Physical Activity Following Total Hip Replacement : Measurement and Enhancement Using a Targeted Stepping Intervention

  • Artaban Johnson Jeldi

Student thesis: Doctoral ThesisDoctor of Philosophy (PhD)


Total hip joint replacement (THR) reduces pain and restores functional capacity for individuals with hip arthritis. It would be expected that this would allow patients to undertake more free-living physical activity (PA) However, there is emerging evidence that free-living physical activity (PA) levels do not change from pre-operative morbid levels. This study initially quantified the levels of PA of THR patients using body worn sensors, pre-operatively, at 3 months and at one-year post operation. Then a pilot feasibility intervention RCT using pedometers was implemented with the aim of encouraging participants to meet daily stepping targets. A detailed examination of THR patients in-hospital PA was also recorded.

For the first stage, 30 primary THR patients (68±6 years) had PA objectively measured using the ActivPAL3 pre-operatively, in-hospital, 1st week after discharge, at three months and at 12 months post-operation. Standard objective clinical outcome measures, including hip strength, balance (timed up and go test), speed (10 meter walk test) and endurance (the six minute walk test) along with subjective outcomes such as the Harris Hip Score (HHS), Oxford Hip Score (OHS), Hip disability and the osteoarthritis outcome score (HOOS) were also recorded. In stage two 20 participants were randomised into control (70.9 ±6.5years) and intervention groups (68.1±6.8 years) and followed up to 3 months post-operative. To enhance stepping activity a targeted step based pedometer protocol was implemented in the intervention group for 3 months. In-hospital PA data was collated from both stages 1 and 2.

PA levels did not change significantly from pre to 12 months post operation (sit-to-stand transitions/day (47 vs 44, p=0. 380), upright time/day (5.0 vs 5.4h, p=0. 861) or steps/day (5914 vs 6102, p=0. 283)) in the stage 1 study. Although all clinical measures improved (all p<0.001: HHS 51 vs 95; OHS 14 vs 47; HOOS 145 vs 466; 6MWT 250m vs 423m). Most of the PA measures demonstrated strong correlations (all r>0.6) between pre- and 12 month post-operative time points. In stage 2 there was a trend for both intervention and control groups to have improved number of steps at the 3 month time point when compared to stage 1. The intervention group, who underwent the targeted stepping protocol, appear to achieve higher levels of daily stepping when compared to the control group. From the overall in-hospital study, females were less active than males initially, but towards the end of stay both were equally active with most activity-taking place outside rehab.

Although clinical outcome measures improved post-THA as expected, habitual patterns of PA established pre-operation were not significantly altered. The use of a pedometer based intervention to promote enhanced stepping gave positive outcomes, suggesting that this may be a route to raising daily stepping activity. Using the acticvPAL3 monitor also provided invaluable insight into patients' recovery from surgery and the response to the rehabilitation regimes during In-hospital admission.
Date of Award2016
Original languageEnglish
Awarding Institution
  • Glasgow Caledonian University
SupervisorBen Stansfield (Supervisor) & Margaret Grant (Supervisor)

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