Introduction
Methods
Search protocol and registration
Data sources
Search strategy
Data extraction and risk of bias assessment
Data analysis
Results
Study characteristics
Reference/country/duration | Participants | Interventions | Control | Effectiveness | ||
---|---|---|---|---|---|---|
Number | Mean (SD) age | % of female | ||||
Umpierres et al. [31]/Brazil/2 weeks | Total = 106 Int = 54; Cot = 52 | Total = 61.4 (15.0) Int = 61.8 (15.6); Cot = 60.9 (14.5) | Int = 51.9 Cot = 55.8 | Verbal instructions and demonstrations associated with daily exercise practice guided by a physiotherapist | Verbal instructions and physiotherapy exercise demonstrations | Flexion: Int = 4.3 (0.1); p = < 0.001 Cot = 3.9 (0.7); p = < 0.001 MD = 0.807 [0.411, 1.204, p = 0.00] Extension: Int = 4.5 (0.1); p = 0.004 Cot = 4.1 (3.1); p = < 0.001 MD = 0.184 [− 0.197,0.566, p = 0.34] Motor performance, Int = 8.6 (0.1); p = 0.03 Cot = 8.3 (0.1), p = 0.16 MD = 3 [2.44, 3.55, p = 0.00] Clinical (pain), Int = 4.1 (0.1); Cot = 3.4 (0.1) |
Haas et al. [19]/Australia/1 year | Total = 276 Int = 130; Cot = 146 | Int = 67.77 (10.62) Cot = 68.58 | Int = 58 Cot = 62 | Acute weekend physiotherapy service | No physiotherapy | Int: Utility (Median, IQR) = 0.54 (0.31, 0.67) Pain (median, IQR) = 6 (5, 7); Cot: Utility = 0.55 (0.30, 0.70); Pai n = 5 (5, 7) |
Naylor et al. [24]/Australia/1 year | Total = 246 Int = 123; Cot = 123 | Int = 67.8 (10) Cot = 66.9 (10.6) | Int = 36.8 Cot = 31.7 | Inpatient physiotherapy | No physiotherapy | Int: (3 months, 1 year): Oxford Hip Score (OHS) median (IQR) = 46 (41, 48); 48 (46 48) p = 0.6; EuroQol scale, Median (IQR) = 85 (80, 95); 85 (75, 95) p = 0.09 Cot: (3 months, 1 year): Oxford Hip Score: 46 (41, 48); 48 (46, 48); EuroQol = 90 (80 95); 90 (80, 95) |
Trudelle-Jackson and Smith [36]/USA/8 weeks | Total = 34 Int = 18; Cot = 16 | 59.5 (11.2) | N/A | Sitting: sit to stand. Standing: unilateral heel raises, partial knee flexion, single leg stand, knee raises with alternate arm raises, side and back leg raises, unilateral pelvic raising, and lowering. Repetition rate (RR) = 15, 3 to 4 × week for 8 weeks. If able RR increased to 20 at 1st follow-up (2 weeks) and 2 × 20 at 2nd follow-up (8 weeks) | Gluteal muscle sets, hamstrings and quadriceps sets, ankle pumps, heel slides Hip abduction in supine, internal rotation, and external rotation. RR as for intervention group | Flexors Int: Hip Questionnaire-12 (median, range) = 16 (12, 38) Cot: Hip Questionnaire-12 (median, range) = 17.5 (12, 33) |
Jan et al. [20]/USA/12 weeks | Total = 53 Int = 26 Cot = 27 | Int = 58.8 (12.9) Cot = 57.0 (12.8) | Int = 34 Cot = 37 | Patients underwent a 12-week home program that included hip flexion, range of motion exercises for both hip joints; strengthening exercises for bilateral hip flexors, extensors, and abductors; and a 30-min walk every day | No training | Flexors, Int = 57.5 (22.3); Cont = 50.8 (21.2) MD = 0.31 [− 0.23, 0.85, p = 0.26] Function score, Int = 13.1 (0.6); p < 0.05 Cot = 12.0 (1.4), MD = 0.922 [0.356, 1.49, p = 0.001] |
