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This study aims to investigate the effects of an early postoperative rehabilitation program combined with neuromuscular electrical stimulation (NMES) and telerehabilitation on functional recovery in patients undergoing total hip arthroplasty (THA).
In the early postoperative period, patients commonly experience muscle weakness, impaired gait, and functional limitations that may delay recovery. Early rehabilitation has been shown to improve functional outcomes, while NMES may enhance muscle activation, particularly in hip abductor muscles. Additionally, telerehabilitation may support continuity of care following discharge by enabling supervised home-based exercise.
In this prospective study, participants will be assigned to either an intervention group receiving early physiotherapy combined with NMES and telerehabilitation, or a control group receiving standard postoperative care. Functional outcomes, gait parameters, quality of life, and muscle-related changes will be evaluated at predefined time points.
This study is designed as a prospective, randomized controlled clinical trial to evaluate the effectiveness of an early postoperative rehabilitation program combined with neuromuscular electrical stimulation (NMES) and telerehabilitation in patients undergoing total hip arthroplasty (THA).
Following THA, patients frequently experience muscle weakness, gait asymmetries, and reduced functional capacity, which may prolong recovery. Although early mobilization and rehabilitation are widely recommended, the combined effects of NMES and telerehabilitation within a structured early-phase rehabilitation program have not been sufficiently investigated.
Participants will be randomly allocated into intervention and control groups using a simple randomization method. The intervention group will receive a structured physiotherapy program initiated on the first postoperative day and continued daily during hospitalization. This program will be combined with NMES targeting the gluteus medius muscle, applied using surface electrodes placed over the motor point with stimulation parameters adjusted according to patient tolerance.
After discharge, participants in the intervention group will continue a structured home-based exercise program supported by synchronous telerehabilitation sessions conducted three times per week. These sessions will enable real-time supervision, feedback on exercise performance, and progression based on standardized tolerance criteria.
The control group will receive the standard postoperative care protocol routinely applied in the clinic, without additional NMES or telerehabilitation support.
All participants will be evaluated at predefined time points: preoperatively (within 3 days before surgery), at discharge (postoperative day 6), and at postoperative week 4. Outcome assessments will be performed by an experienced physiotherapist blinded to group allocation, and intervention delivery and outcome assessment will be conducted by different physiotherapists.
The primary objective of the study is to determine whether the addition of NMES and telerehabilitation to early rehabilitation improves functional recovery following THA. Secondary objectives include evaluating changes in muscle strength, joint mobility, pain levels, gait characteristics, and muscle morphology.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Experimental Group (Early Physiotherapy + NMES + Telerehabilitation) | Experimental | Participants will receive a structured physiotherapy program initiated on the first postoperative day, including exercise and neuromuscular electrical stimulation (NMES) targeting the gluteus medius during hospitalization (5 days). After discharge, the intervention will continue with a 3-week home-based exercise program supported by synchronous telerehabilitation sessions conducted three times per week. |
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| Control Group (Standard Care) | Active Comparator | Participants will receive the hospital's standard postoperative care during hospitalization, including routine monitoring and wound care without a structured physiotherapy program. At discharge, they will be provided with a home exercise brochure with instructions but will not receive supervised telerehabilitation. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Early Postoperative Physiotherapy | Other | A structured physiotherapy program including mobilization and therapeutic exercises initiated on postoperative day 1 and continued daily until discharge (5 days). |
| Measure | Description | Time Frame |
|---|---|---|
| Timed Up and Go (TUG) Test | Functional mobility will be assessed using the Timed Up and Go (TUG) test. The time required to stand up from a chair, walk 3 meters, turn, return, and sit down will be recorded in seconds. | Preoperative (within 3 days before surgery), postoperative day 6 (at discharge), and postoperative week 4. |
| 10-Meter Walk Test (10MWT) | Gait speed will be assessed using the 10-Meter Walk Test. Walking speed will be recorded in meters per second (m/s). | Preoperative (within 3 days before surgery), postoperative day 6 (at discharge), and postoperative week 4 |
| Stair Climb Test | Functional lower extremity performance will be assessed using the Stair Climb Test. The time required to ascend and descend a standardized flight of stairs will be recorded in seconds. | Preoperative (within 3 days before surgery), postoperative day 6 (at discharge), and postoperative week 4 |
| Measure | Description | Time Frame |
|---|---|---|
| 6-Minute Walk Test (6MWT) | Functional exercise capacity will be assessed using the 6-Minute Walk Test. The total walking distance covered in 6 minutes will be recorded in meters. | Preoperative (within 3 days before surgery), postoperative day 6 (at discharge), and postoperative week 4 |
| Hip Muscle Strength (Manual Muscle Testing) |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Cansu Dal, Specialist Physiotherapist | Contact | +905379773071 | ptcansudal@gmail.com |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Niğde Ömer Halisdemir University, Education and Research Hospital | Recruiting | Niğde | Merkez | 51200 | Turkey (Türkiye) |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 16627680 | Background | Baldwin ER, Klakowicz PM, Collins DF. Wide-pulse-width, high-frequency neuromuscular stimulation: implications for functional electrical stimulation. J Appl Physiol (1985). 2006 Jul;101(1):228-40. doi: 10.1152/japplphysiol.00871.2005. Epub 2006 Apr 20. | |
| 32844909 | Background | Marchisio AE, Ribeiro TA, Umpierres CSA, GalvAo L, Rosito R, Macedo CAS, Galia CR. Accelerated rehabilitation versus conventional rehabilitation in total hip arthroplasty (ARTHA): a randomized double blinded clinical trial. Rev Col Bras Cir. 2020;47:e20202548. doi: 10.1590/0100-6991e-20202548. Epub 2020 Aug 12. English, Portuguese. |
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At this stage, the plan for sharing individual participant data has not yet been determined.
