Good article on physical therapy outcomes

[IslandCatt]

http://www.todayinpt.com/ce/PT37/CoursePage/

Interesting reading.

I was a little worried that I might have been a little too aggressive in my exercise program since being released from physical therapy to start into my own program a couple of weeks ago, but it looks like I'm pretty much right in line with what this approach shows. Whew!


Here's an excerpt:

While a specific rehabilitation progression has not been published, a case study describing the successful use of joint mobilization for restricted range of motion for a patient three months post-operative bilateral hip resurfacing has been presented.20 Clinical meaningful improvements in range of motion and function were seen after a multimodal rehabilitation approach that included joint mobilization. Specific techniques included were inferior hip mobilization with medial and lateral rotation, anterior hip mobilization with lateral rotation, long axis distraction, and lateral femoral mobilization. This case study would appear to suggest that aggressive, non-traditional approaches to mobilization after hip resurfacing would be appropriate.

A case study presented at The APTA Combined Sections meeting in 2010 detailed a patient’s experience with Birmingham Hip Resurfacing rehabilitation.21 The patient’s initial weight-bearing status was TDWB with two crutches from day one until week three. He progressed to WBAT, one crutch prn, and was ambulating at six weeks without a device. Range of motion, pain assessment, and Harris Hip Score for various dates are listed in the sidebar below.

The patient was initially treated as if he had a traditional THA for the first two weeks, allowing a slow progression in weight bearing using crutches, basic postoperative exercises twice daily for 20 to 30 repetitions, activity modification, and motion restriction. The exercises included quad sets, gluteal sets, ankle pumps, heel slides, and gentle PT-assisted range of motion, observing hip precautions. At week three the surgeon cleared the patient for more aggressive stretching and range of motion activities, as well as gentle stationary cycling; the hip precautions were lifted. Single knee to chest, seated flexion activities, and four-way hip range of motion in standing were added. The patient was assisted in isolating hip motion without pelvic compensation through hands-on techniques and visual feedback, allowing him to monitor his motion in a mirror. At five weeks, muscle energy was used to gain additional motion and the therapist was advised to “be aggressive” by the referring physician.

At six weeks postop, the patient began outpatient therapy two to three times per week. The focus remained on increasing range of motion as well as overall hip, core, and lower extremity strengthening. Additional weight-bearing strengthening exercises were added using Thera-Band tubing. Static proprioceptive exercises using balance boards and trampolines were added. These exercises were progressed to dynamic proprioceptive activities and closed kinetic chain strengthening.  In addition, the patient slowly progressed from light jogging to running and functional activities and was cleared to return to road cycling and coaching lacrosse. A follow-up at 45 weeks postop was performed at the patient’s home. He was very satisfied with the surgery and was active in pick-up lacrosse games, road cycling and weight training, which were the activities he hoped to return to without pain. While this case study offers a general framework for the rehabilitation process, further studies are obviously needed to determine the best course of action for patients following hip resurfacing.

To further compound the issue of rehabilitation dosage, progression, and intensity, much of the published outcomes data for hip resurfacing doesn’t describe the rehabilitation process. Obviously more research must be presented in this area. Adherence to rehabilitation following resurfacing leads to better outcomes; this was documented in a retrospective study of 147 patients over 52 months. Patients who were more committed to their rehabilitation had better outcomes, higher levels of satisfaction, and were able to participate in higher levels of activity.22 Until more research on rehabilitation becomes available, clinicians should discuss their rehabilitation approach with the referring surgeon.