title: A targeted home- and center-based exercise program for people after total hip replacement: a randomized clinical trial. Age- and gender-related test performance in community-dwelling elderly people: Six-Minute Walk Test, Berg Balance Scale, Timed Up & Go Test, and gait speeds. Group physiotherapy provides similar outcomes for participants after joint replacement surgery as 1-to-1 physiotherapy: a sequential cohort study. Minimal perceptible clinical improvement with the Western Ontario and McMaster Universities osteoarthritis index questionnaire and global assessments in patients with osteoarthritis. Physiotherapy after total hip replacement for primary arthrosis. Effects of a late-phase exercise program after total hip arthroplasty: a randomized controlled trial. The Assessment of Quality of Life (AQoL) instrument: a psychometric measure of Health-Related Quality of Life Reliability of the PEDro scale for rating quality of randomized controlled trials. Home program of physical therapy: effect on disabilities of patients with total hip arthroplasty. The effect of exercise on hip muscle strength, gait speed and cadence in patients with total hip arthroplasty: a randomized controlled study
abstract: OBJECTIVE To examine the physical function , gait , and quality of life of patients after total hip replacement ( THR ) r and omly assigned to either a targeted home- or center-based exercise program . DESIGN R and omized controlled trial . SETTING Rehabilitation research center in Australia . PARTICIPANTS Twenty-three patients with unilateral THR were r and omly assigned to a supervised center-based exercise group ( n=11 ) or an unsupervised home-based exercise group ( n=12 ) . INTERVENTION The center-based group completed an 8-week targeted exercise program while under the direct supervision of a physiotherapist . After initial instruction , the home-based group completed the 8-week targeted exercise program at home without further supervision . MAIN OUTCOME MEASURES Quality of life , physical function , and spatiotemporal measures of gait . RESULTS No significant interaction ( group by time ) or main effects of grouping were found . Within each group , quality of life , and stair climbing improved significantly ( P<.05 ) as did Timed Up & Go test and 6-minute walk test performances ( P<.05 ) . Walking speed increased by 16 cm/s ( P<.01 ) , cadence by 8 steps/min ( P<.05 ) , step length by 4.7 cm ( P<.05 ) , and double-support time reduced by a factor of 16 % . Step length symmetry showed significant improvement ( P<.05 ) over time . Step length differential between the affected and unaffected limbs reduced from 4.0 to 2.7 cm . CONCLUSIONS The targeted strengthening program was effective for both the home- and center-based groups . No group differences were found in the majority of the outcome measures . This finding is important because it shows that THR patients can achieve significant improvements through a targeted strengthening program delivered at a center or at home BACKGROUND AND PURPOSE The interpretation of patient scores on clinical tests of physical mobility is limited by a lack of data describing the range of performance among people without disabilities . The purpose of this study was to provide data for 4 common clinical tests in a sample of community-dwelling older adults . SUBJECTS Ninety-six community-dwelling elderly people ( 61 - 89 years of age ) with independent functioning performed 4 clinical tests . METHODS Data were collected on the  Six-Minute Walk Test ( 6MW ) , Berg Balance Scale ( BBS ) , and Timed Up & Go Test ( TUG ) and during comfortable- and fast-speed walking ( CGS and FGS ) . Intraclass correlation coefficients ( ICCs ) were used to determine the test-retest reliability for the 6MW , TUG , CGS , and FGS measurements . Data were analyzed by gender and age ( 60 - 69 , 70 - 79 , and 80 - 89 years ) cohorts , similar to previous studies . Means , st and ard deviations , and 95 % confidence intervals for each measurement were calculated for each cohort . RESULTS The 6MW , TUG , CGS , and FGS measurements showed high test-retest reliability ( ICC [2,1]=.95-.97 ) . Mean test scores showed a trend of age-related declines for the 6MW , BBS , TUG , CGS , and FGS for both male and female subjects . DISCUSSION AND CONCLUSION Preliminary descriptive data suggest that physical therapists should use age-related data when interpreting patient data obtained for the 6MW , BBS , TUG , CGS and FGS . Further data on these