Bayram Unver

The effect of preoperative physiotherapy and education on the outcome of total hip replacement: a prospective randomized controlled trial:

Objective: To investigate the effects of preoperative physical therapy for patients undergoing total hip replacement. Design: Prospective randomized controlled study. Setting: Department of Orthopaedics and Traumatology in a university hospital. Subjects: Sixty patients with osteoarthritis of the hip scheduled to receive total hip replacement were randomly assigned into two groups. Interventions: Subjects in the study group received preoperative physiotherapy designed to strengthen the muscles of the upper and lower limbs and to improve range of motion of the hip, beginning from eight weeks before the operation. These patients also received an educational programme about living with a prosthesis. The control group received no preoperative physiotherapy or educational programme. Main outcome measures: Patients were evaluated at baseline (study group only, eight weeks prior to operation), before surgery, at discharge, three months and two years postoperatively using Harris Hip Score, visual analogue scale and range at hip abduction. Results: Although patients in the study group performed transfer activities earlier than the control group, there were no significant differences between the groups at discharge with regard to the improvement in Harris Hip Score (p < 0.48) and hip adduction (p < 0.97) and visual analogue scale at rest (p < 0.54) and activity (p < 0.89). At the latest follow-up (two years postoperatively) both groups had improved in Harris Hip Score, but rate of improvement between the groups was similar (p < 0.05). Conclusions: We conclude that the routine use of preoperative physiotherapy and education programme is not useful in total hip replacement surgery.

ABILITY TO RISE INDEPENDENTLY FROM A CHAIR DURING 6-MONTH FOLLOW-UP AFTER UNILATERAL AND BILATERAL TOTAL KNEE REPLACEMENT

OBJECTIVE The purpose of this study was to compare extensor mechanism function using a sit-to-stand test in patients undergoing uni- and bilateral total knee replacement, with a 6-month follow-up. DESIGN Prospective controlled study. PATIENTS The series included 72 patients with total knee replacement (unilateral 32 patients, bilateral 40 patients). METHODS All patients were evaluated pre-operatively by the physiotherapist and then at 2-weekly intervals during the postoperative 6 months using Hospital for Special Surgery knee score, and range of motion. Extensor mechanism function was evaluated at the same time points using a sit-to-stand test. RESULTS At the end of study, there was no difference between the groups in their knee range of motion and Hospital for Special Surgery scores (p>0.05). There was a significant difference between the groups in their chair rising ability (p<0.05). At 2 weeks, 22% of patients in the group with unilateral total knee replacement and 20% of patients in the group with bilateral total knee replacement could rise independently. However, there was significant difference in favour of unilateral total knee replacement at 4, 6, 8 and 10 weeks. At 10 weeks, all patients in the group with unilateral total knee replacement and at 6 months all patients in the group with bilateral total knee replacement could rise independently. CONCLUSION We conclude that patients with unilateral total knee replacement gain independence earlier than patients with bilateral total knee replacement. However, for patients with bilateral total knee replacement eventually to gain independence, they should be prepared for a longer rehabilitation programme.

Comparison of two different rehabilitation programmes for thrust plate prosthesis: a randomized controlled study

Objective: Weight bearing after total hip arthroplasty is postponed in order to prevent early loosening, but this negatively affects the rehabilitation programme. For the force transfer characteristics of thrust plate prosthesis (TPP), a new type of hip prosthesis used without cement is similar to the normal hip. We evaluated the possibilities of early weight bearing after TPP by comparing early partial with early full weight bearing. Design: Randomized controlled study. Setting: Department of orthopaedics and traumatology in a university hospital. Subjects: Sixty hips of 51 patients who underwent total hip arthroplasty with TPP were randomly assigned into two groups. Interventions: Both groups received accelerated rehabilitation programmes: group 1 with early partial weight bearing and group 2 with early full weight bearing. Main outcome measures: Patients were evaluated by a blind observer preoperatively, at three months after surgery by clinical (measurement of range of hip motion (universal goniometry), muscle strength (Manual Muscle Test), functional test (6-minute walk test), hip function (Harris Hip Scoring System)) and radiographical parameters and one year after surgery by clinical (Harris Hip Scoring System) and radiographical parameters. Results: Group 2 performed transfer activities earlier, had more walking distance at the time of discharge and shorter hospital stay than group 1. At three months, Harris Hip Score, muscle strength, 6-minute walk test, and duration of crutch use were significantly (p < 0.05) in favour of group 2. None of the patients in either group showed signs of loosening one year after the operation. Conclusions: These results suggest that patients with TPP can tolerate an accelerated rehabilitation programme with early weight bearing and will gain the goals of rehabilitation earlier.

