Physical and sports activity after hip arthroplasty

A artroplastia é utilizada para reconstrução da articulação do quadril, visando minimizar a dor e possibilitar o retorno às atividades de vida diária, esportivas e de lazer. O objetivo deste artigo é analisar na literatura as indicações e contraindicações referentes à prática de atividade física, esportiva e lazer após a artroplastia de quadril. Essa revisão aborda estudos publicados entre os anos de 1980 e 2009, obtidos por buscas em bancos de dados eletrônicos Medline, Scielo, Ovid, Infomaworld, Sciencedirect, Springerlink, Interscience, Sportdiscuss, Bireme, Informglobal, Opas, Ovid, Diseasedex, Eric, que totalizaram 39 artigos. Os artigos analisados apontam para a utilização de atividade física, esportiva e de lazer de baixo impacto. como a caminhada, natação, boliche, ciclismo, dentre outras. Outra indicação constatada na literatura é a utilização da atividade física e esportiva visando à manutenção do condicionamento físico, qualidade óssea e controle do peso corporal. Há ressalvas na literatura sobre a utilização de atividades de alto impacto, esporte com giro como o basquete e futebol ou com grande intensidade como tênis e a corrida, bem como os esportes de luta. As atividades físicas, esportivas e de lazer mais indicadas após uma atroplastia de quadril são as de baixo impacto como a hidroginástica, natação, caminhada, dentre outras. O início dessas atividades deve aguardar a liberação do médico, mas em média iniciam 60 dias após a cirurgia.Hip arthroplasty is used for reconstruction of the hip joint to reduce pain and to make the return to daily life, physical, sports and leisure activities possible. The objective of this article was to analyze in the literature the indications and counter-indications referring to practice of physical, sportive and leisure activities after hip arthroplasty. This revision approaches studies published between 1980 and 2009, obtained in searches in the Medline, Scielo, Ovid, Infomaworld, Sciencedirect, Springerlink, Interscience, Sportdiscuss, Bireme, Informglobal, Opas, Ovid, Diseasedex and Erics electronic databases with a total of 39 articles. The analyzed articles point to the use of physical, leisure and sports of low impact activities such as walking, swimming, bowling, cycling and others. Another indication evidenced in the literature is the use of physical and sportive activity aiming at the maintenance of physical fitness, bone quality and body weight control. The literature shows concerns with the use of activities of high impact or with great intensity like tennis and jogging, as well as fights

Effectiveness and Cost-effectiveness of Outpatient Physiotherapy After Knee Replacement for Osteoarthritis: Study Protocol for a Randomised Controlled Trial

Background: Primary total knee replacement is a common operation that is performed to provide pain relief and restore functional ability. Inpatient physiotherapy is routinely provided after surgery to enhance recovery prior to hospital discharge. However, international variation exists in the provision of outpatient physiotherapy after hospital discharge. While evidence indicates that outpatient physiotherapy can improve short-term function, the longer term benefits are unknown. The aim of this randomised controlled trial is to evaluate the long-term clinical effectiveness and cost-effectiveness of a 6-week group-based outpatient physiotherapy intervention following knee replacement. Methods/design: Two hundred and fifty-six patients waiting for knee replacement because of osteoarthritis will be recruited from two orthopaedic centres. Participants randomised to the usual-care group (n = 128) will be given a booklet about exercise and referred for physiotherapy if deemed appropriate by the clinical care team. The intervention group (n = 128) will receive the same usual care and additionally be invited to attend a group-based outpatient physiotherapy class starting 6 weeks after surgery. The 1-hour class will be run on a weekly basis over 6 weeks and will involve task-orientated and individualised exercises. The primary outcome will be the Lower Extremity Functional Scale at 12 months post-operative. Secondary outcomes include: quality of life, knee pain and function, depression, anxiety and satisfaction. Data collection will be by questionnaire prior to surgery and 3, 6 and 12 months after surgery and will include a resource-use questionnaire to enable a trial-based economic evaluation. Trial participation and satisfaction with the classes will be evaluated through structured telephone interviews. The primary statistical and economic analyses will be conducted on an intention-to-treat basis with and without imputation of missing data. The primary economic result will estimate the incremental cost per quality-adjusted life year gained from this intervention from a National Health Services (NHS) and personal social services perspective. Discussion: This research aims to benefit patients and the NHS by providing evidence on the long-term effectiveness and cost-effectiveness of outpatient physiotherapy after knee replacement. If the intervention is found to be effective and cost-effective, implementation into clinical practice could lead to improvement in patients’ outcomes and improved health care resource efficiency