Husby et al. [37]/Norway/5 weeks | Total = 24 Int = 12 Cot = 12 | Int = 58 (5) Cot = 56 (8) | Int = 58 Cot = 66 | Patients performed maximal strength training (STG) in leg press and abduction with the operated leg only five times a week for 4 weeks in addition to the conventional rehabilitation program | Patients received supervised physical therapy three-to-five times a week for 4 weeks | 1-repetition maximum increased in the bilateral leg press (p < 0.002) and in the operated leg separately (p < 0.002) in the intervention compared with the control |
Monaghan et al. [26]/Ireland/18 weeks | Total = 63 Int = 32 Cot = 31 | Int = 68(8); Cot = 69 (9) | Int = 37 Cot = 26 | The participants were taught 12 exercises by the supervising physiotherapist. They also attended classes twice weekly for 6 weeks, and were not given any additional exercises as a home exercise program | All patients were advised to walk daily with crutches until review by the orthopaedic surgeon at 6 weeks, increasing the distance gradually to approximately 1 mile after 1 month | Mean % at week 18 (Int vs Cot) WOMAC (pain) = − 0.81 (− 1.8 to 0.2), p = 0.1; WOMAC (stiffness) = − 0.44 (− 1.2 to − 0.28); p = 0.2; WOMAC functio n = − 4.0 (− 0.71 to 1.0); p = 0.04 |
Winther et al. [35]/Norway/12 months | Total = 63 Int = 31 Cot = 29 | Int = 61 Cot = 66 | Int = 54 Cot = 52 | Patients were trained at 85–90% of their maximal capacity in leg press and abduction of the operated leg (4 × 5 repetitions), 3 times a week at a municipal physiotherapy institute up to 3 months postoperatively | Patients were followed a training program designed by their respective physiotherapist, mainly exercises performed with low or no external loads. | Int. patients were substantially stronger in leg press and abduction than Cot |
Okoro et al. [18]/UK/6 weeks | Total = 49 Int = 25 Cot = 24 | Int = 65.15 (9.06) Cot = 66.3 (11.02) | Int = 15/25, Cot = 10/24 | Patients were instructed to perform a range of repetitions (0–3, 4–6, 7–10) depending on their initial physiotherapy assessment and then to progress, when able to, to achieve progressive overload. Subjects were encouraged to exercise at least 5 times a week | Home-based functional non-progressive resistance training exercises that were geared towards getting the patients safely mobile | Maximal voluntary contraction of the operated leg quadriceps (MVCOLQ); MD = 26.50 (8.71) p = 0.001; timed up and go (TUG); MD = − 1.44 (0.45); p = 0.0001 Stair Climb Performance (SCP); MD = − 3.41(0.80); p = 0.0001 6 min Walk Test (6MWT); MD = 45.61 (6.10)m; p = 0.0001 |
Maire et al. [27]/France/6 weeks | Total = 14 Int = 7 Cot = 7 | N/A | N/A | Muscular strength, range of motion, aquatics, walking 2 h/day). In addition, this group undertook an arm-interval exercise program with an arm ergometer | Muscular strength, range of motion, aquatics, walking 2 h/day | Int: WOMAC (pain) = − 100; p < 0.05; WOMAC (physical function) = − 45; p < 0.05 Cot: WOMAC (pain) = − 72; p < 0.05 WOMAC (physical function) = − 26 p < 0.05 |
Beaupre et al. [32]/Canada/12 months | Total = 21 Int = 11 Cot = 10 | Int = 51.7 (8.3) Cot = 55.9 (9.9) | Int = 64% Cot = 30% | Received out-patient rehabilitation program. Sessions were approximately two and one half hours in durations and included both aquatic and land-based components with a focus on strength and gait retraining | Usual care | Mean % from 6 weeks to 4 months postoperative Int: hip flexion (SD) = 73.8 (50.1) p = 0.69; hip extension (SD) = 50.5 (26.1); p = 0.78; Cot: hip flexion (SD) = 39.8 (64.1), p = 0.69; hip extension (SD) = 30.5 (67.3), p = 0.78 |
