Abstract
Introduction
Previous systematic reviews have shown that patients experience low physical activity levels following total hip replacement (THR). However no previous systematic reviews have examined the changes between pre- and post-operative physical activity levels.
Methods
AMED, MEDLINE, EMBASE, CENTRAL, CINHAL, openSIGLE, ClinicalTrials.gov and UK Clinical Trials Gateway databases were searched to 19th May 2015. All study designs presenting data on physical activity at pre- and up to one-year post-operatively were included. Eligible studies were critically appraised using the Cochrane risk of bias tool (for randomised controlled trials (RCTs)) and the CASP tool (non-RCTs). Where possible, mean differences (MD) and 95% confidence intervals (CI) were calculated through meta-analyses.
Results
From 3850 citations, 16 met the eligibility criteria; nine included in the meta-analysis. The quality of the evidence was graded low to moderate. There was no statistically significant difference in physical activity pre- to one year post-THR when assessed using: movement-related activity (MD: −0.08; 95% CI:- 1.60 to 1.44; I2=0%; n=77), percentage of 24 hours spent walking (MD: −0.21; 95% CI: −1.36 to 0.93; I2=12%; n=65), six minute walk test (MD: −60.85; 95% CI: −122.41 to 0.72; I2=84%; n=113) or the cardiopulmonary exercise test (MD: −0.24; 95% CI: −1.36 to 0.87; I2=0%; n=76).
Discussion
There is no evidence to suggest that physical activity changes pre- compared to post-THR. The low methodological quality of the included papers means this finding should be viewed with caution. Further research is warranted to better understand the relationship between physical activity pre- and post-THR, as greater consideration may be needed to increase physical activity in this population post-operatively.
Conclusion
Surprisingly, there is no significant change in physical activity following THR. Surgeons, physiotherapists and patients should consider how to increase and maintain physical activity levels to maximise the potential for wider-health benefits following THR.