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| ID | Term |
|---|---|
| D000069350 | Telerehabilitation |
| ID | Term |
|---|---|
| D012046 | Rehabilitation |
| D000359 | Aftercare |
| D003266 | Continuity of Patient Care |
| D005791 | Patient Care |
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2 groups with two different applications
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The study was designed as a single-blind randomized controlled trial in which outcome assessments were performed by an independent and experienced physiotherapist blinded to group allocation.
| Neuromuscular Electrical Stimulation (NMES) | Device | NMES applied to the gluteus medius muscle starting on postoperative day 1, administered daily for 5 days using standard stimulation parameters to enhance muscle activation. |
|
| Telerehabilitation | Other | A 3-week home-based exercise program supported by synchronous video-based telerehabilitation sessions conducted three times per week after discharge. |
|
| Standard Postoperative Care | Other | Routine postoperative care including wound monitoring and general medical follow-up during hospitalization. At discharge, patients receive a home exercise brochure without supervised rehabilitation or telerehabilitation. |
|
Hip muscle strength (flexion, extension, and abduction) will be evaluated using Manual Muscle Testing, graded on a scale from 0 to 5, where 0 indicates no muscle contraction and 5 indicates normal muscle strength. Higher scores indicate better muscle strength. |
| Preoperative (within 3 days before surgery), postoperative day 6 (at discharge), and postoperative week 4 |
| Range of Motion (ROM) | Hip joint range of motion (flexion, extension, and abduction) will be measured using a goniometer and recorded in degrees. Higher values indicate greater joint mobility. | Preoperative (within 3 days before surgery), postoperative day 6 (at discharge), and postoperative week 4 |
| Pain Intensity (Visual Analog Scale - VAS) | Pain intensity during movement will be assessed using the Visual Analog Scale (VAS), a 10-centimeter scale ranging from 0 to 10, where 0 indicates no pain and 10 indicates the worst imaginable pain. Higher scores indicate worse pain. | Preoperative (within 3 days before surgery), postoperative day 6 (at discharge), and postoperative week 4 |
| Hip Function and Quality of Life (International Hip Outcome Tool-12) | Hip-related function and quality of life will be assessed using the International Hip Outcome Tool-12 (IHOT-12). Scores range from 0 to 100, with higher scores indicating better hip function and quality of life. | Preoperative (within 3 days before surgery), postoperative day 6 (at discharge), and postoperative week 4 |
| Gluteus Medius Muscle Sarcopenia (CT-Based Assessment) | Gluteus medius muscle sarcopenia will be assessed using computed tomography (CT) imaging. Muscle cross-sectional area and composition will be analyzed. | Preoperative (within 3 days before surgery) and postoperative week 4 |
| Step Length | Step length will be assessed using gait analysis methods and recorded in meters. Higher values indicate better gait performance. | Preoperative (within 3 days before surgery), postoperative day 6 (at discharge), and postoperative week 4 |
| Cadence | Cadence will be assessed using gait analysis methods and recorded as steps per minute. Higher values indicate better gait performance. | Preoperative (within 3 days before surgery), postoperative day 6 (at discharge), and postoperative week 4 |
| Walking Speed | Walking speed will be assessed using gait analysis methods and recorded in meters per second (m/s). Higher values indicate better gait performance. | Preoperative (within 3 days before surgery), postoperative day 6 (at discharge), and postoperative week 4 |
| 31440408 | Background | Madara KC, Marmon A, Aljehani M, Hunter-Giordano A, Zeni J Jr, Raisis L. PROGRESSIVE REHABILITATION AFTER TOTAL HIP ARTHROPLASTY: A PILOT AND FEASIBILITY STUDY. Int J Sports Phys Ther. 2019 Jul;14(4):564-581. |
| 23190932 | Background | Monaghan B, Grant T, Hing W, Cusack T. Functional exercise after total hip replacement (FEATHER): a randomised control trial. BMC Musculoskelet Disord. 2012 Nov 28;13:237. doi: 10.1186/1471-2474-13-237. |
| D013812 |
| Therapeutics |
| D006296 | Health Services |
| D005159 | Health Care Facilities Workforce and Services |
| D017216 | Telemedicine |
| D003695 | Delivery of Health Care |
| D010346 | Patient Care Management |
| D006298 | Health Services Administration |