Objective: to identify the most predictive factors for the functional outcome of hip replacement surgery and which of these factors can be modified through physiotherapy intervention; to evaluate the feasibility and efficacy of different types of treatment on the modification of these factors in the preoperative phase and on the functional outcomes following surgery. Materials and Methods: a literature research was carried out through the PubMed and PEDro online databases. Only the articles beyond 2012 were included in the review. These articles have, as a sample, adult subject affected by hip osteoarthritis. The first part of the research was based on the collection of data regarding the predictive factors of the functional outcome of total hip replacement surgery, through the selection of prospective studies. In the second part of the research, controlled clinical trials were selected. They analyze the effectiveness of physiotherapy intervention in the pre and postoperative period. Results: 8 studies concerning predictive factors were selected. They took into account age, gender, body mass index, comorbidity, physical function, pain, psychosocial aspects, severity of osteoarthritis on radiography and level of school education of the patients. For the evaluation of the effectiveness of physiotherapy intervention, 12 articles were included. They comprise treatments based on an exercise program, education or both. The selected studies assessed physical function through patient-filled questionnaires (Harris Hip Score, Short Form Health Survey 36, Oxford Hip Score, Iowa Level of Assistance Scale, Western Ontario and McMaster University Osteoarthritis index and Hip Disability and Osteoarthritis Outcome Score), and through functional tests. Conclusions: preoperative physical function seems to be the most relevant predictor of functional outcomes after hip replacement surgery among the investigated predictive factors. Other factors that can have a notable impact on postoperative function are: age, presence of comorbidities and patient’s psychosocial condition. Preoperative physiotherapy in patients with hip osteoarthritis has been found to be a feasible treatment. The literature notes that a programs based only on exercises, or also based on patient education, have moderately improved the patients' functional abilities prior to total hip replacement surgery. These positive changes of the functional status are maintained even in the first months following the intervention. This occurs to a greater extent in patients who took part in a physiotherapy education program. It is therefore desirable to activate preoperative programs in order to obtain the greatest possible functional outcome in post surgery recovery.
Obiettivo: individuare i fattori maggiormente predittivi per l’esito funzionale dell’intervento di artroprotesi d’anca e quali tra questi fattori siano modificabili tramite l’intervento fisioterapico; valutare la fattibilità e l’efficacia di diversi tipi di trattamento sulla modificazione di questi fattori nella fase preoperatoria e quindi, sugli esiti funzionali a seguito dell’intervento chirurgico. Materiali e metodi: è stata effettuata una ricerca bibliografica nelle banche dati online PubMed e PEDro; sono stati inclusi nella revisione solo gli articoli successivi al 2012, che hanno come campione soggetti adulti affetti da artrosi d’anca. La prima parte della ricerca si è basata sulla raccolta dei dati riguardanti i fattori predittivi dell’esito funzionale dell’intervento chirurgico, tramite la selezione di studi prospettici. Nella seconda parte della ricerca sono stati selezionati i trials clinici controllati che prendono in considerazione l’efficacia dell’intervento fisioterapico nel pre e nel postoperatorio. Risultati: sono stati selezionati 8 studi riguardanti i fattori predittivi, che hanno preso in considerazione età, genere, indice di massa corporea, comorbidità, funzionalità fisica, dolore, aspetti psicosociali, gravità dell’artrosi alla radiografia e livello di educazione scolastica dei pazienti; per la valutazione dell’efficacia dell’intervento fisioterapico sono stati inclusi 12 articoli, che comprendevano dei trattamenti basati su un programma di esercizi, sull’educazione o su entrambi. Gli studi selezionati hanno valutato la funzionalità fisica, sia tramite dei questionari compilati dai pazienti (Harris Hip Score, Short Form Health Survey 36, Oxford Hip Score, Iowa Level of Assistance Scale, Western Ontario and McMaster University Osteoarthritis index e Hip Disability and Osteoarthritis Outcome Score) che tramite dei test funzionali. Conclusioni: tra i fattori predittivi indagati, la funzionalità fisica preoperatoria sembra essere il più rilevante rispetto agli esiti funzionali dopo l’intervento di artroprotesi d’anca. Altri fattori che possono incidere in modo importante sulla funzione postoperatoria sono l’età, la presenza di comorbidità e la condizione psicosociale del paziente. La fisioterapia preoperatoria, nei pazienti con artrosi d’anca, si è rivelata essere un trattamento fattibile. La letteratura rileva che sia un programma di esercizi che uno basato anche sull’educazione hanno migliorato in modo moderato le capacità funzionali dei pazienti in vista dell’intervento di sostituzione totale d’anca. Questi cambiamenti positivi dello stato funzionale si mantengono anche nei primi mesi a seguito dell’intervento e ciò avviene in misura maggiore nei pazienti che hanno partecipato a un programma di educazione fisioterapica. Si auspica quindi l’attivazione di programmi preoperatori al fine di ottenere il maggior esito funzionale possibile nel recupero post chirurgico.
Fisioterapia e fattori predittivi degli outcomes funzionali nell’artroprotesi di anca: revisione della letteratura
ZARATIN, DAVIDE
2021/2022
Abstract
Objective: to identify the most predictive factors for the functional outcome of hip replacement surgery and which of these factors can be modified through physiotherapy intervention; to evaluate the feasibility and efficacy of different types of treatment on the modification of these factors in the preoperative phase and on the functional outcomes following surgery. Materials and Methods: a literature research was carried out through the PubMed and PEDro online databases. Only the articles beyond 2012 were included in the review. These articles have, as a sample, adult subject affected by hip osteoarthritis. The first part of the research was based on the collection of data regarding the predictive factors of the functional outcome of total hip replacement surgery, through the selection of prospective studies. In the second part of the research, controlled clinical trials were selected. They analyze the effectiveness of physiotherapy intervention in the pre and postoperative period. Results: 8 studies concerning predictive factors were selected. They took into account age, gender, body mass index, comorbidity, physical function, pain, psychosocial aspects, severity of osteoarthritis on radiography and level of school education of the patients. For the evaluation of the effectiveness of physiotherapy intervention, 12 articles were included. They comprise treatments based on an exercise program, education or both. The selected studies assessed physical function through patient-filled questionnaires (Harris Hip Score, Short Form Health Survey 36, Oxford Hip Score, Iowa Level of Assistance Scale, Western Ontario and McMaster University Osteoarthritis index and Hip Disability and Osteoarthritis Outcome Score), and through functional tests. Conclusions: preoperative physical function seems to be the most relevant predictor of functional outcomes after hip replacement surgery among the investigated predictive factors. Other factors that can have a notable impact on postoperative function are: age, presence of comorbidities and patient’s psychosocial condition. Preoperative physiotherapy in patients with hip osteoarthritis has been found to be a feasible treatment. The literature notes that a programs based only on exercises, or also based on patient education, have moderately improved the patients' functional abilities prior to total hip replacement surgery. These positive changes of the functional status are maintained even in the first months following the intervention. This occurs to a greater extent in patients who took part in a physiotherapy education program. It is therefore desirable to activate preoperative programs in order to obtain the greatest possible functional outcome in post surgery recovery.File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.12608/38711