clinical tests with larger sample sizes are needed to serve as a reference for patient comparisons UNLABELLED Coulter CL , Weber JM , Scarvell JM . Group physiotherapy provides similar outcomes for participants after joint replacement surgery as 1-to-1 physiotherapy :  a sequential cohort study . OBJECTIVES To compare effectiveness and time efficiency of physiotherapy rehabilitation provided within a group with an individualized program provided at home for improving participants ' outcomes after total joint replacement surgery . DESIGN Quasiexperimental sequential cohort trial with 12-week follow-up . SETTING A tertiary acute care hospital . PARTICIPANTS Consecutive patients ( N=51 ) having hip or knee replacement surgery in an 8-month period and who were able to weight-bear postoperatively . INTERVENTIONS The first group admitted to the study entered the exercise group  , and patients in the following 4 months entered the home physiotherapy group . MAIN OUTCOME MEASURES Primary outcome measures included the Western Ontario McMaster 's University Osteoarthritis Index ( WOMAC ) , Medical Outcomes Study 36-Item Short-Form Health Survey ( SF-36 ) , Timed Up & Go ( TUG ) test , and knee range of motion ( ROM ) . Secondary measures included the 6-m walk test and a patient evaluation question naire . Staff time costs were recorded . Outcomes were recorded preoperatively or at hospital discharge , and 5 and 12 weeks postoperatively . RESULTS There was no difference between the 2 groups for either the WOMAC or SF-36 scores , 6-m walk test , TUG test , or ROM measures at 12 weeks ( P>.05 ) , although both groups of patients improved between hospital discharge and 12 weeks . The class group accessed more frequent physiotherapy than the home group ( mean , 7.5 and 3.96 visits , respectively ) . The physiotherapist 's time was less per patient per visit for the class group ( mean , 27min direct and 10min indirect ) than for the home visits ( mean , 38min direct and 26min indirect ) . CONCLUSIONS This trial suggests that the class-based exercise rehabilitation was the most efficient method of delivery of the physiotherapy service , without cost to patient outcomes OBJECTIVE To determine the minimal perceptible clinical improvement ( MPCI ) in patients with osteoarthritis ( OA ) with the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) question naire , and patient and investigator global assessment of disease status in r and omized clinical trials for treatment of OA . METHODS Subjects with OA of the knee or hip were r and omized to receive either rofecoxib 12.5 or 25 mg once daily , ibuprofen 800 mg 3 times daily , or placebo for 6 weeks . The WOMAC and global assessment s were completed at baseline and Weeks 2 , 4 , and 6 . A patient global assessment of response to therapy ( 0 to 4 scale ) was used to " anchor " the WOMAC scores . MPCI was defined as the difference in mean change from baseline in WOMAC ( 100 mm normalized visual analog scale , VAS ) between patients with 0 = " None " global response to therapy and patients with 1 = " Poor " global response to therapy . RESULTS MPCI was determined to be 9.7 , 9.3 , and 10.0 mm for the WOMAC pain , physical function and stiffness subscales , respectively , and 11.1 mm for WOMAC question 1 : Pain walking on a flat surface . The MPCI for the investigator was 0.4 with investigator assessment of disease status reported on a 0 to 4 Likert scale . Of note , the estimated MPCI for the WOMAC and investigator globals were similar irrespective of treatment , sex , age , or geographic region . CONCLUSION In this analysis , mean changes of roughly 9 to 12 mm ( 100 mm normalized VAS ) on WOMAC scales were perceptible changes to patients with hip and knee OA . A mean decrease of 0.4 in global disease status ( 0 to 4 Likert scale ) as assessed by the investigator corresponded to the patients ' MPCI . Underst and ing the minimal perceptible differences may permit a better assessment of the clinical relevance of therapeutic interventions in OA Organized physiotherapy starting two months after uncomplicated total hip replacements for primary arthrosis did not improve the rehabilitation . Six months after surgery there were no significant differences between 14 patients with and 16 patients without physiotherapy regarding improvement of passive hip motion , or hip or knee muscle strength of the operated limb . Neither were there any differences in walking ability or activities of daily living OBJECTIVE To investigate