A targeted home- and center-based exercise program for people after total hip replacement: a randomized clinical trial. Shared responsibility for ongoing rehabilitation: a new approach to home-based therapy after stroke Exercise induced effects on muscle function and range of motion in patients with hip osteoarthritis Early exercise-based rehabilitation improves health-related quality of life and functional capacity after acute myocardial infarction: a randomized controlled trial. Maintaining benefits following pulmonary rehabilitation: a randomised controlled trial Comparison of the effects of a physiotherapist-supervised exercise programme and a self-supervised exercise programme on quality of life in patients with Parkinson’s disease The effect of exercise on hip muscle strength, gait speed and cadence in patients with total hip arthroplasty: a randomized controlled study Pelvic floor muscle exercises utilizing trunk stabilization for treating postpartum urinary incontinence: randomized controlled pilot trial of supervised versus unsupervised training Effects of extended outpatient rehabilitation after hip fracture: a randomized controlled trial. Early, intensified home-based exercise after total hip replacement--a pilot study.
OBJECTIVE To examine the physical function , gait , and quality of life of patients after total hip replacement ( THR ) r and omly assigned to either a targeted home- or center-based exercise program . DESIGN R and omized controlled trial . SETTING Rehabilitation research center in Australia . PARTICIPANTS Twenty-three patients with unilateral THR were r and omly assigned to a supervised center-based exercise group ( n=11 ) or an unsupervised home-based exercise group ( n=12 ) . INTERVENTION The center-based group completed an 8-week targeted exercise program while under the direct supervision of a physiotherapist . After initial instruction , the home-based group completed the 8-week targeted exercise program at home without further supervision . MAIN OUTCOME MEASURES Quality of life , physical function , and spatiotemporal measures of gait . RESULTS No significant interaction ( group by time ) or main effects of grouping were found . Within each group , quality of life , and stair climbing improved significantly ( P<.05 ) as did Timed Up & Go test and 6-minute walk test performances ( P<.05 ) . Walking speed increased by 16 cm/s ( P<.01 ) , cadence by 8 steps/min ( P<.05 ) , step length by 4.7 cm ( P<.05 ) , and double-support time reduced by a factor of 16 % . Step length symmetry showed significant improvement ( P<.05 ) over time . Step length differential between the affected and unaffected limbs reduced from 4.0 to 2.7 cm . CONCLUSIONS The targeted strengthening program was effective for both the home- and center-based groups . No group differences were found in the majority of the outcome measures . This finding is important because it shows that THR patients can achieve significant improvements through a targeted strengthening program delivered at a center or at home Objective : To assess the efficacy of a programme of continuing self-directed exercises for people discharged home after a stroke , supervised once a week by therapists . Design : A r and omized controlled trial of 100 patients discharged from hospital after a stroke , requiring ongoing therapy . The control group received outpatient or day hospital therapy ; the experimental group were visited once a week by an occupational and /or physiotherapist who prescribed a programme of exercises and activities for the following week . Subjects were studied for the first three months after discharge from hospital . Setting : A district general hospital , or the homes of subjects r and omized to the experimental group , in New Zeal and . Main outcome measures : ( 1 ) Characteristics of the groups , ( 2 ) gait speed , limb function , activities of daily living , ( 3 ) time with therapists , ( 4 ) mood of both subjects and caregivers , ( 5 ) anticipation of outcome at entry , compared with perceived outcome at exit . Results : No statistical differences between the control and experimental groups in characteristics , or in any outcomes measured , except that the contact time period , but not the number of visits , was longer in the experimental group ( p = 0.003 ) . Conclusions : A supervised home-based programme is as effective as outpatient or day hospital therapy BACKGROUND AND PURPOSE Patients with hip osteoarthritis have impairments in muscle function ( muscle strength and power ) and hip range of motion ( ROM ) , and it is commonly believed that effective clinical management of osteoarthritis should address these impairments to reduce pain and disability . Therefore , the purpose of this study was to compare the short- and long-term effects of 4 months of physiotherapist-supervised strength training , physiotherapist-supervised Nordic Walking ( NW ) , or unsupervised home-based exercise ( HBE ) on muscle function and hip ROM in patients diagnosed with hip osteoarthritis . METHODS Secondary outcome analyses from an