None listed
Conditions
Brief summary
Total Hip Arthroplasty (THA) is a recognised treatment in Australia and internationally for people with disabling, painful hips. THA patients participate in number of models of rehabilitation, including; inpatient, outpatient and domiciliary programmes. To date there is no definitive evidence to support one model over another. Inpatient rehabilitation is far costlier than outpatient or domiciliary programmes. If the cost is to be justified we argue that the functional outcomes from inpatient rehabilitation should be superior to alternative programmes. HIHO 2 aims to compare the functional outcomes of individuals who undergo THA and then receive inpatient rehabilitation plus a home-based programme with individuals who receive a home-based programme alone (standard treatment). Eligible participants are people undergoing a planned, hip replacement, on one side (first time on that side). They must be able to read English and follow instructions for hospital and home-based programmes. Those who are eligible but decline randomisation will be asked to join the observational arm which receives a home-based programme (standard treatment). HO-Group (Home-based) - 2 -5 days after surgery a physiotherapist will instruct the participants on exercises to be preformed, unsupervised at home. The participants will attend group exercise sessions in the local outpatient department. On their first visit, 3 weeks after surgery, they will rehearse exercises to perform at home and receive a personalised instruction booklet. They will attend 1 or 2 sessions to advance the exercises tailored to their individual needs. The participants continue to preform the exercises at home, between group sessions. The last session is at 10 weeks after surgery. HI - Group (Hospital Inpatient followed by home-based) - individuals will be admitted to Braeside Hospital Rehabilitation Ward for 10 days of inpatient multidisciplinary rehabilitation comprising of 2-3 hours of individual and group based exercises per day. After leaving the rehabilitation hospital, these participants will follow the home-based programme as outlined above. The baseline characteristics recorded pre-operatively are ; age, gender, height, weight, other health problems and education level. The main outcome is the distance walked in six minutes, 26 weeks after surgery. Secondary outcomes will be patient reports of function, pain, quality of life, patient preference for and satisfaction with the type of rehabilitation, satisfaction with surgical outcome and their perceived change in distance walked. Measurements will be taken prior to surgery and at 3, 10, 26 and 52 weeks after surgery. Nested studies will examine the minimal important change for the 6MWT and the parameters of a functional mobility tool (IBMAT). The intention is to published these separately to the HIHO 2 study.
Interventions
Intervention (Arm - 1) - Hospital Inpatient Rehabilitation followed by a Monitored HOme-based programme (HI)
Comparator (Arm - 2) - Standard treatment which is a Monitored HOme-based programme (HO)
Participants will have their elective total hip replacement surgery in an acute hospital.They will be reviewed by the treating team and if assessed as able to be discharged home they will be randomly allocated to one of the two arms of the study.
Those allocated to HI will be admitted to a rehabili
Intervention (Arm - 1) - Hospital Inpatient Rehabilitation followed by a Monitored HOme-based programme (HI) Comparator (Arm - 2) - Standard treatment which is a Monitored HOme-based programme (HO) Participants will have their elective total hip replacement surgery in an acute hospital.They will be reviewed by the treating team and if assessed as able to be discharged home they will be randomly allocated to one of the two arms of the study. Those allocated to HI will be admitted to a rehabilitation hospital for 10 days. They will receive supervised physiotherapy comprising of 1-1.5 hours of one:one therapy plus 1-1.5 hours of class based exercises, a total of 2-3hours, Monday through Friday. They will receive 1-1.5 hours of one:one therapy on Saturday and Sunday. The inpatient rehabilitation programme combines general aerobic and functional exercises combined with muscle-specific exercises that focus on lower limb strengthening, joint range of motion, neuromuscular coordination and restoration of a normal gait pattern. After discharge from the inpatient unit participants will attend the monitored group exercise sessions as per HO (below) for monitoring and progression of the programme. All participants will be required to complete a diary detailing the programme adherence, health care utilisation, health expenditure and social costs related to carer burden. An additional Functional Independence Measure (FIM) will be recorded for this arm on admission and discharge from the inpatient unit.
Sponsors
HammondCare
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
40 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Adults presenting to Fairfield hospital for an initial, single side, planned, total hip replacement for treatment of hip arthritis secondary to, but not limited to, osteoarthritis, avascular necrosis or congenital hip deformity.
Exclusion criteria
Inability to understand the requirements of the study. This may include but is not limited to, a history of dementia, memory impairment secondary to stoke or brain injury or developmental cognitive impairment. Inability to read English. Inability to perform an exercise programme without hands on support or supervision from another person. Inability to complete 52 weeks follow up (eg. moving interstate) Pregnancy The need for restricted weight-bearing through the operated limb.
Outcome results
None listed