Functional Movement Retraining After Hip Arthroplasty in Veterans: Pilot Study
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Arthroplasty, Replacement, Hip
- Sponsor
- VA Office of Research and Development
- Enrollment
- 15
- Locations
- 2
- Primary Endpoint
- Change in Hip Disability and Osteoarthritis Outcomes Score (HOOS) - Pain Scale
- Status
- Completed
- Last Updated
- 9 years ago
Overview
Brief Summary
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 will 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.
Detailed Description
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, the investigators 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 visits 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. The investigators 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.
Investigators
Eligibility Criteria
Inclusion Criteria
- •Veteran, Scheduled for hip arthroplasty at Durham, NC VA Medical Center
Exclusion Criteria
- •Dementia or other significant cognitive impairment;
- •movement or motor neuron disorders (e.g., Parkinson's Disease, post-stroke neurological deficiencies);
- •rheumatoid arthritis,
- •fibromyalgia,
- •or other systemic rheumatic disease;
- •hospitalization for a stroke,
- •myocardial infarction,
- •heart failure,
- •or coronary artery revascularization in the past 3 months;
- •psychosis or current, uncontrolled substance abuse disorder;
Outcomes
Primary Outcomes
Change in Hip Disability and Osteoarthritis Outcomes Score (HOOS) - Pain Scale
Time Frame: Change between Pre-intervention (6 weeks post-surgery) to post-intervention (15 weeks post-surgery)
The HOOS is a validated outcome measure in patients with painful hip conditions. It contains 5 subscales; Pain, other Symptoms, Function in daily living (ADL), Function in sport and recreation (Sport/Rec) and hip related Quality of life (QOL). The last week is taken into consideration when answering the questions. Standardized answer options are given (5 Likert boxes) and each question gets a score from 0 to 4. A normalized score (100 indicating no symptoms and 0 indicating extreme symptoms) is calculated for each subscale. Change was defined as pre-intervention minus post-intervention. Therefore a negative change score indicates improvement over time.
Change in Hip Disability and Osteoarthritis Outcomes (HOOS) Score - Sport Subscale
Time Frame: Change between Pre-intervention (6 weeks post-surgery) to post-intervention (15 weeks post-surgery)
The HOOS is a validated outcome measure in patients with painful hip conditions. It contains 5 subscales; Pain, other Symptoms, Function in daily living (ADL), Function in sport and recreation (Sport/Rec) and hip related Quality of life (QOL). The last week is taken into consideration when answering the questions. Standardized answer options are given (5 Likert boxes) and each question gets a score from 0 to 4. A normalized score (100 indicating no symptoms and 0 indicating extreme symptoms) is calculated for each subscale. Change was defined as pre-intervention minus post-intervention. Therefore a negative change score indicates improvement over time.
Change in Hip Disability and Osteoarthritis Outcomes (HOOS) Score - Symptom Subscale
Time Frame: Change between Pre-intervention (6 weeks post-surgery) to post-intervention (15 weeks post-surgery)
The HOOS is a validated outcome measure in patients with painful hip conditions. It contains 5 subscales; Pain, other Symptoms, Function in daily living (ADL), Function in sport and recreation (Sport/Rec) and hip related Quality of life (QOL). The last week is taken into consideration when answering the questions. Standardized answer options are given (5 Likert boxes) and each question gets a score from 0 to 4. A normalized score (100 indicating no symptoms and 0 indicating extreme symptoms) is calculated for each subscale. Change was defined as pre-intervention minus post-intervention. Therefore a negative change score indicates improvement over time.
Change in Hip Disability and Osteoarthritis Outcomes Score (HOOS) - Activities of Daily Living Scale
Time Frame: Change between Pre-intervention (6 weeks post-surgery) to post-intervention (15 weeks post-surgery)
The HOOS is a validated outcome measure in patients with painful hip conditions. It contains 5 subscales; Pain, other Symptoms, Function in daily living (ADL), Function in sport and recreation (Sport/Rec) and hip related Quality of life (QOL). The last week is taken into consideration when answering the questions. Standardized answer options are given (5 Likert boxes) and each question gets a score from 0 to 4. A normalized score (100 indicating no symptoms and 0 indicating extreme symptoms) is calculated for each subscale. Change was defined as pre-intervention minus post-intervention. Therefore a negative change score indicates improvement over time.
Change Hip Disability and Osteoarthritis Outcomes (HOOS) - Quality of Life Subscale
Time Frame: Change between Pre-intervention (6 weeks post-surgery) to post-intervention (15 weeks post-surgery)
The HOOS is a validated outcome measure in patients with painful hip conditions. It contains 5 subscales; Pain, other Symptoms, Function in daily living (ADL), Function in sport and recreation (Sport/Rec) and hip related Quality of life (QOL). The last week is taken into consideration when answering the questions. Standardized answer options are given (5 Likert boxes) and each question gets a score from 0 to 4. A normalized score (100 indicating no symptoms and 0 indicating extreme symptoms) is calculated for each subscale. Change was defined as pre-intervention minus post-intervention. Therefore a negative change score indicates improvement over time.
Secondary Outcomes
- Change in Satisfaction With Physical Function Questionnaire(Change between Pre-intervention (post-surgery) to post-intervention (15 weeks post-surgery))
- Change in Objective Functional Test: Sit to Stand(Change between Pre-intervention (6 weeks post-surgery) to post-intervention (15 weeks post-surgery))
- Change in Objective Functional Test: Stair Climbing(Change between Pre-intervention (6 weeks post-surgery) to post-intervention (15 weeks post-surgery))
- Global Assessment of Hip Symptom Change(15 weeks (post-intervention))
- Change in Objective Functional Test: Walking Speed(Change between Pre-intervention (6 weeks post-surgery) to post-intervention (15 weeks post-surgery))
- Change in University of California Los Angeles (UCLA) Activity Questionnaire(Change between Pre-intervention (6 weeks post-surgery) to post-intervention (15 weeks post-surgery))
- Change in Harris Hip Score (HHS)(Change between Pre-intervention (6 weeks post-surgery) to post-intervention (15 weeks post-surgery))
- Change in Objective Functional Test: Timed Get Up-and-go(Change between Pre-intervention (6 weeks post-surgery) to post-intervention (15 weeks post-surgery))
- Change in Lower Quarter Y-balance Test (YBT-LQ)(Change between Pre-intervention (6 weeks post-surgery) to post-intervention (15 weeks post-surgery))