations, which may be the biggest rehabilitative challenge after THA. These movement compensations reflect failure to fully remediate strength losses resulting from hip OA and THA as well as a failure to integrate muscle strength gains into functional movement. Functional strength integration during performance of functional tasks refers to the ability of the body to produce stable, coordinated movements. Around the hip joint, optimal functional strength integration is largely dependent on the ability of hip abductor muscles to produce hip abduction moments, which stabilize the pelvis during unilateral stance tasks. Thus, inability to integrate hip abductor strength during functional tasks leads to lower hip abduction moments during functional tasks, resulting in poor pelvic stability and movement compensations. This lack of functional strength integration possibly explains lingering deficits in functional recovery after THA. However, current rehabilitation practices do not target the integration of strength and functional movement to resolve movement compensations for improved physical function. A rehabilitation program emphasizing functional strength integration after THA has the potential to substantially improve postoperative physical function by improving movement compensations with greater hip abductor strength and recruitment during function, providing greater pelvic control and movement quality. Therefore, the proposed investigation involves a randomized controlled trial to determine if an 8-week functional strength integration (FSI) program improves physical function and muscle performance more than control intervention (CON) in Veterans undergoing unilateral THA. The secondary goal is to determine if FSI improves movement compensations during functional activity (walking and stair climbing). Functional and biomechanical outcomes will be assessed pre-operatively (PRE) and at three postoperative time points: intervention mid-point, 4 weeks (POST1), intervention end-point, 8 weeks (POST2) (primary endpoint) and late recovery, 26 weeks (POST3).

Currently, over 230,000 total hip arthroplasties (THA) are performed each year in the United States to alleviate pain and disability associated with osteoarthritis (OA). However, full recovery of muscle strength and function after hip arthroplasty remains a major challenge. A major factor influencing full recovery of physical function is the presence of chronic movement compensations, which may be the biggest rehabilitative challenge after THA. These movement compensations reflect failure to fully remediate strength losses resulting from hip OA and THA as well as a failure to integrate muscle strength gains into functional movement. Functional strength integration during performance of functional tasks refers to the ability of the body to produce stable, coordinated movements. Around the hip joint, optimal functional strength integration is largely dependent on the ability of hip abductor muscles to produce hip abduction moments, which stabilize the pelvis during unilateral stance tasks. Thus, inability to integrate hip abductor strength during functional tasks leads to lower hip abduction moments during functional tasks, resulting in poor pelvic stability and movement compensations. This lack of functional strength integration possibly explains lingering deficits in functional recovery after THA. However, current rehabilitation practices do not target the integration of strength and functional movement to resolve movement compensations for improved physical function. A rehabilitation program emphasizing functional strength integration after THA has the potential to substantially improve postoperative physical function by improving movement compensations with greater hip abductor strength and recruitment during function, providing greater pelvic control and movement quality. Therefore, the proposed investigation involves a randomized controlled trial to determine if an 8-week functional strength integration (FSI) program improves physical function and muscle performance more than control intervention (CON) in Veterans undergoing unilateral THA. The secondary goal is to determine if FSI improves movement compensations during functional activity (walking and stair climbing). Functional and biomechanical outcomes will be assessed pre-operatively (PRE) and at three postoperative time points: intervention mid-point, 4 weeks (POST1), intervention end-point, 8 weeks (POST2) (primary endpoint) and late recovery, 26 weeks (POST3).

项目成果

Incorporating Specific Functional Strength Integration Techniques to Improve Functional Performance for Veterans After Total Hip Arthroplasty: Protocol for a Randomized Clinical Trial.

结合特定的功能力量整合技术来提高退伍军人全髋关节置换术后的功能表现：随机临床试验方案。

• DOI: 10.1093/ptj/pzz109
• 发表时间: 2019
• 期刊: Physical therapy
• 影响因子: 3.2
• 作者: Judd,DanaL;Cheuy,VictorA;Forster,JeriE;Christiansen,CoryL;Stevens-Lapsley,JenniferE
• 通讯作者: Stevens-Lapsley,JenniferE