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

Day-zero ambulation may enable patients to recover and leave hospital quicker following total hip replacement (THR). The present randomised control feasibility study investigated the efficacy of day-zero ambulation as a physiotherapeutic intervention. Thirty-six non-blinded adults aged 44–85 (Mean 67.1; SD 9.6 years) undergoing primary, uncomplicated THR were block randomized to either a control group (n = 18) with standard post-operative physiotherapy or an intervention group (n = 18) incorporating walking on the same day as the operation. Outcomes were length of hospital stay (LOS), time to reach functional milestones and achieve all physiotherapy discharge criteria, post-operative pain scores, complications and patient experience. Participants treated with day-zero ambulation had reduced median hospital LOS of 1 day (p = .096), and median reduced times to reaching functional milestones of 39.7 h quicker to transfer to a chair (p < .001), 24.5 h quicker to walk 10 m (p = .009) and 26.4 h quicker to independently ascend and descend stairs (p = .01). Participants in the intervention group were deemed physiotherapy ready to leave hospital significantly earlier than control group (1.04 days, p = .015). Day-zero ambulation appears safe and may have clinically relevant effects in speeding patient functional recovery and facilitating earlier discharge from hospital. Implications for RehabilitationDay-zero ambulation following total hip replacement (THR) appears safe.Preliminary data suggest that day-zero mobilisation following THR could be efficacious and support the need for a fully powered randomised controlled trial.There may be a clinically relevant effect in speeding patient functional recovery and facilitating an earlier discharge from hospital. Day-zero ambulation following total hip replacement (THR) appears safe. Preliminary data suggest that day-zero mobilisation following THR could be efficacious and support the need for a fully powered randomised controlled trial. There may be a clinically relevant effect in speeding patient functional recovery and facilitating an earlier discharge from hospital.全髋关节置换术（total hip replacement, THR）后即刻下床活动，可助力患者在术后更快康复并出院。本项随机对照可行性研究，旨在评估即刻下床活动作为物理治疗干预手段的临床疗效。研究共纳入36名年龄介于44~85岁（平均67.1岁，标准差9.6岁）、接受初次单纯全髋关节置换术的非盲成年患者，通过区组随机化分为两组：对照组（n=18）接受标准术后物理治疗，干预组（n=18）则在手术当日即开展行走训练。本研究的观察结局包括住院时长（length of hospital stay, LOS）、达到功能里程碑及所有物理治疗出院标准所需时间、术后疼痛评分、并发症发生情况及患者体验。结果显示，接受即刻下床活动的患者中位住院时长缩短1天（p = .096）；达到各项功能里程碑的中位时间显著提前：转移至坐位快39.7小时（p < .001）、行走10米快24.5小时（p = .009）、独立上下楼梯快26.4小时（p = .01）。干预组患者达到物理治疗出院标准并可出院的时间较对照组显著提前1.04天（p = .015）。研究表明，全髋关节置换术后即刻下床活动安全性良好，可显著加快患者的功能恢复进程并促进早期出院，具备临床相关意义。 康复领域启示：全髋关节置换术后即刻下床活动安全性良好。初步数据提示，该干预措施或具有临床疗效，支持开展效力充足的随机对照试验。该干预或可加快患者功能恢复、促进早期出院。全髋关节置换术后即刻下床活动安全性良好。初步数据提示，该干预措施或具有临床疗效，支持开展效力充足的随机对照试验。该干预或可加快患者功能恢复、促进早期出院。