CRITICAL THINKING IN RESEARCH METHODOLOGIES WITH RESPECT TO EXERCISES OF HIP REPLACEMENT SURGERY

Critical Thinking in Research Methodologies With Respect To Exercises of Hip Replacement Surgery

Critical Thinking in Research Methodologies With Respect To Exercises of Hip Replacement Surgery

Introduction

An Increasing Number of hip and knee replacements are performed each year throughout the world. It is estimated that current numbers could double by the year 2016. This increase has been attributed to the aging population, prosthetic advancements, and an increased number of younger people receiving the operation. Lengthy waits for hip or knee joint replacement surgery have been reported in several countries. (I.N. Ackerman and K.L. Bennell, 2004, pp 176-182)

People awaiting joint replacement surgery of the hip or knee experience high levels of pain and reduced physical performance, which can have a profound impact on quality of life. Long waits for surgery prolong this experience and could increase disability. (C.A. Jones, D.C. Voaklander, W.C. Johnston and M.E. Suarez-Almazor, 2000, pp1745-1752)

Although it is generally accepted that exercise can reduce pain and improve function in those with lower-limb arthritis, few studies have demonstrated this benefit in those awaiting hip or knee joint replacement surgery. (M. Fransen, J. Crosbie and J. Edmonds, 2001, pp 156-164) However, methodologic limitations and small sample sizes affected the conclusiveness of many of these trials. A systematic review of randomized trials in those with earlier stage hip or knee OA has demonstrated improvements in pain and physical function after exercise-based interventions. The optimal content of the exercise interventions remains uncertain. Few studies have compared the effects of land-based and pool-based exercise, and few differences in their effects have been found. (C.H. MacWilliam, 1996, pp623-638)

This study aimed to determine whether 2 different exercise-based interventions, together with education and a home environment assessment, might improve the preoperative status of those awaiting joint replacement surgery of the hip or knee. Additionally, it aimed to determine whether land-based exercise or pool-based exercise was more effective in reducing disability, and whether 1 form of exercise was better tolerated than another.

Methods

Study Population

Volunteers were recruited from the surgical waiting list of a tertiary health care provider in regional Victoria, Australia. Patients were eligible if they were on the waiting list for joint replacement surgery of the hip or knee. (C.H. MacWilliam, 1996, pp623-638) Subjects were excluded if only tibial osteotomy was to be performed, if they were currently completing a physiotherapy program, if surgery was scheduled before completion of the 6-week supervised program, if they were not medically fit to complete an exercise program as assessed by their local doctor, or if they had inadequate communication skills in English. (I.N. Ackerman and K.L. Bennell, 2004, pp 176-182) Subjects were not excluded if they had previously had physiotherapy, including physiotherapy for their affected joints. They were not excluded if they completed a self-directed exercise program or a group exercise program under the direction of a lay instructor. Participants were recruited over a 10-month period. (C.A. Jones, D.C. Voaklander, W.C. Johnston and ...