the effects of a late-phase exercise program for patients who underwent total hip arthroplasty ( THA ) 4 to 12 months earlier . DESIGN A single-blind , r and omized controlled trial . SETTING Exercises were performed in subjects ' homes . Exercise instruction and measurements taken before and after the trial were performed in an outpatient research and treatment center . PARTICIPANTS Convenience sample of 34 adults 4 to 12 months post-THA r and omly allocated to experimental or control groups . Twenty-eight subjects completed the study . INTERVENTION An 8-week , hip-exercise intervention , during which the control group received basic isometric and active range of motion exercises ; the experimental group received strength and postural stability exercises . MAIN OUTCOME MEASURES Score on the 12-Item Hip Question naire ; fear of falling ; hip flexor , extensor , abductor , and knee extensor muscle torque ; and postural stability in single stance . RESULTS There was a statistically significant improvement in all measures of self-perceived function , muscle strength ( hip flexors , 24.4 % ; hip extensors , 47.8 % ; hip abductors , 41.2 % ; knee extensors , 23.4 % ) , and postural stability ( 36.8 % ) in the experimental group and no significant change in the control group . Neither group had statistically significant changes in fear of falling measures . CONCLUSIONS An exercise program emphasizing weight bearing and postural stability significantly improved muscle strength , postural stability , and self-perceived function in patients 4 to 12 months after THA This paper describes constructing the Assessment of Quality of Life ( AQoL ) instrument ; design ed to measure health-related quality of life ( HRQoL )  , and to be the descriptive system for a multi-attribute utility instrument . Unlike previous utility instruments ' descriptive systems , the AQoL 's has been developed using state-of-the-art psychometric procedures . The result is a descriptive system which emphasizes five different facets of HRQoL and which can cl aim to have construct validity . Based on the WHO 's definition of health a model of HRQoL was developed . Items were written by focus groups of doctors and the research ers . These were administered to a construction sample , comprising hospital patients , and community members chosen at r and om . Final construction was through an iterative process of factor and reliability analyses . The AQoL measures 5 dimensions : illness , independent living , social relationships , physical senses and psychological wellbeing . Each has three items . Exploratory factor analysis showed the dimensions were orthogonal , and each was unidimensional . Internal consistency was α = 0.81 . Structural equation modeling explored its internal structure ; the comparative fit index was 0.90 . These preliminary results indicate the AQoL has the prerequisite qualities for a psychometric HRQoL instrument for evaluation ; replication with a larger sample is needed to verify these findings . Scaling it for economic evaluation using utilities is being undertaken . Respondents have indicated the AQoL is easy to underst and and is quickly completed . Its initial properties suggest it may be widely applicable BACKGROUND AND PURPOSE Assessment of the quality of r and omized controlled trials ( RCTs ) is common practice in systematic review s. However , the reliability of data obtained with most quality assessment scales has not been established . This report describes 2 studies design ed to investigate the reliability of data obtained with the Physiotherapy Evidence Data base ( PEDro ) scale developed to rate the quality of RCTs evaluating physical therapist interventions . METHOD In the first study , 11 raters independently rated 25 RCTs r and omly selected from the PEDro data base . In the second study , 2 raters rated 120 RCTs r and omly selected from the PEDro data base , and disagreements were resolved by a third rater ; this generated a set of individual rater and consensus ratings . The process was repeated by independent raters to create a second set of individual and consensus ratings . Reliability of ratings of PEDro scale items was calculated using multirater kappas , and reliability of the total ( summed ) score was calculated using intraclass correlation coefficients ( ICC [ 1,1 ] ) . RESULTS The kappa value for each of the 11 items ranged from.36 to.80 for individual assessors and from.50 to.79 for consensus ratings generated by groups of 