QUALITY OF LIFE IN PATIENTS WITH TOTAL HIP REPLACEMENT – A PILOT STUDY

: Introduction :


INTRODUCTION
Total hip replacement is a major surgery intervention with great importance for individuals suffering from degenerative joint diseases. Total hip replacements (THRs) are increasing as the aging population grows [1]. The goal of postsurgical rehabilitation is to improve the function of the affected joint and to help for returning to the labor market or to daily activities. The development of THR surgery requires an adequate rehabilitation protocol is focused on functional recovery, social adaptation and personal satisfaction from the healthcare services [2,3,4].
There are some controversial points of view according to the appropriate physical therapy modalities for each of the rehabilitation stages. Most authors recommend that physical therapy should be avoided in the early stage of rehabilitation in order to avoid complications such as joint dislocation and tromboembolia [4,5]. On the other hand, there are some evidence indicating that deep oscilations is an effective method for reducing pain, inflammation and swelling in the early rehabilitation stage following joint arthroplasty [6].
Pain management and functional recovery after THR are widely explored [7], but there is no research focus on a broader range of influence of THR on life, or such concepts are less evident. Discussing outcomes beyond pain and function generates a more holistic understanding of the recovery, relevant to the individual [8,9,10].
WHO defines the quality of life (QOL) as "an individual's perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns" [11]. This philosophy is based on the impact of illness on life in four dimensions -physical health, psychological health, social relationships, environment [12]. Two types of indicators could be used for quality of life assessment in THR patients, according to the purpose of the study. Specific tools are related to functional recoverypain, range of motion, gate, daily activities. The most used instrument for functional assessment after THR is Harris https://doi.org/10.5272/jimab.2023293.5039 Hip Score [13]. It consists of patient reported outcome component and physician-assessed range of motion. Although a self-reported outcome component only, called modified Harris Hip Score, is available, the main disadvantages of this tool are its narrow range and no validation in the Bulgarian population [14,15].
THR encompasses different personal feelings, activities and expectations, which makes it difficult to dichotomize individuals for analysis. Although QOL is a construct helping to unify heterogenic groups for research purposes, the assessment by using generic instruments is not familiar to most clinicians than pain and function. The best known generic instrument for QOL assessment is WHOQOL -BREF, but its reliability for THR patients has never been demonstrated in Bulgarian country [16,17].

AIM:
To evaluate QOL in THR patients undergoing personalized rehabilitation program and to define its influence on physical health, psychological health, social relationships and environmental aspects of life. We hypothesized that the personalized rehabilitation program improved QOL bias in physical health.

MATERIAL:
The study was conducted in the Department of Rehabilitation at University Hospital "St.Marina", Varna, after approval from the Commission for Scientific Research Ethics of Medical University -Varna. Patients who underwent conventional THR were admitted for 7 days rehabilitation course 1-4 weeks after surgery, following early rehabilitation protocol applied at the Orthopaedic and Traumatology clinic. Non consenting patients were excluded from the study. WHO QOL-BREF were given to all included patients on the first and the last day of hospital stay. The hospital rehabilitation program consists of: deep oscillations (in case of contraindications, DO were excluded)) and kinesitherapy (isometric exercises, isotonic exercises, suspension, crutch walking education, gait training exercises).

RESULTS and DISCUSSION:
Socio-demographic characteristics. The number of patients included in the study was 19 (13 females and 6 males), ages 18-65 were involved in the study. The causes for THR were identified as follows: Primary hip joint osteoarthritis -14; Fracture -2; Aseptic necrosis of the femoral head -2; Congenital dislocation of hip -1. Comorbidity was reported in all participants.
Quality of life measurement. Cronbach alpha = 0.918, which means strong reliability for THR patients. We found a statistically significant improved total QOL score in 58% of cases with a variation of 10-54% comparing results before and after the rehabilitation program.
Statistical hypothesis testing showed significant improvement in physical health, psychological health and environment, with no difference regarding social relationships.
The mean value of the physical domain at the admission was 7,79, and that of patients discharged was 13,32 (table 1) The alternative hypothesis H1 states that a statistically significant difference exists.
2. A significance level of α=0.05 (5% risk of error) is assumed at a probability guarantee of p=95%.

A t-test is used.
4. The accepted level of significance α=0.05 (5% risk of error) at a guaranteed probability p=95%, and the estimated cutoff level of significance Sig (p) are compared 5. p=0.000< α=0.05, therefore from the theory of statistics, it can be concluded that the null hypothesis H0 is rejected and the alternative is accepted, and therefore there is a statistically significant difference in the Physical do-main regarding patients on admission and upon discharge (table 3) The mean value of the psychological domain at admission was 10.68, at that of patients at discharge 12.47(table 4)  of error) at a guaranteed probability p=95%, and the estimated cutoff level of significance Sig (p) are compared 5. p=0.004< α=0.05, therefore, from the theory of statistics, it can be concluded that the null hypothesis H0 is rejected and the alternative is accepted, and therefore there is a statistically significant difference in the Psychological Area block regarding patients on admission and upon discharge. (table 6)  A strong positive correlation (0.906) was reported between social relationships at admission and social rela-  The alternative hypothesis H1 states that a statistically significant difference exists.
2. A significance level of α=0.05 (5% risk of error) is assumed at a guaranteed probability of p=95% 3. A t-test is used 4. The accepted level of significance α=0.05 (5% risk of error) at a guaranteed probability p=95%, and the estimated cutoff level of significance Sig (p) are compared 5. p=0.360> α=0.05, therefore, from the theory of statistics, it can be concluded that the null hypothesis H0 is accepted, and therefore there is no statistically significant difference in Attitude block regarding patients on admission and on discharge. (table 12) The comparison of QOLscores before and after the personalized rehabilitation program showed significantly improved QOL in domains 1,2, 4 but not in domain one. Functional improvement in the hip joint range of motion was reported far all THR patients. Similar to the results of other researchers, our study shows validity in surgical interventions such as THRs.

CONCLUSION:
Rehabilitation medicine aims not just to recover from specific diseases but to provide overall healing and resocialization. Personalized rehabilitation protocol, including a combination of physical modalities (deep oscillations) and kinesitherapy, applied in the early stage after surgery, could impact different aspects of life in addition to functional recovery. WHO-QOL BREF scores mean a reflection of every aspect of individuals being and could be used as a single too for recovery monitoring after THR and setting person oriented rehabilitation programs.