observer-blinded three-armed parallel- design r and omized controlled trial in 60 + -year-old patients with clinical hip osteoarthritis ( American College of Rheumatology criteria ) who were not on a waiting list for hip replacement . One hundred and fifty-two patients were r and omized to either 4 months of physiotherapist-supervised , moderate , progressive , strength training ( n = 50 ) , physiotherapist-supervised NW ( n = 50 ) , or unsupervised HBE ( n = 52 ) . Maximal isometric hip and thigh muscle strength and leg extensor power and active hip ROM were assessed at baseline 2 , 4 , and 12 months . RESULTS Intention-to-treat-analyses did not show any significant between-group differences for improvements in muscle strength and power or ROM at any time points . Short-term significant ( p < .05 ) increases in muscle strength were present in the physiotherapist-supervised exercise groups and in the long-term for muscle power in the NW-group . All exercise modes result ed in significant increases of ROM but long-term improvements were only shown for NW and HBE . DISCUSSION Four months of physiotherapist-supervised , progressive , moderate , and strength training was less effective than hypothesized for improving muscle strength and power in patients with hip osteoarthritis who are not awaiting hip replacement . Our results may indicate that in these patients , improvements in disability are not necessarily dependent on improvements in strength and power or ROM BACKGROUND The purpose of this study was to evaluate the influence of an early cardiac rehabilitation ( CR ) program on health-related quality of life ( HRQL ) and functional capacity in patients who recently experienced an acute myocardial infa rct ion ( AMI ) . This program was initiated in the inpatient setting and was followed by an unsupervised outpatient intervention . METHODS After the same inpatient care plan , low-risk patients who experienced an AMI were r and omized into 2 groups : ( 1 ) a control group ( CG ) ( n = 43 )  entailing usual care and ( 2 ) an intervention group ( IG ) ( n = 45 ) entailing outpatient ( unsupervised ) CR primarily centered on a progressive walking program . Initially , all patients underwent a supervised exercise program with early mobilization beginning 12 hours after an AMI . On hospital discharge , all patients were classified according to cardiovascular risk . Quality of life was evaluated by the MacNew Heart Disease HRQL question naire 30 days after discharge . Functional capacity was determined by a 6-minute walk test ( 6MWT ) distance on the day of inpatient discharge as well as 30 days afterward . RESULTS The HRQL global score was higher in the IG compared with the CG 30 days after discharge ( P < 0.001 ) ; physical and emotional domain scores were both significantly higher in the IG ( P < 0.001 ) . Furthermore , the IG showed a greater 6MWT distance compared with the CG ( P < 0.001 ) . CONCLUSIONS A CR program based on early progressive exercises , initiated by supervised inpatient training and followed by an unsupervised outpatient program , improved HRQL and functional capacity in patients at low cardiovascular risk who recently experienced an AMI The aim of this study was to determine if weekly , supervised , outpatient-based exercise plus unsupervised home exercise following an 8-week pulmonary rehabilitation programme would maintain functional exercise capacity and quality of life at 12 months better than st and ard care of unsupervised home exercise training . Chronic obstructive pulmonary disease ( COPD ) subjects completed an 8-week pulmonary rehabilitation programme  , were r and omised to an intervention group ( IG ) of weekly , supervised , exercise plus home exercise or to a control group ( CG ) of unsupervised home exercise and followed for 12 months . Outcome measurements at baseline ( after pulmonary rehabilitation ) , and 3 , 6 and 12 months included the 6-min walk test and St George 's Respiratory Question naire ( SGRQ ) .  59 subjects with moderate COPD ( Global Initiative for Chronic Obstructive Lung Disease stage II ) were recruited and 48 subjects completed the study . 12-month mean difference showed no significant change from baseline in 6-min walk distance ( IG -11 m , 95 % CI -21–10 m ; CG -6 m , 95 % CI -34–11 m ) or total SGRQ score ( IG 3 , 95 % CI -0.8–7 ; CG -3 , 95 % CI -7–3 ) . 