Achtergrond: Coxartrose wordt vaak in het eindstadium behandeld met een Totale Heup Artroplastiek (THA). In de postoperatieve fase na een THA varieert het fysiotherapeutische beleid. Mogelijk leidt een verhoogd BMI tot een trager functioneel herstel na een THA. Een aangepast revalidatietraject zou dan van belang zijn. Vraagstelling: Is er een verschil in mate van functioneel herstel na een THA, bij patiënten met normaal gewicht, overgewicht en obesitas 12 weken en 6 maanden postoperatief? Daarnaast wordt de mate van associatie bepaald tussen BMI en de mate van functioneel herstel. Methode: In dit longitudinaal, prospectief onderzoek werden patiënten geïncludeerd in het PIUS ziekenhuis in Oldenburg; ze kregen allen eenzelfde revalidatietraject na de THA. Indeling vond plaats in 3 subgroepen, met normaal gewicht (BMI 18,5- 25 kg/m²), overgewicht (BMI 25 - 30 kg/m²) en obesitas (BMI > 30kg/m²). Mate van functioneel herstel werd objectief gemeten met de Timed Up & Go test (TUG) en de 5 Times Sit-to-Stand Test (5TSST), en subjectief met de self-reported vragenlijsten: de Hip disability and Osteoarthritis Outcome Score (HOOS) en de Short Form 36 (SF-36). Metingen werden verricht preoperatief (T0), en 12 weken (T1) en 6 maanden (T2) postoperatief. Met behulp van de Kruskall-Wallis test werden de verschilscores van de uitkomstmaten in de 3 subgroepen tussen T0-T1 en T0-T2 geanalyseerd. De mate van associatie werd berekend met de Spearman correlatiecoëfficiënt (rS). Het significantieniveau was p<0.05. Resultaten: Er werden 62 patiënten geïncludeerd. Er waren geen significante verschillen in functioneel herstel in beide tijdsintervallen tussen de groepen met een normaal gewicht (n=14), overgewicht (n=23) en obesitas (n=25); de p-waarde varieerde bij T0-T1 van p=0,069 tot p=0,962 en bij T0-T2 van p=0,068 tot p=0,931. Er werden zeer zwakke tot zwakke correlaties gevonden tussen BMI en de mate van functioneel herstel, variërend bij T0-T1 van rS=0,02 (p=0,892) bij de TUG tot rS=0,26 (p=0,041) bij ‘Algemene gezondheidsbeleving’ van de SF-36. Tussen T0-T2 varieerde de correlatiecoëfficiënt van rS=0,02 (p=0,876) bij ’Fysiek functioneren’ van de SF-36 tot rS=0,25 (p=0,053) bij ’Kwaliteit van leven’ van de HOOS.Conclusie: In deze studie werd geen verschil gevonden in de mate van functioneel herstel tussen patiënten met een normaal gewicht, overgewicht en obesitas na een THA. BMI was zwak tot zeer zwak geassocieerd met functioneel herstel na een THA tussen preoperatief en 12 weken en 6 maanden postoperatief. Implicaties voor de fysiotherapie: Tot op heden is er geen indicatie om voor groepen met overgewicht of obesitas een specifiek revalidatietraject te starten na een THA.
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Background: A meta-analysis examined differences in health-related quality of life (HRQoL) between seekers of surgical and non-surgical treatment, and non-treatment seekers, over and above differences that are explained by weight, age, and gender. Methods: Our literature search focused on the 'Impact of Weight on Quality of Life-Lite' (IWQOL-Lite) and the 'Short Form-36' (SF-36) questionnaires. Included were studies published between 1980 and April 2006 providing (pre-treatment) descriptive statistics of adult overweight or (morbid) obese persons. Excluded were elderly and ill patient groups. Results: Fifty-four articles, with a total number of nearly 100.000 participants, met the inclusion criteria. Persons seeking surgical treatment demonstrated the most severely reduced HRQoL. IWQOL-Lite scores showed larger differences between populations than SF-36 scores. After adjustment for weight, the population differences on the IWQOL disappeared. In contrast, the differences on the SF-36 between the surgical treatment seeking population and the other populations were maintained after adjustment for weight. Conclusion: The IWQOL-Lite questionnaire predominantly reflects weight-related HRQoL, whereas the SF-36 mostly reflects generic HRQoL that is determined by both weight and other factors. Our meta-analysis provides reference values that are useful when explicating or evaluating obesity-specific (IWQOL-Lite) or generic (SF-36) HRQoL, weight, and demographic characteristics of obese persons seeking or not seeking surgical or non-surgical treatment.
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Background: Recent technological developments such as wearable sensors and tablets with a mobile internet connection hold promise for providing electronic health home-based programs with remote coaching for patients following total hip arthroplasty. It can be hypothesized that such a home-based rehabilitation program can offer an effective alternative to usual care.Objective: The aim of this study was to determine the effectiveness of a home-based rehabilitation program driven by a tablet app and remote coaching for patients following total hip arthroplasty.Methods: Existing data of two studies were combined, in which patients of a single-arm intervention study were matched with historical controls of an observational study. Patients aged 18-65 years who had undergone total hip arthroplasty as a treatment for primary or secondary osteoarthritis were included. The intervention consisted of a 12-week home-based rehabilitation program with video instructions on a tablet and remote coaching (intervention group). Patients were asked to do strengthening and walking exercises at least 5 days a week. Data of the intervention group were compared with those of patients who received usual care (control group). Effectiveness was measured at four moments (preoperatively, and 4 weeks, 12 weeks, and 6 months postoperatively) by means of functional tests (Timed Up & Go test and the Five Times Sit-to Stand Test) and self-reported questionnaires (Hip disability and Osteoarthritis Outcome Score [HOOS] and Short Form 36 [SF-36]). Each patient of the intervention group was matched with two patients of the control group. Patient characteristics were summarized with descriptive statistics. The 1:2 matching situation was analyzed with a conditional logistic regression. Effect sizes were calculated by Cohen d.Results: Overall, 15 patients of the intervention group were included in this study, and 15 and 12 subjects from the control group were matched to the intervention group, respectively. The intervention group performed functional tests significantly faster at 12 weeks and 6 months postoperatively. The intervention group also scored significantly higher on the subscales "function in sport and recreational activities" and "hip-related quality of life" of HOOS, and on the subscale "physical role limitations" of SF-36 at 12 weeks and 6 months postoperatively. Large effect sizes were found on functional tests at 12 weeks and at 6 months (Cohen d=0.5-1.2), endorsed by effect sizes on the self-reported outcomes.Conclusions: Our results clearly demonstrate larger effects in the intervention group compared to the historical controls. These results imply that a home-based rehabilitation program delivered by means of internet technology after total hip arthroplasty can be more effective than usual care.Keywords: home-based rehabilitation program; internet; osteoarthritis; physiotherapy; rehabilitation; remote coaching; tablet app; total hip arthroplasty; total hip replacement; usual care.
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