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，以及负荷不对称，这使他们面临患上对侧关节骨关节炎的风险。这项研究的目的是收集初步数据，以支持一个更大的项目，该项目将检验退伍军人全髋关节置换术后12节功能性运动再培训(FMR)计划的有效性。FMR计划的一个新方面是，它不仅专注于改善整体功能，而且通过针对患者的量身定制运动来正常化平衡和力量方面的侧向不对称。该方案还包括远程康复过程，以改善机会。参与者将是n=15名计划在达勒姆VAMC接受THA的患者，这些患者是从电子医疗记录中确定的。参与者将完成术前评估，然后大约在术后6周完成评估，届时FMR计划将开始。12次FMR会议将以每周两次为最佳方案，为期6周。然而，为了解释缺席的原因，我们将留出总共9周的时间来完成12次会议。因此，将在临终手术后15周为所有参与者安排后续评估。FMR会话将组合为：1。)与有执照的物理治疗师进行面对面、现场访问和电话联系，以及2.)远程保健技术专家或理疗助理在家中进行远程保健访问。FMR计划将专注于改善下肢活动能力、肌肉稳定性和功能运动模式。参与者将被指导每天进行一系列伸展运动，每周进行三次强化运动。每个患者的锻炼将根据下四分之一Y-平衡测试(在基线和计划中期进行)的结果量身定做，该测试评估四肢之间以及前后屈之间的不对称。结果将包括客观功能测量(定时起立、坐立、步行速度、楼梯攀登、下半身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果评分)以及治疗师评估的功能(Harris髋关节评分)。基本描述性统计学将用于比较每个结果的变化(术前至术后15周，以及术后6周至术后15周)，并为更大规模试验的样本量估计提供信息。我们还将评估计划可行性的各个方面(招募成功、坚持、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，以评估干预措施的方面，这些方面可能需要在更大规模的研究之前进行修改。 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性关节炎，这在退伍军人中比普通人群更常见。一些患者在全髋关节置换术后继续经历功能障碍，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，这可能会增加该腿发生骨关节炎的风险。这些手术后限制的一个可能的原因是手术后的康复非常少。这个项目将包括开发和初步测试一个功能性运动再培训计划，旨在帮助退伍军人在全髋关节置换后改善他们的功能和生物力学。该项目还将制定在退伍军人之家实施这一计划的程序，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.