Preoperative therapeutic exercise in frail elderly scheduled for total hip replacement: a randomized pilot trial

OBJECTIVE: To evaluate the feasibility and preliminary effectiveness of therapeutic exercise before total hip replacement in frail elderly. DESIGN: A single-blind, randomized clinical pilot trial. SETTING: Outpatient physiotherapy department. SUBJECTS: Frail elderly with hip osteoarthritis awaiting total hip replacement. INTERVENTIONS: A short (3-6 weeks) tailor-made, therapeutic exercise programme was compared with usual care. MAIN MEASURES: Feasibility was assessed through patient satisfaction, adherence, occurrence of adverse events and the number of eligible non-volunteers. Preliminary preoperative effectiveness was assessed with performance and self-reported measures of pain, functioning, physical activity and quality of life. Postoperatively we measured functional recovery and length of hospital stay. RESULTS: Sixty-two eligible patients were approached of whom 21 (mean age 76 years) agreed to participate. Exercisers (n = 10), rated the intervention as very good 8.9 (8-10) (10-point rating scale). No serious adverse events occurred. Forty-one (66%) eligible patients did not participate, mainly because of logistic considerations, resulting in selection bias. The intervention group (trainings sessions participated 91%) showed relevant preoperative improvements on the chair-rise time (delta -2.9 seconds; 95% confidence interval (CI) -6.2 to 0.4) and timed-up-and-go (delta -4.4 seconds; 95% CI -9.3 to 0.5). Postoperatively, no significant differences were seen. CONCLUSIONS: A short, tailor-made, exercise programme is well tolerated and appreciated in elderly patients awaiting total hip replacement. However, a larger randomized clinical trial in the same setting is not warranted, because of the high number of eligible non-volunteers.