Clinical and cost-effectiveness of physiotherapy interventions following total hip replacement: a systematic review and meta-analysis

Rheumatol Int. 2020 Sep;40(9):1385-1398. doi: 10.1007/s00296-020-04597-2. Epub 2020 May 25.


To examine the reported clinical and cost-effectiveness of physiotherapy interventions following total hip replacement (THR). A systematic review was completed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). MEDLINE, CINAHL, AMED, Scopus, DARE, HTA, and NHS EED databases were searched for studies on clinical and cost-effectiveness of physiotherapy in adults with THR published up to March 2020. Studies meeting the inclusion criteria were identified and key data were extracted. Risk of bias was assessed using the Cochrane Risk of Bias Tool and a Consolidated Health Economic Evaluation Reporting Standards (CHEERS). Data were summarised and combined using random-effect meta-analysis. A total of 1263 studies related to the aim of the review were identified, from which 20 studies met the inclusion criteria and were included in the review. These studies were conducted in Australia (n = 3), Brazil (n = 1), United States of America (USA) (n = 2), France (n = 2), Italy (n = 2), Germany (n = 3), Ireland (n = 1), Norway (n = 2), Canada (n = 1), Japan (n = 1), Denmark (n = 1), and United Kingdom (UK) (n = 1). The duration of follow-up of the included studies was ranged from 2 weeks to 12 months. Physiotherapy interventions were found to be clinically effective for functional performance, hip muscle strength, pain, and range of motion flexion. From the National Health Service perspective, an accelerated physiotherapy programme following THR was cost-effective. The findings of the review suggest that physiotherapy interventions were clinically effective for people with THR. However, questions remain on the pooled cost-effectiveness of physiotherapy interventions, and further research is required to examine this in patients with THR. Future studies are required to examine the cost-effectiveness of these interventions from patients, caregivers, and societal perspectives.Registration Prospero (ID: CRD42018096524).

Keywords: Cost-effectiveness; Physiotherapy; Systematic review; Total hip replacement.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Aged
  • Arthroplasty, Replacement, Hip / rehabilitation*
  • Cost of Illness
  • Exercise Therapy / economics
  • Exercise Therapy / methods*
  • Female
  • Humans
  • Length of Stay
  • Male
  • Middle Aged
  • Quality of Life
  • Treatment Outcome