Effects of a Home-Based Resistance Training Program on Recovery From Total Hip Replacement Surgery: Feasibility and Pilot Testing

居家阻力復健運動於骨關節炎病人行全髖關節置換術後之可行性及初步成效探討

張靜芬(Ching-Fen Chang) ； 林寬佳(Kuan-Chia Lin) ； 陳威明(Wei-Ming Chen) ； 簡淑慧(Sui-Whi Jane) ； 葉淑惠(Shu-Hui Yeh) ； 王采芷(Tsae-Jyy Wang)

《The Journal of Nursing Research》 25卷1期 (2017/02) Pp. 21-30

https://doi.org/10.1097/jnr.0000000000000128

摘要

Background: Postoperative exercise rehabilitation helps patients recover normal joint functions after total hip arthroplasty (total hip replacement surgery or THR) by strengthening the muscles that surround the replaced hip joint. However, the high cost of professionally supervised exercise rehabilitation programs limits access to program participation and, thus, to optimal recovery of normal joint functions. Therefore, the development of an effective home-based, self-monitored exercise rehabilitation program is critical to promote the optimal recovery of THR patients. Purpose: This study tests the efficacy of a home-based resistance-band exercise program on mobility, functional exercise capacity, and health-related quality of life in THR patients. Methods: This study uses a preexperimental repeated measures design. A convenience sample of 30 patients who underwent total hip replacement for osteoarthritis was recruited. All patients participated in a 12-week home-based resistance training program. Data were collected at baseline and at 2, 6, and 12 weeks postoperation on the following dimensions: up-and-go time, timed walking distance, and quality of life. In addition, intervention-related adverse events and the exercise adherence rate were monitored. Generalized estimation equations were used to analyze changes in the outcome variables across time. Results: The study included 21 women and nine men. The mean age of the participants was 67.9 years (SD = 8.1 years, range = 55-86 years). Results of the generalized estimation equations showed a statistically significant time effect for up-and-go time, 6-minutewalking distance, and health-related quality of life. After 12 weeks of training, the participants' up-and-go time decreased 40.33% from the baseline measurements, with a mean change of 6.38 seconds (p ＜ .001). The 6-minute walking distance increased 41.34%, with a mean change of 117.12 meters (p ＜ .001). The score for health-related quality of life decreased 78.94%, with a mean change of 39.10 (p ＜ .001). The average exercise adherence rate was 72.63%. The average score for the feasibility of the intervention was 8.8 (range = 6-10). Conclusions/Implications for Practice: The results of this study support the hypothesis that a home-based resistance training program is safe, feasible, and effective for improving the mobility, functional exercise capacity, and health-related quality of life of THR patients. Considering the low cost and convenience of a home-based resistance training program, health professionals should consider this and similar exercise programs when providing guidance to THR patients.

關鍵字

home-based training ； resistance band ； hip arthroplasty ； total hip replacement

並列摘要

背景　復健運動對全髖關節置換術後病人的復原及關節功能十分重要，髖關節周圍肌群訓練更是復健運動的關鍵，考量於醫療院所或復建中心進行的復健計畫費用昂貴，因此，發展與測試術後居家復健運動訓練有其必要性。目的　探討「居家彈力帶阻力復健運動」對改善髖關節置換術後病人下肢功能與生活品質的可行性和初步成效。方法　採重複測量之前實驗研究設計，以方便性取樣，招募骨關節炎單側初次進行全髖關節置換術病人為研究對象，以彈力帶進行12週漸進性阻力居家復健運動訓練。於術前一天、術後2週、6週及12週進行資料收集，包括計時起走量測、六分鐘步行距離測試及關節炎相關之生活品質量表填答。結果　共30位病人參與本研究，其中21位女性、9位男性，平均年齡67.9歲（標準差8.1，範圍55-86），GEE的結果顯示計時起走、六分鐘步行距離測試及生活品質在隨時間的進展上均有統計上顯著意義，計時起走花費時間從術前到術後12週減少40.33%，平均減少6.38秒（p ＜ .001）。六分鐘步行距離增加41.34%，平均增加117.12公尺（p ＜ .001）。生活品質從術前到術後12週改善78.94%，平均改善39.10分（p ＜ .001）。運動的執行率高，平均為72.63%，對介入措施的可行性的平均得分是8.8（範圍6-10）。結論／實務應用　研究結果顯示居家彈力帶阻力復健運動是安全、可行的有效措施，其能增加病人的活動與運動功能及改善健康相關的生活品質。考量居家復健成本低、便利性高，根據本研究結果醫療人員應可對全髖關節置換的病患介紹居家彈力帶阻力復健運動。

並列關鍵字

居家訓練 ； 彈力帶 ； 髖關節成形術 ； 全髖關節置換術

參考文獻

Bellamy, N.,Buchanan, W. W.,Goldsmith, C. H.,Campbell, J.,Stitt, L. W.(1988).Validation study of WOMAC: A health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee.The Journal of Rheumatology.15(12),1833-1840.

Chang, T. F.,Liou, T. H.,Chen, C. H.,Huang, Y. C.,Chang, K. H.(2012).Effects of elastic-band exercise on lower-extremity function among female patients with osteoarthritis of the knee.Disability and Rehabilitation.34(20),1727-1735.

Di Monaco, M.,Vallero, F.,Tappero, R.,Cavanna, A.(2009).Rehabilitation after total hip arthroplasty: A systematic review of controlled trials on physical exercise programs.European Journal of Physical and Rehabilitation Medicine.45(3),303-317.

Ferrara, P. E.,Rabini, A.,Maggi, L.,Piazzini, D. B.,Logroscino, G.,Magliocchetti, G.,Bertolini, C.(2008).Effect of pre-operative physiotherapy in patients with end-stage osteoarthritis undergoing hip arthroplasty.Clinical Rehabilitation.22(10-11),977-986.

Galea, M. P.,Levinger, P.,Lythgo, N.,Cimoli, C.,Weller, R.,Tully, E.,Westh, R.(2008).A targeted home- and centerbased exercise programfor people after total hip replacement: A randomized clinical trial.Archives of Physical Medicine and Rehabilitation.89(8),1442-1447.