Article

Postsurgical physiotherapy programs after total hip arthroplasty
(THA) show important differences between types and numbers of treatment sessions.
To increase functional recovery in postsurgical patients, manual therapy can be
added to traditional physiotherapy programs. Fascial manipulation (FM) has been
demonstrated to be effective in decreasing pain and increasing muscular capacity.
OBJECTIVE: To compare the effectiveness of FM when added to a standard protocol
of care. DESIGN: Randomized controlled trial. SETTING: Rehabilitation center.
PATIENTS: A total of 51 patients were recruited after total hip arthroplasty.
Inclusion criteria were first THA surgery, posterior-lateral access, and onset of
pain within a maximum 2 years. Exclusion criteria were previous hip or knee
prosthesis, congenital hip dysplasia, elective THA secondary to trauma, real
leg-length discrepancy (>/=1.5 cm), cognitive impairment, concomitant rheumatic
pathology in acute phase, and serious comorbidities such as cardiac, respiratory,
and/or neuromuscular pathologies. METHODS: Patients were randomized into 2
groups; both followed a standard protocol based on 2 daily sessions of active
exercises for 45 minutes. In the study group, 2 sessions were replaced by FM. The
clinical trial was registered at clinicaltrials.gov (NCT02576028). MAIN OUTCOME MEASURES: Functional outcome measures were collected before and after treatment
and at the end of the rehabilitation program. The measures included the Harris
Hip Score; Timed Up-and-Go test; articular range of motion in abduction, flexion,
extension, and bilateral external rotation with heels together; and verbal
numerical scale. RESULTS: Statistically significant differences were observed in
degrees of flexion between the study and control group with 25.4 (+/-11.3) and
18.7 (+/-9.5), respectively (P = .04); for abduction with 16.8 (+/-7.0) and 11.1
(+/-6.1), respectively (P = .005); for extension with 16.2 (+/-4.9) and 9.3
(+/-3.8), respectively (P = .001); for bilateral external rotation with heels
together with 8.3 (+/-4.3) and 5.5 (+/-4.6), respectively (P = .04); for the
Harris Hip Score 23.3 (+/-8.9) and 14.5 (+/-8.5), respectively (P = .002); and
for verbal numerical scale score 1.1 (+/-2.1) and 0.5 (+/-1.1), respectively.
CONCLUSIONS: This study demonstrates that 2 FM sessions are able to significantly
improve several functional outcomes in patients compared to usual treatment after THA.
LEVEL OF EVIDENCE: II.
CI - Copyright (c) 2016 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS