Does an early home-based progressive resistance training program improve function following total hip replacement? Results of a randomized controlled study

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Fracture in the Elderly Multidisciplinary Rehabilitation (FEMuR):study protocol for a phase II randomised feasibility study of a multidisciplinary rehabilitation package following hip fracture [ ISRCTN22464643 ]

Background Proximal femoral fracture is a common, major health problem in old age resulting in loss of functional independence and a high-cost burden on society, with estimated health and social care costs of £2.3 billion per year in the UK. Rehabilitation has the potential to maximise functional recovery and maintain independent living, but evidence of effectiveness is lacking. Usual rehabilitation care is delivered by a multi-disciplinary team in the hospital and in the community. An ‘enhanced rehabilitation’ intervention has been developed consisting of a workbook, goal-setting diary and extra therapy sessions, designed to improve self-efficacy and increase the amount and quality of the practice of physical exercise and activities of daily living. Methods/design This paper describes the design of a phase II study comprising an anonymous cohort of all proximal femoral fracture patients admitted to the three acute hospitals in Betsi Cadwaladr University Health Board over a 6-month period with a randomised feasibility study comparing the enhanced rehabilitation intervention with usual care. These will assess the feasibility of a future definitive randomised controlled trial and concurrent economic evaluation in terms of recruitment, retention, outcome measure completion, compliance with the intervention and fidelity of delivery, health service use data, willingness to be randomised and effect size for a future sample size calculation. Focus groups will provide qualitative data to contribute to the assessment of the acceptability of the intervention amongst patients, carers and rehabilitation professionals and the feasibility of delivering the planned intervention. The primary outcome measure is function assessed by the Barthel Index. Secondary outcomes measure the ability to perform activities of daily living, anxiety and depression, potential mediators of outcomes such as hip pain, self-efficacy and fear of falling, health utility, health service use, objectively assessed physical function and adverse events. Participants’ preference for rehabilitation services will be assessed in a discrete choice experiment. Discussion Phase II studies are an opportunity to not only assess the feasibility of trial methods but also to compare different methods of outcome measurement and novel methods of obtaining health service use data from routinely collected patient information. Trial registration Current Controlled Trials ISRCTN22464643, UKCRN16677

The efficacy of exercise rehabilitation in restoring physical function following total hip replacement for osteoarthritis: A review

Introduction Standard physiotherapy rehabilitation fails to restore normal levels of muscle mass, strength and physical function in patients following elective total hip arthroplasty for osteoarthritis. Consequently, more intense forms of exercise rehabilitation have been advocated for these patients. The aim of this article was to review the controlled trials that have evaluated post-total-hip-arthroplasty exercise interventions aimed at improving function. Materials and methods The electronic databases MEDLINE and CINAHL were searched using the following terms: �total hip arthroplasty/replacement�, �exercise�, �rehabilitation� and �function�. This search was expanded by hand-checking the reference lists of the studies and reviews identified by electronic scanning. Results Thirteen appropriate studies (18 papers) were identified, comprising 8 �early� intervention studies (<5 weeks from surgery) and 5 �delayed� intervention studies. Conclusion The studies reviewed suggest that centre-based, but not home-based, exercise rehabilitation are effective in restoring muscle mass, strength and function in total hip arthroplasty patients during the immediate post-surgery phase, and that the efficacy of the centre-based interventions is most likely due to higher training intensity that is facilitated by supervision and access to specialised equipment and facilities. When commencement of training is delayed, however, both home- and centre-based training programs provide significant improvements in patient strength and function

Exercise as Medicine in Rheumatoid Arthritis: Effects on Function, Body Composition, and Cardiovascular Disease Risk

Rheumatoid arthritis (RA) is characterised by functional disability and inflammation. This review explores the beneficial effects of exercise on function and cardiovascular disease risk in RA and explores the possibility that some of these beneficial effects may be moderated via exercise-induced improvements in body composition

Can progressive resistance training reverse cachexia in patients with rheumatoid arthritis? Results of a pilot study

Objective. A Phase II trial was performed as a preliminary test of the efficacy and safety of progressive resistance training (PRT) as adjunct treatment for rheumatoid cachexia. Methods. Ten mildly disabled patients with well-controlled rheumatoid arthritis (RA) trained, on average, 2.5 times per week for 12 weeks. Ten age and sex matched RA patients with similar disease characteristics were non-randomly assigned to a control group. Body composition, physical function, and disease activity were assessed pre and post intervention period. Results. Between group comparisons at followup by ANCOVA using baseline scores as covariate showed significant increases in fat-free mass (+1253 g, p = 0.004), total body protein (+1063 g, p = 0.044), and arm (+280 g, p = 0.005) and leg (+839 g, p = 0.001) lean mass (a proxy measure of total body skeletal muscle mass) in response to PRT with no exacerbation of disease activity. There was also a trend for loss of fat mass in the trunk (-752 g, p = 0.084) and a significant reduction in percent body fat (-1.1%, p = 0.047). Changes in body composition were associated with improvements in various measures of physical function. Conclusion. Intense PRT with adequate volume seems to be an effective and safe intervention for stimulating muscle growth in patients with RA. Pending confirmation of these results in a larger randomized controlled trial that includes patients with more active and severe disease, a similar PRT program should be included in the management of RA as adjunct treatment for cachexia

Significant muscle loss following intramuscular corticosteroid injection used to treat active rheumatoid arthritis; a case report

Introduction: Intramuscular (IM) injection of corticosteroids (CS) is recommended and routinely used to suppress inflammation and relieve pain during an acute episode or exacerbation of rheumatoid arthritis (RA). We present the case of a patient with RA who developed significant muscle loss following an IM CS (triamcinolone acetonide, 40 mg) injection given for a disease 'flare'. Case presentation: During a clinical trial assessing the effects of oral creatine monohydrate supplementation, we were able to assess changes to dual x-ray absorptiometry (DXA)-assessed body composition following an IM injection given to one of our patients. Although DAS28 was dramatically improved following the injection, assessment revealed a 2.4 kg (4%) loss of total lean mass (TLM) had occurred, the majority of which occurred in the arms and legs (2.0 kg (7%)). Discussion: Whilst it is possible that the depletion of LM occurred between the onset of flare and the CS injection, this single case report raises the possibility that the IM CS injection, which is regularly used and recommended as treatment of active RA, may be contributing to the substantial and sudden loss of muscle mass observed. Keywords: Rheumatoid arthritis, muscular atrophy, cachexia, intramuscular corticosteroid injectio