Functional Movement Retraining After Hip Replacement

Rehabilitation following total hip arthroplasty (THA) is limited in scope, and some patients
continue to exhibit functional limitations, as well as loading asymmetries that place them
at risk for developing osteoarthritis in contralateral joints. The purpose of this study is
to collect preliminary data to support a larger project that will examine the effectiveness
of a 12-session functional movement retraining (FMR) program for Veterans following THA. A
novel aspect of the FMR program is that it focuses not only on improving overall function
but also normalizing side-to-side asymmetries in balance and strength via patient-specific
tailoring of exercises. The program also involves telerehabilitation processes to improve
access.

Participants will be n=15 patients scheduled for THA at the Durham VAMC, identified from
electronic medical records. Participants will complete assessments pre-operatively, then
approximately 6-weeks post-THA, at which time FMR program will begin. The 12 FMR sessions
will optimally be delivered twice weekly for 6 weeks. However, to account for missed visits,
the investigators will allow for 9 total weeks to complete the 12 sessions. Therefore
follow-up assessments will be scheduled at 15-weeks post-THA for all participants. FMR
sessions will be a combination of: 1.) in-person, on-site visits and telephone contacts with
a licensed physical therapist and 2.) in-home telehealth visits by a telehealth technologist
or physical therapy assistant. The FMR program will focus on improving lower extremity
mobility, muscle stability and functional movement patterns. Participants will be instructed
to perform a series of stretching exercises daily and strengthening exercises three times
weekly. Exercises for each patient will be tailored according to results of the Lower
Quarter Y-Balance Test (conducted at baseline and mid-way through the program), which
assesses asymmetries between limbs and between anterior vs. posterior reach. Outcomes will
include objective functional measures (timed up-and-go, sit-to-stand, walking speed, stair
climb, Lower Quarter Y-Balance Test), self-reported pain and activity limitations (Hip
disability and Osteoarthritis Outcome Score), and therapist-assessed function (Harris Hip
Score). Basic descriptive statistics will be used to compare changes in each outcome
(pre-operative to 15-week post-THA and 6-week post THA to 15-week post-THA) and inform
sample size estimates for a larger trial. The investigators will also assess various aspects
of program feasibility (recruitment success, adherence, telerehabilitation processes) and
collect in-depth qualitative information from both patients and therapists to assess aspects
of the intervention that may need to be modified prior to a larger study.

Inclusion Criteria:

- Veteran, Scheduled for hip arthroplasty at Durham, NC VA Medical Center

Exclusion Criteria:

- Dementia or other significant cognitive impairment;

- movement or motor neuron disorders (e.g., Parkinson's Disease, post-stroke
neurological deficiencies);

- rheumatoid arthritis,

- fibromyalgia,

- or other systemic rheumatic disease;

- hospitalization for a stroke,

- myocardial infarction,

- heart failure,

- or coronary artery revascularization in the past 3 months;

- psychosis or current, uncontrolled substance abuse disorder;

- any other health conditions determined by the study team to be contraindications to
performing the exercise program (e.g., mild home exercises);

- transportation or other limitations that would prevent visits to the Durham VAMC for
the retraining program.