Does rapid mobilisation as part of an enhanced recovery pathway improve length of stay, return to function and patient experience post primary total hip replacement? A randomised controlled trial feasibility study

Figures & data

Table 1. Inclusion/Exclusion criteria.

Inclusion criteria

Exclusion criteria

Able to give informed written consent Any age Returned from theatre > 4 h Primary uni-lateral THR No intra-operative complications Weight-bearing status: ○Fully weight bearing ○Weight bearing as tolerated Adequate home support to facilitate early discharge

No current or historical serious co-morbidities: ○Cerebro-vascular accident ○Myocardial infarction ○PE ○DVT ○DM Significant intra- or post-operative wound ooze Poor pre-morbid mobility/level of function Clinical signs of DVT or PE Altered weight-bearing status Repair to abductor muscle complex Nerve block as part of anaesthetic Inflammatory arthritis Developmental dysplasia of the hip Concomitant procedure at time of THR Participation in any other research trials

DM: diabetes mellitus; DVT: deep vein thrombosis; THR: total hip replacement; PE: pulmonary embolism.

Table 2. Functional milestones.

Functional milestones
First prosthetic hip joint ROM First sit on the edge of the bed First transferred to a bedside chair First walk 5 m First walk 10 m First walk 40 m First achieved flight of stairs Time until physiotherapy complete for discharge

Table 3. Baseline group comparison.

	CONTROL (n = 18)		RAPID (n = 18)		Difference (Mean)	Difference (Median)	Significance (P)
	Mean (SD)	Median (IQR)	Mean (SD)	Median (IQR)
Age	67.2 (10.1)	69.0 (14)	66.9 (9.3)	69.5 (10.5)	0.7	0.5	p = .812
Number on theatre list	1.94 (0.73)	2 (0.75)	1.94 (0.8)	2 (1.75)	0.13	0	p = 1.000
Gender	30% Male		35% Male		5%	–	–

IQR: interquartile range; SD: standard deviation

Table 4. Length of stay, functional milestones and pain numerical rating results.

Variable	Descriptive statistic	Control group	Rapid group	Difference between groups	Significance
LOS (days)	Mean (SD)	4.53 (3.94)	3.00 (1.41)	–1.43	p = .096
	Median (IQR)	4.00 (2.00)	3.00 (1.00)	–1.00
Time to physiotherapy complete (days)	Mean (SD)	4.49 (2.89)	2.88 (0.88)	–1.61	p = .015
	Median (IQR)	3.97 (2.06)	2.93 (0.98)	–1.04
Time to functional milestones
First range of motion (ROM) (h)	Mean (SD)	6.9 (9.8)	5.0 (0.8)	–1.9	p = .302
	Median (IQR)	4.5 (1.2)	4.8 (1.4)	0.3
First sat on edge of bed (SOEOB) (h)	Mean (SD)	45.2 (26.5)	5.2 (0.9)	–40.0	p < .001
	Median (IQR)	45.1 (2.8)	5.2 (1.4)	–39.9
First transferred to chair (h)	Mean (SD)	46.9 (27.0)	12.8 (14.5)	–34.1	p < .001
	Median (IQR)	45.0 (17.6)	5.3 (20.4)	–39.7
First walk >5 m (h)	Mean (SD)	49.9 (30.0)	28.1 (20.5)	–21.8	p = .011
	Median (IQR)	45.3 (23.2)	25.4 (38.1)	–19.9
First walk >10 m (h)	Mean (SD)	60.0 (29.9)	40.0 (12.7)	–20.0	p = .009
	Median (IQR)	68.0 (25.8)	43.5 (20.8)	–24.5
First walk >40 m (h)	Mean (SD)	81.4 (34.7)	60.4 (21.5)	–20.9	p = .017
	Median (IQR)	71.3 (25.8)	67.3 (24.0)	–3.9
First independent stairs	Mean (SD)	107.5 (69.4)	65.8 (23.9)	–41.6	p = .010
	Median (IQR)	93.9 (49.6)	67.5 (23.7)	–26.4
Pain Numerical Rating Scale results
Post-operative Day 0 PNRS
PNRS at rest	Mean (SD)	1.12 (1.73)	1.79 (1.97)	0.67	p = .309
	Median (IQR)	0.00 (2.00)	1.50 (3.00)	1.50
PNRS on hip ROM	Mean (SD)	2.41 (2.27)	3.00 (2.99)	0.59	p = .683
	Median (IQR)	2.00 (5.00)	2.00 (4.00)	0.00
PNRS on walking	Mean (SD)	N/A	3.57 (3.01)	N/A	N/A
	Median (IQR)	N/A	3.50 (6.00)	N/A
Post-operative Day 1 PNRS
PNRS at rest	Mean (SD)	2.72 (1.99)	2.36 (2.59)	–0.36	p = .708
	Median (IQR)	3.00 (3.00)	1.00 (4.00)	–2.00
PNRS on hip ROM	Mean (SD)	4.78 (2.58)	3.79 (2.49)	–0.99	p = .322
	Median (IQR)	5.00 (3.50)	3.50 (4.00)	–1.50
PNRS on walking	Mean (SD)	4.73 (2.40)	3.79 (2.49)	–0.87	p = .892
	Median (IQR)	5.00 (2.50)	3.50 (4.00)	–1.00

IQR: interquartile range; LOS: length of hospital stay; PNRS: pain numerical rating scores; SD: standard deviation.

Table 5. Incidences of post-operative complications.

	Severity classification^a	Number of instances
Complication	Grade	Control	RAPID
Apnoea	IVa	1	0
Blood transfusion	II	1	0
Pulmonary embolism	II	1	0
Orthostatic hypotension	I	5	6
Wound ooze	I	0	2
Post-operative nausea and vomiting	I	4	3
Bruising around op-site	I	0	1
Chest pain	I	0	1
Dizziness	I	2	0
Pain limiting mobility	I	1	0
Post-operative confusion	I	1	0
Slow mobility progress	I	1	0
Syncope	I	1	0

^aGraded using the Clavien–Dindo classification.

Table 6. Patient experience questionnaire results.

	Control – Mean (SD)	RAPID – Mean (SD)	Difference between groups	Significance
Question 1	9.87 (0.516)	9.88 (0.485)	0.01	p = .575
Question 2	9.93 (0.258)	9.88 (0.332)	–0.05	p = 1.000
Question 3	9.87 (0.352)	9.88 (0.332)	0.01	p = .349
Question 4	9.93 (0.258)	9.94 (0.243)	0.01	p = .551
Question 5	9.60 (0.737)	9.41 (1.326)	–0.19	p = .960
Question 6	9.80 (0.561)	9.82 (0.529)	0.02	p = .654

Q1: Do you think the hospital staff did everything they could to help control your pain?

Q2: Overall, how was your experience of physiotherapy following your operation?

Q3: Overall, how was your experience of your overall hospital treatment?

Q4: Did you have confidence and trust in the physiotherapists treating you?

Q5: How beneficial was walking early after your operation?

Q6: How well was your progression with your physiotherapist paced to suit you?