12 months following pulmonary rehabilitation both weekly , supervised , outpatient-based exercise plus unsupervised home exercise and st and ard care of unsupervised home exercise successfully maintained 6-min walk distance and quality of life in subjects with moderate COPD Objectives : To compare the effects of a physiotherapist-supervised exercise programme in an exercise unit and self-supervised home exercise programme on quality of life in patients with Parkinson ’s disease . Design : Assessor-blinded , quasi-r and omized trial ( alternate allocation ) . Setting : An outpatient exercise unit ; home setting s. Participants : Thirty patients with idiopathic Parkinson ’s disease , Hoehn & Yahr I — III , stable medication use . Interventions : Patients were included in the physiotherapist-supervised or home group . The exercise programme was performed for 10 weeks , three times/week either under the supervision of a physiotherapist or at home without supervision . Main outcome measures : Parkinson ’s Disease Quality of Life Question naire ( PDQLQ ) , Nottingham Health Profile ( NHP ) , Unified Parkinson ’s Disease Rating Scale ( UPDRS ) , Beck Depression Inventory ( BDI ) . Results : Patients in the supervised physiotherapy group improved more than the home exercise group in Parkinson ’s Disease Quality of Life Question naire ( total score , Parkinson ’s symptoms , emotional function ) , Nottingham Health Profile total , Unified Parkinson ’s Disease Rating Scale ( all domains ) and Beck Depression Inventory scores . Conclusions : The exercise programme under physiotherapist supervision was found to be more effective at improving activities of daily living , motor , mental , emotional functions and general health quality in patients with Parkinson ’s disease compared with a self-supervised home programme Objective : To evaluate the effect of home versus in-hospital exercise ( under supervision ) programmes on hip strength , gait speed and cadence in patients with total hip arthroplasty at least one year after operation . Setting : Physical therapy and rehabilitation department . Subjects : Twenty-six patients who had had a total hip arthroplasty operation 12—24 months prior to the study were enrolled . Interventions : The patients were r and omized into three groups : group 1 patients were assigned a home exercise programme , group 2 patients exercised under physiotherapist supervision in hospital , and group 3 served as the control group , with no specific intervention . The study duration was six weeks . Main measures : Maximum isometric abduction torque of operated hip muscle , gait speed and cadence were measured before and after the study . Results : Maximum isometric abduction torques of the hip abductor muscles improved in groups 1 and 2 , but not in group 3 ( 30 ± 12 to 38 ± 11 ft.lb in group 1 , 18 ± 10 to 30 ± 9.8 ft.lb in group 2 ) . Gait speed improved from 67.8 ± 23 to 74.35 ± 24 m/min in group 1 , from 48.53 ± 4 to 56.7 ± 5 m/min in group 2 and from 58.01 ± 12 to 59.8 ± 14 m/min in group 3 . Cadence also improved , from 97.7 ± 18 to 111 ± 17 steps/min in group 1 , from 90.75 ± 6 to 104.75 ± 7 steps/min in group 2 , and from 87 ± 16 to 88.22 ± 16 steps/min in group 3 . When the three groups were compared , group 2 showed the best improvement ( P = 0.006 ) only in maximum isometric abduction torque . Conclusion : Our findings suggest that both home and supervised exercise programmes are effective one year after total hip arthroplasty . Home exercise programmes with close follow-up could be recommended Objective : To investigate the effect of supervised and unsupervised pelvic floor muscle exercises utilizing trunk stabilization for treating postpartum urinary incontinence and to compare the outcomes . Design : R and omized , single-blind controlled study . Setting : Outpatient rehabilitation hospital . Subjects : Eighteen subjects with postpartum urinary incontinence . Interventions : Subjects were r and omized  to either a supervised training group with verbal instruction from a physiotherapist , or an unsupervised training group after undergoing a supervised demonstration session . Main measures : Bristol Female Lower Urinary Tract Symptom question naire ( urinary symptoms and quality of life ) and vaginal function test ( maximal vaginal squeeze pressure and holding time ) using a perineometer . Results : The change values for urinary symptoms ( −27.22 ± 6.20 versus −18.22 ± 5.49 ) , quality of life ( −5.33 ± 2.96 versus −1.78 ± 3.93 ) , total score ( −32.56 ± 8.17 versus −20.00 ± 6.67 ) , maximal vaginal squeeze pressure ( 18.96 ± 9.08 versus 2.67 ± 3.64 mmHg ) , and holding time ( 11.32 ± 3.17 versus 5.72 ± 2.29 seconds ) were more improved in the supervised group than in the unsupervised group ( P < 0.05 ) . In the supervised group , significant differences were found for all variables between pre- and post-test values ( P < 0.01 ) , whereas the unsupervised group showed significant differences for urinary symptom score , total score and holding time between the pre- and post-test results ( P < 0.05 ) . Conclusions : These findings suggest that exercising the pelvic floor muscles by utilizing trunk stabilization under physiotherapist supervision may be beneficial for the management of postpartum urinary incontinence CONTEXT Hip fractures are common in the elderly , and despite st and ard rehabilitation , many patients fail to regain their prefracture ambulatory or functional status . OBJECTIVE To determine whether extended outpatient rehabilitation that includes progressive resistance training improves physical function and reduces disability compared with low-intensity home exercise among physically frail elderly patients with hip fracture . DESIGN , SETTING , AND PATIENTS R and omized controlled trial conducted between August 1998 and May 2003 among 90 community-dwelling women and men aged 65 years or older who had had surgical repair of a proximal femur fracture no more than 16 weeks prior and had completed st and ard physical therapy .  