Reliability of the six-minute walk test after total hip arthroplasty.

Background Walking ability is a crucial component of lower extremity function. Assessment of walking after total hip arthroplasty (THA) provides important information about the healing process. Walking endurance, an important functional component of walking, can be reliably measured with the 6-minute walk test (6 mWT). Even though the 6 mWT is commonly used in patients with THA, its reliability has never been reported for this patient population. The aim of this study is to assess the reliability of the test-retest 6 mWT after THA. Methods Thirty-four patients with THA performed two test trials on the same day, separated by a one hour seated rest. To assess reliability, intra-class correlation coefficient (ICC2,1 ), standard error of measurement (SEM), and smallest real difference (SRD) were calculated. Results The 6 mWT showed a high reliability. The patients walked 3.71 metres more at the end of the second 6 mWT in comparison with the first test. The ICC2,1 (AS95 ), SEM (m), SEM95 (m) and SRD95 (m) were 0.96 (0.92), 3.67, 7.19, and 10.17 m respectively. Conclusions Reliability of the 6 mWT was high in patients with THA. The 6 mWT is a simple and sensitive method to measure the functional performance in patients with THA in the clinical setting. Moreover, clinicians and researchers can use the 6 mWT to quantify even small changes in functional performance after THA.

Level of evidence in four selected rehabilitation journals.

OBJECTIVE To investigate the methodologic quality and level of evidence of publications in major peer-reviewed general rehabilitation journals (Archives of Physical Medicine and Rehabilitation [APMR], American Journal of Physical Medicine and Rehabilitation [AJPMR], Clinical Rehabilitation [CR], and Physical Therapy [PT]). DESIGN Descriptive, comparative. MAIN OUTCOME MEASURES All the articles published in AJPMR, APMR, CR, and PT between January 2005 and December 2009 were investigated. Type of study and level of evidence were recorded for all articles. Selection and assessment of articles were based on the title and abstract by 2 independent raters. RESULTS The most frequently published reports were randomized controlled trials (12.7%), followed by cross-sectional studies (12.1%), case reports/case series (10.3%), validation studies (9.3%), cohort studies (8.9%), clinical trials (7.5%), case-control studies (6.8%), and other study types (32.4%). When the articles were classified according to their level of evidence, level I studies most frequently appeared in CR (29.1%), followed by PT (11.0%), APMR (10.5%), and AJPMR (7.1%). Most of the meta-analyses (10) were in APMR, and there were none in AJPMR. CONCLUSIONS Randomized controlled trials and meta-analyses form only a small proportion of articles published in the current rehabilitation literature. The numbers of randomized controlled trials and meta-analysis are comparable with those in other fields.

Reference accuracy in four rehabilitation journals

Objective: To investigate the incidence of reference errors in major peer-reviewed general physical therapy and rehabilitation journals (American Journal of Physical Medicine and Rehabilitation (AJPMR), Archives of Physical Medicine and Rehabilitation (APMR), Clinical Rehabilitation (CR) and Physical Therapy (PT)). Design: Descriptive, comparative. Main outcome measures: All issues of the AJPMR, APMR, CR and PT between 2003 and 2007 were studied. For each journal, references from articles were consecutively numbered, and using a random number generator, 100 references were selected from each journal. For each reference, ease of retrieval on MEDLINE and the presence of citation errors were noted. If discrepancies were identified, the reference was compared with the original publication. Two observers independently evaluated each reference for citation errors. Results: The total number of citations with errors among all published journals was 123 (30.7%). The reference error rates by journal ranged from 23% to 44%. Most errors (48.0%) occurred in the author element, followed by the title (31.7%), journal (8.9%), page (5.7%), year (4.1%), and volume (1.6%). Only 8 (2%) were likely to make retrieval of the reference difficult. Conclusions: Errors in references still appear in current physical therapy and rehabilitation literature, but most are not severe.

