Preoperative home-based physical therapy versus usual care to improve functional health of frail older adults scheduled for elective total hip arthroplasty: a pilot randomized controlled trial

Arch Phys Med Rehabil. 2012 Apr;93(4):610-6. doi: 10.1016/j.apmr.2011.11.006. Epub 2012 Feb 24.


Objective: To investigate the feasibility and preliminary effectiveness of a home-based intensive exercise program to improve physical health of frail elderly patients scheduled for elective total hip arthroplasty (THA).

Design: Single-blind pilot randomized controlled trial.

Setting: Patients' homes and a general hospital in The Netherlands.

Participants: Frail patients (N=30) older than 65 years.

Intervention: A preoperative, home-based program supervised by an experienced physical therapist to train functional activities and walking capacity. The control group received usual care consisting of 1 session of instructions.

Main outcome measures: Feasibility was determined on the basis of adherence to treatment, patient satisfaction, adverse events, walking distance (measured with a pedometer), and intensity of exercise (evaluated with the Borg scale). Preliminary pre- and postoperative effectiveness was determined by the Timed Up & Go (TUG) test, 6-minute walk test (6MWT), Chair Rise Time, and self-reported measures of functions, activities, and participation.

Results: Patient satisfaction and adherence to the training were good (median=5 on a 5-point Likert scale) and no serious adverse events occurred. The Borg score during training was 14 (range, 13-16). Preoperative clinical relevant differences on the TUG test (2.9 s; 95% confidence interval [CI], -0.9 to 6.6) and significant differences on the 6MWT (41 m; 95% CI, 8 to 74) were found between groups.

Conclusions: Intensive preoperative training at home is feasible for frail elderly patients waiting for THA and produces relevant changes in functional health. A larger multicenter randomized controlled trial is in progress to investigate the (cost-)effectiveness of preoperative training.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Arthroplasty, Replacement, Hip*
  • Disability Evaluation
  • Feasibility Studies
  • Female
  • Frail Elderly*
  • Home Care Services / organization & administration*
  • Humans
  • Linear Models
  • Male
  • Motivation
  • Patient Compliance
  • Patient Satisfaction
  • Physical Therapy Modalities*
  • Pilot Projects
  • Postoperative Complications / prevention & control*
  • Preoperative Care / methods*
  • Statistics, Nonparametric
  • Treatment Outcome