Date of Award


Degree Type

Selective Evidence-Based Medicine Review

Degree Name

Master of Science in Health Sciences - Physician Assistant


Physician Assistant Studies

Department Chair

John Cavenagh, MBA, PhD, PA-C


Objective: The objective of this selective EBM review is to determine whether or not pre-operative exercise improves quality of life, compared to patient education alone, in patients with hip osteoarthritis (OA) while awaiting total hip arthroplasty (THA).

Study Design: Systematic review of three randomized controlled trials (RCTs) published in peer-reviewed journals between 2015 and 2016, all in the English language.

Data Sources: Three randomized controlled trials were found using PubMed.

Outcomes Measured: The change in ADL (activities of daily living), recreational function, and pain were measured in all trials using self-reported patient questionnaires (WOMAC) and a variety of physical activities before and after the patient completed the required pre-operative exercise program. Which were then presented as a change in mean from baseline and compared to the control group.

Results: Study by Hermann et al. showed in increase in ADL function in the intervention group vs. control group (p-value <0.001) after completing a pre-operative progressive explosive-type resistance training. Study by Svege et al. saw at long term follow up that the patients that performed the pre-operative exercise program prolonged their need for THA (p-value 0.034) and had an increase in ADL function compared to the control group (p-value 0.004). Study by Zeng et al. showed that the patients that performed pre-operative tai chi and strength training had an increase in ADL function compared to the control group (p-value <0.01). However, none of the studies showed a significant change in pain outcomes between the intervention and control groups.

Conclusions: Evidence supporting the use of pre-operative exercise regimens is feasible for increase in activities of daily living and function, but not for pain in patients with hip OA awaiting THA. Pre-operative exercise programs should be considered in patients that can tolerate it while awaiting their surgery, but the THA is what will ultimately improve pain.