Nankaku et al. [33]/Japan/4 weeks | Total = 28 Int = 14 Cot = 14 | Int = 60.5(6.4) Cot = 60.8 (7.5) | Int = 50 Cot = 50 | Exercise program of hip external rotator was performed and supervised by an experienced physical therapist. | Usual care | Int, hip pain; p = 0.05; hip flexion angle, p = 0.05; hip abduction angle, p = 0.05 Cot, hip pain; p = 0.05; hip flexion angle, p = 0.05; hip abduction angle, p = 0.05 |
Beck et al. [21]/Germany/12 months | Total = 160 Int = 80 Cot = 80 | Int = 59® Cot = 61.9® | Int = 52.5 Cot = 63.8 | Intensive exercise therapy: walking slowly in circles, fast walking, leg axis training from various start positions, correct sitting, and team circles games | No exercise therapy | Int WOMAC (pain) = 100, Cot = 95; p = 0.003 Int EQ-5D (VAS) = 90; Cot = 85; p = 1.00 Int WOMAC (stiffness) = 87.5; Cot = 100; p = 0.373 |
Maire et al. [28] /France/12 months | Total = 14 Int = 7 Cot = 7 | N/A | N/A | Muscular strength, range of motion, aquatics, walking 2 h/day). In addition, this group undertook an arm-interval exercise program with an arm ergometer | Muscular strength, range of motion, aquatics, walking, 2 h/day | Int: WOMAC (physical function) = 5 (3–15); p < 0.05; Walking distance (m) = 486 (343–584) Cot: WOMAC (physical function) = 14 (4–18); walking distance = 398 (333–482) |
Galea et al. [25]/Australia/8 weeks | Total = 23 Int = 11 Cot = 12 | Int = 68.6 (9.7) Cot = 66.6 (7.9) | Int = 8/11 Cot = 8/12 | Advice about how to progress the exercises. The maximum time period for each exercise was 5 min, which included a rest period if required | Patients were not given any further instruction on progressing or modifying the exercises | Int: WOMAC (pain), p = 0.07; stiffness, p = 0.26; quality of life, 0.02; Cot: WOMAC (pain), p = 0.08; stiffness p = 0.34; quality of life, p = 0.02 |
Giaquinto et al. [29]/Italy/6 months | Total = 64 Int = 31 Cot = 33 | Int = 70.6 (8.4); Cot = 70.1 (8.5) | Int = 66.6 Cot = 67.7 | The hydrotherapy group was treated in a special pool for 40 min after 20 min of passive joint motion, during which participants were prepared | Patients received land therapy followed by a ‘neutral’ massage on the hip scar for 20 min | Int: WOMAC (pain), p < 0.01; WOMAC (stiffness), p < 0.01; WOMAC (function) p < 0.01 Cot: WOMAC (pain), p = 0.08; stiffness, p = 0.58; function, p = 0.01 |
Monticone et al. [30]/Italy/12 months | Total = 100 Int = 50 Cot = 50 | Int = 69.5 (7.5); Cot = 68.8 (8.1) | Int = 32/50 Cot = 28/50 | Performed task-oriented exercises, such as moving from a sitting to a standing position, etc. Sessions of stationary cycling were added to optimise hip strength and mobility | Performed open kinetic chain exercises | WOMAC (function), p < 0.001; WOMAC (pain) p < 0.001; WOMAC (stiffness) p < 0.001 |
