ĭepending on when surgery is scheduled, early mobilization and walking are administered the day of surgery (WDS) or the day after. Moreover, this approach has been reported to have a key role also in reducing physiological and psychological stress related to surgery. In particular, satisfactory functional status allowing for continuing rehabilitation in autonomy has been described a few days after THA in patients who underwent early mobilization and walking. Early mobilization and walking performed in fast track THA patients produce several benefits such as reduction of deep vein thrombosis, increased patient satisfaction, shorter length of stay and hospitalization cost reduction. In particular, early mobilization and walking consists of transfers, out-of-bed functional activities such as sit-to-stand and maintenance of standing posture and ambulation as soon as possible after spinal anesthesia washout. It is characterized by procedures designed to administrate preoperative information and education, to alleviate surgical stress response, to treat pain, to support nutrition and to promote early mobilization and walking. Fast-track consist of a multimodal and interdisciplinary approach applied to patients undergoing elective surgery. In fact, several studies showed that improvements in perioperative care have significantly made early discharge possible without increasing complication rates, mainly through the fast track approach. Over the last few years, length of stay after THA has decreased from several weeks to a few days, allowing for cost reductions in National Health Services of many countries. The rapid achievement of functional independence represents a goal after THA, allowing for decreasing in hospital stay. Total hip arthroplasty (THA) is an effective and definitive treatment for end-stage hip osteoarthritis, able to improve functional status, quality of life (QoL) and relieve pain when conservative treatment fails. Absence of pain aggravation or adverse effects on hip function and quality of life may allow clinicians to recommend WDS to promote discharge with functional independence. WDS produces additional benefits in patients’ independence in the first week after THA. FIM total and motor scores ( p < 0.001), FIM self-care ( p = 0.027) and transfer-locomotion (p < 0.001) and HHS ( p = 0.032) decreased after surgery followed by improvements in postoperative days ( p ≤ 0.001). Between-group differences were found for FIM self-care ( p = 0.021, mean difference: 1.2, CI 95: 0.18, 2.1) in favor of SG at 7 days. Resultsīetween-groups differences were observed for FIM total and motor scores ( p = 0.002, mean difference: 2.1, CI 95: 0.64, 3.7) and FIM self-care ( p = 0.01, mean difference: 1.7, CI 95: 0.41, 3) in favor of SG at 3 days. Analysis of Covariance with age (SG: mean 60.9, SD 9.0 CG: mean 65.5, SD 8.9) and BMI (SG: mean 27.4, SD 2.8 CG: mean 26.7, SD 2.4) as covariates was used to assess between-group differences over time. 5D-VAS)the day before surgery, at 3 and 7 days in a hospital setting. Patients were evaluated for independence (Functional Independence Measure - FIM), pain (Numeric Rating Scale - NRS), hip function (Harris Hip Score - HHS) and quality of life (EuroQoL-5Dimension - EQ.
SG underwent WDS, whereas CG performed mobilization and walking the day after surgery starting the same physiotherapy program 1 day later. made up the SG, whereas patients who underwent surgery later and recovered from anesthesia after 7.00 p.m. Patients who recovered lower limbs sensitivity (disappearance of sensation deficits) and motility (MRC scale ≥3 at knee, ankle and great toe extension) by 7.00 p.m. Seventy-one patients were allocated in a study (SG: n = 36) or control (CG: n = 35) groups according to time of surgery and recovery from anesthesia. The study aim was to assess short-term effects of mobilization and walking the day of THA (WDS) on independence, pain, function and quality of life.
Few data address modalities for speeding up functional independence in subjects included in a fast-track approach after total hip arthroplasty (THA).
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