Rationale, design and protocol of a longitudinal study assessing the effect of total knee arthroplasty on habitual physical activity and sedentary behavior in adults with osteoarthritis

Background: Physical activity levels are decreased and sedentary behaviour levels are increased in patients with knee osteoarthritis (OA). However, previous studies have shown that following total knee arthroplasty (TKA), objectively measured physical activity levels do not change compared to before the surgery. Very few studies have objectively assessed sedentary behaviour following TKA. This study aims to assess patterns of objective habitual physical activity and sedentary behaviour in patients with knee OA and to determine whether these change following TKA. Methods: Patients diagnosed with knee osteoarthritis and scheduled for unilateral primary total knee arthroplasty will be recruited from the Orthopaedic Division at the Charlotte Maxeke Johannesburg Academic Hospital. Eligible participants will have assessments completed one week before the scheduled arthroplasty, six weeks, and six months post-operatively. The primary outcomes are habitual physical activity and sedentary behaviour which will be measured using accelerometry (Actigraph GTX3+ and activPal monitors) at the specific time points. The secondary outcomes will be improvements in osteoarthritis-specific quality of life measures using the following questionnaires: Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee injury and Osteoarthritis Outcome Score (KOOS), Oxford Knee Score (OKS), Knee Society Clinical Rating System (KSS), UCLA activity index; subjective pain scores, and self reported sleep quality.Discussion: The present study will contribute to the field of musculoskeletal health by providing a rich detailed description of the patterns of accumulation of physical activity and sedentary behaviour in patients with knee OA. These data will contribute to existing knowledge using an objective measurement for the assessment of functional ability after total knee arthroplasty. Although studies have used accelerometry to measure physical activity in knee OA patients, the data provided thus far have not delved into the detailed patterns of how and when physical activity is accumulated before and after TKA. Accurate assessment of physical activity is important for physical activity interventions that target special populations

Development and validation of self-reported line drawings of the modified Beighton score for the assessment of generalised joint hypermobility

Background: The impracticalities and comparative expense of carrying out a clinical assessment is an obstacle in many large epidemiological studies. The purpose of this study was to develop and validate a series of electronic self-reported line drawing instruments based on the modified Beighton scoring system for the assessment of selfreported generalised joint hypermobility.Methods: Five sets of line drawings were created to depict the 9-point Beighton score criteria. Each instrument consisted of an explanatory question whereby participants were asked to select the line drawing which best represented their joints. Fifty participants completed the self-report online instrument on two occasions, before attending a clinical assessment. A blinded expert clinical observer then assessed participants’ on two occasions,using a standardised goniometry measurement protocol. Validity of the instrument was assessed by participant observeragreement and reliability by participant repeatability and observer repeatability using unweighted Cohen’s kappa (k). Validity and reliability were assessed for each item in the self-reported instrument separately, and for the sum of the total scores. An aggregate score for generalised joint hypermobility was determined based on a Beighton score of 4 or more out of 9.Results: Observer-repeatability between the two clinical assessments demonstrated perfect agreement (k 1.00; 95%CI 1.00, 1.00). Self-reported participant-repeatability was lower but it was still excellent (k 0.91; 95% CI 0.74, 1.00). Theparticipant-observer agreement was excellent (k 0.96; 95% CI 0.87, 1.00). Validity was excellent for the self-report instrument, with a good sensitivity of 0.87 (95% CI 0.81, 0.91) and excellent specificity of 0.99 (95% CI 0.98, 1.00).Conclusions: The self-reported instrument provides a valid and reliable assessment of the presence of generalisedjoint hypermobility and may have practical use in epidemiological studie