Nursing ResearchFinal PresentationNursing ResearchFinal Presentation

Josh AdamsBrian Bennion

Spencer CannonMatt Gerber

Josh AdamsBrian Bennion

Spencer CannonMatt Gerber

The Question

What are the effects 0f early physical therapy with ambulation after hip replacement surgery on length of

hospitalization and cost, compared to patients with delayed physical therapy

with ambulation?

Significance: Why do we care?

• Decreased costs for patient and society

• Decreased complications (e.g. DVTs, hemorrhages, infections, pressure ulcers)

• Faster recovery and return to activities of daily living; better quality of life

• Less strain on healthcare resources

The Search

• Database: PubMed

• Search terms: early ambulation, hip surgery, arthroplasty, rehabilitation

• Two journal articles explored the link between physical activity after hip replacement surgery and recovery.

The Articles• Munin, M. C., Rudy, T. E., Glynn, N. W.,

Crossett, L. S., Rubash, H. E. (1998). Early inpatient rehabilitation after elective hip and knee arthroplasty. JAMA, 279: 847-852.

• Larsen, K., Hansen, T. B., Thomsen, P. B., Christiansen, T., Soballe, K. (2009). Cost-effectiveness of accelerated perioperative care and rehabilitation after total hip and knee arthroplasty. The Journal of Bone and Joint Surgery (American), 91:761-772.

Levels of EvidenceBoth articles were written about

randomized controlled trials. These are Level II evidence.

FindingsEvidence shows that the intensity of

therapy, as measured by amount of time performed per day, in addition to when

intensive therapy is begun, has significance in regards to positive outcomes. Patients who began intensive therapy earlier than

the standard protocol (3 days vs 7 days post-op), experienced decreased hospital stays (11.7±2.3 days vs 14.5±1.9, P<.001) and lower costs ($25891±$3648 vs $27762±

$3626, P<.03). (Munin et al).

FindingsLarsen et al compared the results of an

accelerated protocol to those of a standard protocol. The accelerated protocol included: 1) starting mobilization and exercise on the day of

surgery and 2) eight hours of daily mobilization in teams after preset daily goals. The standard protocol included: 1) starting exercise and

mobilization on first post-op day and 2) four hours of daily mobilization at intensity per

individualized tolerance. Significant cost savings (approximately $4000 US, p=0.036) were found

to exist for those who engaged in the accelerated protocol.

Recommendations for Practice and Research

• Arrange time for physical therapy to work with patient at least twice daily.

• Encourage ambulation and exercises often at an intensity according to preset goals.

• Additional studies should be conducted for verification of these recommendations.

Limitations• Munin et al attrition rate 21%

• Relatively small sample sizes: (86 for Munin, 87 for Larsen). Munin limited the study group to individuals deemed “high risk.”

• No meta-analysis available. More research needed to verify results.

• Studies had different independent variables. The IV in Munin was the time at which intensive therapy began (3 vs 7 days). The IV in Larsen was the amount of mobilization patients engaged in per day.

clinical site policy“Starting the afternoon after surgery you will have Physical Therapy and twice a day after that, which

includes exercises, learning to sit, stand and walk with your new total joint. Patients usually take a few steps

the first day, then walking around your room, and so on. After you leave the hospital, you will have a list of the

exercises you have learned to continue yourself at home. Many patients will receive Physical Therapy at

home.”

http://healthcare.utah.edu/orthopaedics/patients/education/hipreplacement.html

Summary

Starting intensive therapy earlier leads to fewer days in the hospital and lower cost.

It is our recommendation that patients who undergo total hip replacement surgeries

should ambulate immediately and frequently following surgery in order to decrease

recovery time. We also recommend that further research be done to verify the

reliability of the study results.