Home ex­er­cises work well for re­hab af­ter hip surgery

Daily Freeman (Kingston, NY) - - YOUR DAILY BREAK - An­thony Ko­maroff Ask Dr. K

I’m hav­ing hip re­place­ment surgery next month. I know I’ll need re­ha­bil­i­ta­tion af­ter­ward, but does it mat­ter where I do it?

It’s been rou­tine af­ter hip re­place­ment surgery to have ex­ten­sive phys­i­cal ther­apy. This re­ha­bil­i­ta­tion ther­apy, or “re­hab,” usu­ally con­sists of a se­ries of out­pa­tient ap­point­ments with a phys­i­cal ther­a­pist, as well as ex­er­cises to do at home. The goal of re­hab is to im­prove the strength, stamina and bal­ance of walk­ing.

The vis­its to the phys­i­cal ther­a­pist usu­ally take place two or three times a week for a month or more. But a new study calls into ques­tion the need for all the vis­its to phys­i­cal ther­a­pists.

The re­searchers pre­sented their find­ings at a re­cent meet­ing of the Amer­i­can Academy of Or­thopaedic Sur­geons. They stud­ied 77 peo­ple hav­ing hip re­place­ment surgery. Of these, half were ran­domly as­signed to the con­ven­tional re­hab pro­gram, in which they met with a phys­i­cal ther­a­pist two or three times a week for two months. The rest were taught spe­cific ex­er­cises to per­form on their own at home for two months. Here’s what they found: • One month af­ter surgery, there were no ma­jor dif­fer­ences in the in­di­vid­u­als’ abil­ity to func­tion. “Func­tion” was based on their abil­ity to sit, walk and use stairs, or other mea­sures of daily ac­tiv­i­ties.

• Six months af­ter the surgery, there was still no dif­fer­ence in re­sults.

Chang­ing re­hab from su­per­vised ap­point­ments to ex­er­cis­ing at home could sig­nif­i­cantly re­duce the cost of care. And the con­ve­nience of not hav­ing to be driven to all those phys­i­cal ther­apy vis­its is an ex­tra bonus. (For the first month or two af­ter hip re­place­ment surgery, you can’t drive your­self.)

Of course, this may not work for everyone. Many peo­ple who have hip re­place­ment surgery can­not re­turn home right away. That’s es­pe­cially true if they live alone and have to climb a num­ber of stairs right away. For them, surgery may best be fol­lowed by a stay at a re­ha­bil­i­ta­tion fa­cil­ity. There, they can re­ceive su­per­vised phys­i­cal ther­apy on a daily ba­sis. They would be sent home once they were strong and steady enough to get around safely.

This new re­search should be con­sid­ered pre­lim­i­nary. First, it in­cluded only a small num­ber of study sub­jects. Also, the re­sults have not yet been pub­lished in a peer-re­viewed medical journal. More re­search will likely be needed to con­firm the find­ings. Other stud­ies can help iden­tify who is likely to do well with self­di­rected re­hab.

If the find­ings of this new study are con­firmed, it will be wel­come news. Thou­sands of peo­ple hav­ing hip re­place­ment surgery may no longer have to trudge back and forth to phys­i­cal ther­apy ap­point­ments.

Based on my own ex­pe­ri­ence un­der­go­ing a hip re­place­ment, I’ll bet that this study is ba­si­cally cor­rect: All those vis­its to a phys­i­cal ther­a­pist may not be nec­es­sary. On the other hand, not everyone is alike. Some peo­ple will need more ther­apy vis­its than others, to master the ex­er­cises they need to do at home.

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