Date of Award
Selective Evidence-Based Medicine Review
Master of Science in Health Sciences - Physician Assistant
Physician Assistant Studies
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.
McCann, Laura Ann, "Does Pre-Operative Exercise Improve Quality of Life, Compared to Patient Education Alone, In Patients With Hip Osteoarthritis (OA) While Awaiting Total Hip Arthroplasty (THA)?" (2018). PCOM Physician Assistant Studies Student Scholarship. 332.