Mikkelsen et al. [34]/Denmark/10 weeks | Total = 62 Int = 32 Cot = 30 | Int = 64.8 (8); Cot = 65.1 (10) | Int = 44 Cot = 40 | Patients warmed up on a stationary bike for 5–10 min and then performed unilateral patient resistance training of the operated leg for 30–40 min. One-to-one supervision by physiotherapists | Patients were recommended to perform one set of ten repetitions twice a day in their maximum possible range of motion | Ten weeks, maximum walking speed Int = 11.08, Cot = 11.99, p = 0.008; hip abduction strength, Int = 1.03 (0.3), Cot = 1.03 (0.3); p = 0.26; hip flexion strength, Int = 1.25 (0.3); Cot = 1.32 (0.4); p = 0.29 |
Risk of bias
Random sequence generation (selection bias) | Allocation concealment (selection bias) | Blinding of participants and personnel (performance bias) | Blinding of outcome assessment (detection bias) | Incomplete outcome data (attrition bias) | Selective reporting (reporting bias) | Other bias | |
---|---|---|---|---|---|---|---|
Umpierres et al. [31] | + 1 | + 1 | − 1 | + 1 | + 1 | + 1 | + 1 |
Haas et al. [19] | − 1 | − 1 | − 1 | + 1 | + 1 | ? | + 1 |
Naylor et al. [24] | − 1 | − 1 | − 1 | + 1 | + 1 | + 1 | + 1 |
Trudelle-Jackson and Smith [36] | ? | − 1 | 1 | + 1 | ? | + 1 | + 1 |
Jan et al. [20] | − 1 | − 1 | − 1 | ? | + 1 | + 1 | + 1 |
Husby et al. [37] | + 1 | − 1 | − 1 | + 1 | ? | + 1 | + 1 |
Monaghan et al. [26] | + 1 | + 1 | − 1 | + 1 | + 1 | + 1 | + 1 |
Okoro et al. [18] | + 1 | + 1 | − | + 1 | ? | − 1 | + 1 |
Maire et al. [27] | ? | − 1 | − 1 | + 1 | + 1 | + 1 | + 1 |
Beaupre et al. [32] | + 1 | − 1 | 1 | + 1 | + 1 | + 1 | + 1 |
Nankaku et al. [33] | + 1 | − 1 | − 1 | + 1 | + 1 | + 1 | + 1 |
Maire et al. [28] | + 1 | − 1 | − 1 | + 1 | + 1 | + 1 | + 1 |
Galea et al. [25] | + 1 | − 1 | − 1 | + 1 | + 1 | + 1 | + 1 |
Giaquinto et al. [29] | ? | − 1 | − 1 | + 1 | ? | + 1 | + 1 |
Monticone et al. [30] | + 1 | + 1 | − 1 | + 1 | + 1 | + 1 | + 1 |
Mikkelsen et al. [34] | + 1 | + 1 | − 1 | + 1 | + 1 | + 1 | + 1 |
Winther et al. [35] | ? | − 1 | − 1 | ? | + 1 | + 1 | + 1 |
Beck et al. [21] | ? | − 1 | − 1 | + 1 | ? | + 1 | + 1 |
Effectiveness of physiotherapy interventions
Acute hospital length of stay
Health-related quality of life
Function
Muscle strength
Range of movement
Pain
Clinical and motor performance
Cost-effectiveness of physiotherapy interventions
Study/location/study design/time-horizon | Population | Intervention | Control | Outcomes/measurement used | Cost/perspective | Results (Int vs Cot) | /24φ |
---|---|---|---|---|---|---|---|
Fusco et al. [22]; UK/cost-utility analysis/12 months | #80 | Accelerated physiotherapy re-education to increase walking distance and direction and reduce reliance on aids | Standard physiotherapy | EuroQol EQ-5D | Direct cost/National Health Service | Cost I n = £504 per patient Cot = £705 per patient Effectiveness Int = 0.91 (0.03) Cot = 0.73 (0.05) Cost-effectiveness Int. was cost-effective than Cot | 22 |
Krummenauer et al. [23] Germany/cost-effectiveness analysis/6 months | #28 | In-patient physiotherapy | Out-patient physiotherapy | WOMAC score (%), utility, quality adjusted life years | Direct costs/healthcare insurer | Cost Int = €9126.00; Cot = €8706.00 Effectiveness Int = 38% before, and 87% after surgery (WOMC score) Cot = 41% before, and 88% after surgery Cost-effectiveness Cost/effect = €420 [198, 475]/0.77 [95% CI − 2.13, 3.18] QALYs = −€841/QALY (p = 0.791) Inpatient rehabilitation was not cost-effective compared to out-patient rehabilitation | 20 |