At discharge gait speed and independence of patients provides a challenges for rehabilitation after total joint arthroplasty: an observational study

BACKGROUND: The level of functioning in people discharged from hospital after hip arthroplasty is very heterogeneous and prognostic factors are not fully understood. The aim of this study was to determine the mean level of autonomy achieved by such patients at discharge from hospital using the Iowa Level of Assistence (ILOA) scale as a measurement tool and to investigate the possible predictive factors of this autonomy. METHODS: It was conducted a prospective cohort study including hip arthroplasty patients treated consecutively in 2012. Hip arthroplasty patients following fractures, revision surgery and partial replacement were excluded, as well as patients with concomitant neurologic or rheumatologic diseases or postoperative complications that did not allow to continue the rehabilitation program, and patients with a hospitalization of more than 7 days. During the last 24 h of hospital stay the physiotherapist filled in the ILOA scale and collected all data (age, gender, number of physiotherapy treatments, length of hospitalization). Statistical analysis (univariate and multivariate analysis) was performed between the variables collected and the ILOA Score. RESULTS: The sample was composed of 167 patients. The mean score of the ILOA was 16.6 (±6.5) and gait speed had the poorest outcome 0.19 m/s - 0.43 m/s. Multivariate analysis showed that older women are most at risk of not achieving good levels of autonomy. CONCLUSIONS: In hip arthroplasty patients at discharge from hospital gait speed is severely impaired. The challenge for rehabilitation should be to recover walking ability and efficiency starting from the early post-operative period. Gender- and age-tailored rehabilitation programs should be considered by placing particular attention on elderly women.