The effect of a preoperative physical therapy education program on short-term outcomes of patients undergoing elective total hip arthroplasty: A controlled prospective clinical trial

Objective: The aim of this study was to determine the effect of a preoperative physical therapy education program on the short-term outcomes of patients undergoing elective Total Hip Arthroplasty (THA). Methods: A prospective, parallel-group controlled clinical trial was conducted from September 2016 to July 2018. Fifty patients who were scheduled for a first elective THA procedure were recruited and were equally allocated into one of two groups: intervention and control groups. While all patients received the routine preparation for the procedure, the intervention group underwent an additional structured physical therapy education session. Functional status was evaluated using The Oxford Hip Score (OHS) preoperatively and 6 weeks after the operation. Length of Hospital Stay (LOS) was recorded. State anxiety was measured by the state-anxiety portion of the Spielberger’s State-Trait Anxiety Inventory questionnaire preoperatively and on the second postoperative day. Gait and balance abilities were assessed using Tinetti Performance-Oriented Mobility Assessment (POMA) test on the second postoperative day. Pain at rest and during weight-bearing was measured by a Numerical Rating Scale (NRS) on the postoperative second day. Satisfaction rates were evaluated by the NRS 6 weeks after the operation. Results: Forty-seven patients completed the study. The intervention group consisted of 24 patients (10 males, 14 females; mean age = 64.29 ± 6.7 years), and the control group consisted of 23 patients (7 males, 16 females; mean age = 65.91 ± 10.19 years). The mean postoperative OHS was significantly higher in the intervention group than in the control group (39.04 ± 3.99 vs 28.04 ± 7.23, P < 0.001). Both groups increased their functional abilities 6 weeks postoperatively; however, the intervention group showed a greater increase than the control group (P = 0.001). No significant difference was found in the LOS between the control (2.83 ± 0.71) and intervention groups (2.71 ± 0.62) (P = 0.551). Patients in the intervention group exhibited lower rates of anxiety two days after the operation compared with the controls (17.75 ± 6.50 vs 27.70 ± 10.32, P < 0.001). The intervention group showed higher postoperative POMA scores compared to the control group (19.67 ± 3.89 vs 15.39 ± 5.85, P = 0.005). Although no significant difference was observed in resting pain between groups (P = 0.105), the intervention group reported a lower pain intensity while walking compared to the control group (5.04 ± 1.68 vs 6.39 ± 2.62, P = 0.041). While both groups reported high satisfaction rates 6 weeks postoperatively, patients in the intervention group were more satisfied than those in the control group (9.67 ± 0.91 vs 8.35 ± 1.82, P = 0.003). Conclusion: A structured interactive preoperative physical therapy education program for patients undergoing a THA may reduce anxiety, generate a faster recovery, reduce pain, and promote higher satisfaction. We recommend this program for routine use. Level of Evidence: Level II, Therapeutic Study.