Pain, fear of falling and stair climbing ability in patients with knee osteoarthritis before and after knee replacement: 6 month follow-up study

OBJECTIVES (1) to evaluate the change in time of pain, stair climbing ability and fear of falling (FOF), (2) to determine the association between pain, stair climbing ability and FOF for patients with knee osteoarthritis (OA) following the knee replacement over the course of six months, (3) and to compare the results with healthy controls in terms of stair climbing ability and FOF. METHODS Fifteen female healthy controls and 21 female consecutive subjects who were scheduled to undergo primary bilateral knee replacement for the treatment of knee OA were involved. Pain, stair climbing ability and FOF were assessed with a numerical pain rating scale, Going up and Down Scale (GUDS) and Tampa Scale for Kinesiophobia (TSK) at pre-surgery and discharge. After discharge, patients were asked to answer the outcome measures at 2, 4, 8, 12 and 26 week by phone. RESULTS Patients had significantly improvement in the postoperative 26-week scores of pain (p< 0.001), stair ability (p< 0.001), and FOF (p=0.006) compared with the preoperative scores. There was also decreased pain at 4.week, improved stair ability at 8.week, and delayed improvement at FOF in patients. While patients had significantly worse stair ability than controls preoperatively (p< 0.001), the difference was not significant at postoperative 26-week (p=0.561). A positive significant correlation was found between the stair ability, FOF and pain scores (p< 0.001). CONCLUSION It would be reasonable to consider that FOF control is potentially useful for preventing severe functional limitation in stair climbing for subsequent knee OA before and early after the surgery.

Cross-cultural adaptation, reliability and validity of the Turkish version of the Hospital for Special Surgery (HSS) Knee Score.

OBJECTIVE The purpose of this study was to adapt the English version of the Hospital for Special Surgery (HSS) knee score for use in a Turkish population and to evaluate its validity, reliability and cultural adaptation. METHODS Standard forward-back translation of the HSS knee score was performed and the Turkish version was applied in 73 patients. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Mini-Mental State Examination and sit-to-stand test were also performed and analyzed. Internal consistency reliability was tested using Cronbachs alpha. The intraclass correlation coefficient (ICC) was used to calculate the test-retest reliability at one-week intervals. Validity was assessed by calculating the Pearson correlation between the HSS, WOMAC and sit-to-stand test scores. RESULTS The ICC ranged from 0.98 to 0.99 with high internal consistency (Cronbachs alpha: 0.87). The WOMAC score correlated with total HSS score (r: -0.80, p<0.001) and sit-to-stand score (r: 0.12, p: 0.312). CONCLUSION The Turkish version of the HSS knee score is reliable and valid in evaluating the total knee arthroplasty in Turkish patients.

Reliability of the 50-foot walk test and 30-sec chair stand test in total knee arthroplasty

OBJECTIVE: To investigate the reliability of the 50-Foot Walk Test (50 FWT) and 30-second Chair Stand Test (30 CST) in patients who have undergone total knee arthroplasty (TKA). METHODS: The study was designed as a test-retest research. Thirty-three patients who would undergo bilateral TKA were recruited. The tests 30 CST and 50 FWT were performed twice on the same day with 5-minute intervals, respectively. Between the first and second tests, patients waited for an hour on sitting position in order to prevent fatigue. In addition to these tests, we registered the knee pain experienced by the patients using a 100 mm VAS scale. RESULTS: The 50 FWT and 30 CST showed excellent reliability. ICC for 50 FWT and 30 CST were 0.97 and 0.92, respectively. SRD95 was 1.07 for 50 FWT and 0.96 for 30 CST. CONCLUSIONS: According to results of this study, both 50 FWT and 30 CST have excellent reliability in patients with TKA. These tests are simple, no time consuming and constitute sensitive methods to measure the functional performance in patients with TKA in the clinical settings. Clinicians and researchers may use these tests to quantify even small changes in functional performance for patients with TKA. Level of Evidence III, Diagnostic Study.

The frequency of visits by the physiotherapist of patients receiving home-based exercise therapy for knee osteoarthritis.

Although home-based physiotherapy (PT) has an important role in the management of knee osteoarthritis (OA), the optimal frequency of monitoring by the physiotherapist is not known. Ninety-six patients with bilateral Kellgren Lawrence grade 3 OA were divided into two groups. All patients received the same PT program but group 1 was monitored at 1, 2, 3, 6, 12 and 24 weeks, while group 2 was seen at 3 and 24 weeks. At the end of the study, both groups had improved their Hospital for Special Surgery score (P<0.05), and there was no statistically significant difference between the groups. We conclude that the frequency of visits for a home-based exercise program can be decreased without affecting the success of the therapy.