2 or 3 raters . The ICC for the total score was.56 ( 95 % confidence interval=.47-.65 ) for ratings by individuals , and the ICC for consensus ratings was.68 ( 95 % confidence interval=.57-.76 ) . DISCUSSION AND CONCLUSION The reliability of ratings of PEDro scale items varied from " fair " to " substantial , " and the reliability of the total PEDro score was " fair " to " good . OBJECTIVE To study the effect of a home program of physical therapy . DESIGN Nonr and omized control trial . SETTING Home based . PATIENTS Subjects had total hip arthroplasty ( THA ) for hip osteoarthritis ( hip-OA ) without THA failure , or cardiopulmonary , neurological , or cognitive problems . Twenty-three subjects ( mean age 63.4 years ; mean post-THA period 793 days , 6 to 48 months ) were divided into 3 groups matching with age , gender , and postoperative periods . INTERVENTION The 6-week home program included range of motion ( ROM ) exercises , and low resistance isometric and eccentric exercises of hip abductors . Physical therapists prescribed ROM and isometric exercises for group A , all programs for group B , and no programs for the control group . The programs were modified every 2 weeks as necessary . MAIN OUTCOME MEASURE Hip ROM , maximum isometric hip abduction torque measured by Cybex II , gait speed , and cadence were evaluated . RESULTS The practice ratio of the program was about 70 % for both groups . Maximum isometric torque improved in the THA side of group A ( p < .01 ) and the control group ( p < .05 ) , and on both sides in group B ( p < .01 ) . Gait speed and cadence also improved significantly . No correlation coefficient existed between practice days and the improvement ratio of the maximum torque . CONCLUSION The home program was effective in long-term post-THA Objective : To evaluate the effect of home versus in-hospital exercise ( under supervision ) programmes on hip strength , gait speed and cadence in patients with total hip arthroplasty at least one year after operation . Setting : Physical therapy and rehabilitation department . Subjects : Twenty-six patients who had had a total hip arthroplasty operation 12—24 months prior to the study were enrolled . Interventions : The patients were r and omized into three groups : group 1 patients were assigned a home exercise programme , group 2 patients exercised under physiotherapist supervision in hospital , and group 3 served as the control group , with no specific intervention . The study duration was six weeks . Main measures : Maximum isometric abduction torque of operated hip muscle , gait speed and cadence were measured before and after the study . Results : Maximum isometric abduction torques of the hip abductor muscles improved in groups 1 and 2 , but not in group 3 ( 30 ± 12 to 38 ± 11 ft.lb in group 1 , 18 ± 10 to 30 ± 9.8 ft.lb in group 2 ) . Gait speed improved from 67.8 ± 23 to 74.35 ± 24 m/min in group 1 , from 48.53 ± 4 to 56.7 ± 5 m/min in group 2 and from 58.01 ± 12 to 59.8 ± 14 m/min in group 3 . Cadence also improved , from 97.7 ± 18 to 111 ± 17 steps/min in group 1 , from 90.75 ± 6 to 104.75 ± 7 steps/min in group 2 , and from 87 ± 16 to 88.22 ± 16 steps/min in group 3 . When the three groups were compared , group 2 showed the best improvement ( P = 0.006 ) only in maximum isometric abduction torque . Conclusion : Our findings suggest that both home and supervised exercise programmes are effective one year after total hip arthroplasty . Home exercise programmes with close follow-up could be recommended
target: Function and quality of life could not be meta-analysed due to insufficient data and heterogeneity of measures , but functional measures tended to favour the physiotherapy rehabilitation group .
  Most outcomes were similar between outpatient and home-based exercise programs .
  Physiotherapy rehabilitation improves hip abductor strength , gait speed and cadence in people who have been discharged from hospital after total hip replacement .
  Physiotherapist-directed rehabilitation exercises appear to be similarly effective whether they are performed unsupervised at home or supervised by a physiotherapist in an outpatient setting
background: QUESTION In people who have been discharged from hospital after a total hip replacement , do rehabilitation exercises directed by a physiotherapist improve strength , gait , function and quality of life ?
  Are these exercises as effective in an unsupervised home-based setting as they are in a supervised outpatient setting ?