INTERVENTION Participants were r and omly assigned to 6 months of either supervised physical therapy and exercise training ( n = 46 ) or home exercise ( control condition ; n = 44 ) . MAIN OUTCOME MEASURES Primary outcome measures were total scores on a modified Physical Performance Test ( PPT ) , the Functional Status Question naire physical function subscale ( FSQ ) , and activities of daily living scales . Secondary outcome measures were st and ardized measures of skeletal muscle strength , gait , balance , quality of life , and body composition . Participants were evaluated at baseline , 3 months , and 6 months . RESULTS Changes over time in the PPT and FSQ scores favored the physical therapy group ( P = .003 and P = .01 , respectively ) . Mean change ( SD ) in PPT score for physical therapy was + 6.5 ( 5.5 ) points ( 95 % confidence interval [ CI ] , 4.6 - 8.3 ) , and for the control condition was + 2.5 ( 3.7 ) points ( 95 % CI , 1.4 - 3.6 points ) . Mean change ( SD ) in FSQ score for physical therapy was + 5.2 ( 5.4 ) points ( 95 % CI , 3.5 - 6.9 ) and for the control condition was + 2.9 ( 3.8 ) points ( 95 % CI , 1.7 - 4.0 ) . Physical therapy also had significantly greater improvements than the control condition in measures of muscle strength , walking speed , balance , and perceived health but not bone mineral density or fat-free mass . CONCLUSION In community-dwelling frail elderly patients with hip fracture , 6 months of extended outpatient rehabilitation that includes progressive resistance training can improve physical function and quality of life and reduce disability compared with low-intensity home exercise BACKGROUND AND PURPOSE Despite a successful surgical procedure , deficits in muscle strength and physical function are documented 1 - 2 years after total hip replacement ( THR ) . There is a lack of evidence concerning which rehabilitation strategy is the most effective after THR . The purpose of this pilot study was to investigate the feasibility of an early-initiated intensified , home-based training regime and to form the basis of future studies with regard to exercises , outcome measures and power calculations . METHODS The trial is a single-blinded , cluster-r and omized controlled trial performed at an orthopaedic physiotherapy department in a public hospital in Denmark . A consecutive sample of 46 patients undergoing primary THR surgery for osteoarthritis between September 2008 and January 2009 was included . Forty-four patients completed the trial ( 96 % follow-up ) . Participants were r and omly assigned to an intervention group ( IG , n = 23 ) receiving 12 weeks of intensified exercises ( e.g. rubber b and resistance ) or a control group ( CG , n = 21 ) receiving st and ard rehabilitation exercises without external resistance . The outcome measurements were maximal gait speed , isometric hip abductor muscle strength , one-legged stance , health-related quality of life ( EuroQol-5 Dimensions ) , patient satisfaction , and patient-evaluated function , stiffness and pain ( Western and Ontario McMasters University Osteoarthritis Index ) . RESULTS There were significant increases in both groups in all the measurements during the 12 weeks of exercises . All participants in the IG were satisfied or very satisfied with the exercises compared with 85 % in the CG ( P = 0.095 ) . In the IG , four participants ( 17.4 % ) had difficulties when performing the intensified exercises at home . Hip abduction strength was significantly weaker in the leg operated compared with the leg not operated on after the intervention in both groups ( P < 0.01 ) . CONCLUSION This pilot study indicates that the majority of THR patients tolerated early-initiated intensified exercises without additional pain and with high patient satisfaction . It seems that some of the patients need supervision to perform intensified exercises
Function and quality of life could not be meta-analysed due to insufficient data and heterogeneity of measures , but functional measures tended to favour the physiotherapy rehabilitation group .
Most outcomes were similar between outpatient and home-based exercise programs .
Physiotherapy rehabilitation improves hip abductor strength , gait speed and cadence in people who have been discharged from hospital after total hip replacement .
Physiotherapist-directed rehabilitation exercises appear to be similarly effective whether they are performed unsupervised at home or supervised by a physiotherapist in an outpatient setting
QUESTION In people who have been discharged from hospital after a total hip replacement , do rehabilitation exercises directed by a physiotherapist improve strength , gait , function and quality of life ?
Are these exercises as effective in an unsupervised home-based setting as they are in a supervised outpatient setting ?