Functional Movement Retraining after Hip Arthroplasty in Veterans: Pilot Study

描述（由申请人提供）： 全髋关节置换术（THA）后的康复范围有限，一些患者继续表现出功能限制，以及载荷不对称，使他们面临患对侧关节骨关节炎的风险。本研究的目的是收集初步数据，以支持一个更大的项目，将检查12届功能运动再训练（FMR）计划的有效性，为退伍军人THA。FMR计划的一个新方面是，它不仅关注改善整体功能，而且还通过患者特定的运动量身定制来规范平衡和力量方面的侧对侧不对称。该方案还涉及远程康复过程，以改善获得服务的机会。 参与者将是n = 15例计划在达勒姆VAMC接受THA的患者，从电子病历中识别。受试者将在术前完成评估，然后在THA术后约6周完成评估，此时FMR项目将开始。12个FMR课程最好每周两次，持续6周。然而，考虑到错过的访视，我们将允许总共9周的时间来完成12个疗程。因此，将在THA术后15周对所有受试者进行随访评估。FMR会议将结合以下内容：1.）亲自、现场访问和电话联系有执照的物理治疗师，以及2.）由远程医疗技术专家或物理治疗助理进行的家庭远程医疗访问。FMR计划将专注于改善下肢活动性，肌肉稳定性和功能性运动模式。参加者将被指示每天进行一系列伸展运动，每周进行三次强化运动。将根据下四分之一Y平衡测试（在基线和程序中途进行）的结果为每位患者量身定制练习，该测试评估肢体之间以及前后距离之间的不对称性。结局将包括客观功能测量（定时起身和行走、坐立、步行速度、爬楼梯、下象限Y平衡测试）、自我报告的疼痛和活动限制（髋关节残疾和骨关节炎结局评分）以及治疗师评估的功能（Harris髋关节评分）。将使用基本描述性统计量比较每种结局的变化（术前至THA术后15周和THA术后6周至THA术后15周），并为更大规模试验提供样本量估计。我们还将评估项目可行性的各个方面（招募成功、依从性、远程康复过程），并从患者和治疗师那里收集深入的定性信息，以评估在进行更大规模的研究之前可能需要修改的干预措施。 公共卫生相关性： 全髋关节置换术（THA）是退伍军人中常见的外科手术。它最常用于治疗髋关节骨关节炎，这在退伍军人中比普通人群更常见。一些患者在THA后继续经历功能限制，研究表明这些患者仍然倾向于在对侧腿上施加更大的负荷，这会增加该腿发生骨关节炎的风险。这些术后限制的一个可能原因是，在此过程后康复非常少。该项目将涉及功能性运动再训练计划的开发和初步测试，旨在帮助退伍军人改善THA后的功能和生物力学。该项目还将制定在退伍军人之家实施这一方案的程序，以增加可及性。

DESCRIPTION (provided by applicant): Rehabilitation following total hip arthroplasty (THA) is limited in scope, and some patients continue to exhibit functional limitations, as well as loading asymmetries that place them at risk for developing osteoarthritis in contralateral joints. The purpose of this study is to collect preliminary data to support a larger project that will examine the effectiveness of a 12- session functional movement retraining (FMR) program for veterans following THA. A novel aspect of the FMR program is that it focuses not only on improving overall function but also normalizing side-to-side asymmetries in balance and strength via patient-specific tailoring of exercises. The program also involves telerehabilitation processes to improve access. Participants will be n=15 patients scheduled for THA at the Durham VAMC, identified from electronic medical records. Participants will complete assessments pre-operatively, then approximately 6-weeks post-THA, at which time FMR program will begin. The 12 FMR sessions will optimally be delivered twice weekly for 6 weeks. However, to account for missed visits, we will allow for 9 total weeks to complete the 12 sessions. Therefore follow-up assessments will be scheduled at 15-weeks post-THA for all participants. FMR sessions will be a combination of: 1.) in-person, on-site visit and telephone contacts with a licensed physical therapist and 2.) in- home telehealth visits by a telehealth technologist or physical therapy assistant. The FMR program will focus on improving lower extremity mobility, muscle stability and functional movement patterns. Participants will be instructed to perform a series of stretching exercises daily and strengthening exercises three times weekly. Exercises for each patient will be tailored according to results of the Lower Quarter Y-Balance Test (conducted at baseline and mid-way through the program), which assesses asymmetries between limbs and between anterior vs. posterior reach. Outcomes will include objective functional measures (timed up-and-go, sit-to- stand, walking speed, stair climb, Lower Quarter Y-Balance Test), self-reported pain and activity limitations (Hip disability and Osteoarthritis Outcome Score), and therapist-assessed function (Harris Hip Score). Basic descriptive statistics will be used to compare changes in each outcome (pre-operative to 15-week post-THA and 6-week post THA to 15-week post-THA) and inform sample size estimates for a larger trial. We will also assess various aspects of program feasibility (recruitment success adherence, telerehabilitation processes) and collect in-depth qualitative information from both patients and therapists to assess aspects of the intervention that may need to be modified prior to a larger study. PUBLIC HEALTH RELEVANCE: Total hip arthroplasty (THA) is a common surgical procedure among veterans. It is most often used to treat hip osteoarthritis, which is more common among veterans than the general population. Some patients continue to experience functional limitations after THA, and studies have shown that these patients still tend to put greater loads on the opposite leg, which can increase the risk of developing osteoarthritis in that leg. One likely reason for these post- surgical limitations is that rehabilitation is very minimal following this procedure. This project ill involve development and preliminary testing of a functional movement retraining program, designed to help veterans improve their function and biomechanics after THA. The project will also develop processes for delivering this program in veterans' homes, to increase accessibility.