A targeted home- and center-based exercise program for people after total hip replacement: a randomized clinical trial. Shared responsibility for ongoing rehabilitation: a new approach to home-based therapy after stroke Exercise induced effects on muscle function and range of motion in patients with hip osteoarthritis Early exercise-based rehabilitation improves health-related quality of life and functional capacity after acute myocardial infarction: a randomized controlled trial. Maintaining benefits following pulmonary rehabilitation: a randomised controlled trial Comparison of the effects of a physiotherapist-supervised exercise programme and a self-supervised exercise programme on quality of life in patients with Parkinson’s disease The effect of exercise on hip muscle strength, gait speed and cadence in patients with total hip arthroplasty: a randomized controlled study Pelvic floor muscle exercises utilizing trunk stabilization for treating postpartum urinary incontinence: randomized controlled pilot trial of supervised versus unsupervised training Effects of extended outpatient rehabilitation after hip fracture: a randomized controlled trial. Early, intensified home-based exercise after total hip replacement--a pilot study. Minimally Supervised Home Rehabilitation Improves Exercise Capacity and Health Status in Patients with COPD Low-intensity exercise as a modifier of physical frailty in older adults. Effect of early supervised progressive resistance training compared to unsupervised home-based exercise after fast-track total hip replacement applied to patients with preoperative functional limitations. A single-blinded randomised controlled trial. Do supervised weekly exercise programs maintain functional exercise capacity and quality of life, twelve months after pulmonary rehabilitation in COPD? Group physiotherapy provides similar outcomes for participants after joint replacement surgery as 1-to-1 physiotherapy: a sequential cohort study. A Survey of Opinions and Attitudes Toward Exercise Following a 12‐month Maintenance Exercise Program for People with COPD Independent home versus supervised rehabilitation following arthroscopic knee surgery--a prospective randomized trial. Hospital vs Home-Based Exercise Rehabilitation for Patients with Peripheral Arterial Occlusive Disease Feasibility and efficacy of an 8-week progressive home-based strengthening exercise program in patients with osteoarthritis of the hip and/or total hip joint replacement: a preliminary trial In hip osteoarthritis, Nordic Walking is superior to strength training and home‐based exercise for improving function Comparison of neuromuscular and quadriceps strengthening exercise in the treatment of varus malaligned knees with medial knee osteoarthritis: a randomised controlled trial protocol Formal Physical Therapy After Total Hip Arthroplasty Is Not Required: A Randomized Controlled Trial Impact of supervised physiotherapeutic pelvic floor exercises for treating female stress urinary incontinence.
OBJECTIVE To examine the physical function , gait , and quality of life of patients after total hip replacement ( THR ) r and omly assigned to either a targeted home- or center-based exercise program . DESIGN R and omized controlled trial . SETTING Rehabilitation research center in Australia . PARTICIPANTS Twenty-three patients with unilateral THR were r and omly assigned to a supervised center-based exercise group ( n=11 ) or an unsupervised home-based exercise group ( n=12 ) . INTERVENTION The center-based group completed an 8-week targeted exercise program while under the direct supervision of a physiotherapist . After initial instruction , the home-based group completed the 8-week targeted exercise program at home without further supervision . MAIN OUTCOME MEASURES Quality of life , physical function , and spatiotemporal measures of gait . RESULTS No significant interaction ( group by time ) or main effects of grouping were found . Within each group , quality of life , and stair climbing improved significantly ( P<.05 ) as did Timed Up & Go test and 6-minute walk test performances ( P<.05 ) . Walking speed increased by 16 cm/s ( P<.01 ) , cadence by 8 steps/min ( P<.05 ) , step length by 4.7 cm ( P<.05 ) , and double-support time reduced by a factor of 16 % . Step length symmetry showed significant improvement ( P<.05 ) over time . Step length differential between the affected and unaffected limbs reduced from 4.0 to 2.7 cm . CONCLUSIONS The targeted strengthening program was effective for both the home- and center-based groups . No group differences were found in the majority of the outcome measures . This finding is important because it shows that THR patients can achieve significant improvements through a targeted strengthening program delivered at a center or at home Objective : To assess the efficacy of a programme of continuing self-directed exercises for people discharged home after a stroke , supervised once a week by therapists . Design : A r and omized controlled trial of 100 patients discharged from hospital after a stroke , requiring ongoing therapy . The control group received outpatient or day hospital therapy ; the experimental group were visited once a week by an occupational and /or physiotherapist who prescribed a programme of exercises and activities for the following week . Subjects were studied for the first three months after discharge from hospital . Setting : A district general hospital , or the homes of subjects r and omized to the experimental group , in New Zeal and . Main outcome measures : ( 1 ) Characteristics of the groups , ( 2 ) gait speed , limb function , activities of daily living , ( 3 ) time with therapists , ( 4 ) mood of both subjects and caregivers , ( 5 ) anticipation of outcome at entry , compared with perceived outcome at exit . Results : No statistical differences between the control and experimental groups in characteristics , or in any outcomes measured , except that the contact time period , but not the number of visits , was longer in the experimental group ( p = 0.003 ) . Conclusions : A supervised home-based programme is as effective as outpatient or day hospital therapy BACKGROUND AND PURPOSE Patients with hip osteoarthritis have impairments in muscle function ( muscle strength and power ) and hip range of motion ( ROM ) , and it is commonly believed that effective clinical management of osteoarthritis should address these impairments to reduce pain and disability . Therefore , the purpose of this study was to compare the short- and long-term effects of 4 months of physiotherapist-supervised strength training , physiotherapist-supervised Nordic Walking ( NW ) , or unsupervised home-based exercise ( HBE ) on muscle function and hip ROM in patients diagnosed with hip osteoarthritis . METHODS Secondary outcome analyses from an observer-blinded three-armed parallel- design r and omized controlled trial in 60 + -year-old patients with clinical hip osteoarthritis ( American College of Rheumatology criteria ) who were not on a waiting list for hip replacement . One hundred and fifty-two patients were r and omized to either 4 months of physiotherapist-supervised , moderate , progressive , strength training ( n = 50 ) , physiotherapist-supervised NW ( n = 50 ) , or unsupervised HBE ( n = 52 ) . Maximal isometric hip and thigh muscle strength and leg extensor power and active hip ROM were assessed at baseline 2 , 4 , and 12 months . RESULTS Intention-to-treat-analyses did not show any significant between-group differences for improvements in muscle strength and power or ROM at any time points . Short-term significant ( p < .05 ) increases in muscle strength were present in the physiotherapist-supervised exercise groups and in the long-term for muscle power in the NW-group . All exercise modes result ed in significant increases of ROM but long-term improvements were only shown for NW and HBE . DISCUSSION Four months of physiotherapist-supervised , progressive , moderate , and strength training was less effective than hypothesized for improving muscle strength and power in patients with hip osteoarthritis who are not awaiting hip replacement . Our results may indicate that in these patients , improvements in disability are not necessarily dependent on improvements in strength and power or ROM BACKGROUND The purpose of this study was to evaluate the influence of an early cardiac rehabilitation ( CR ) program on health-related quality of life ( HRQL ) and functional capacity in patients who recently experienced an acute myocardial infa rct ion ( AMI ) . This program was initiated in the inpatient setting and was followed by an unsupervised outpatient intervention . METHODS After the same inpatient care plan , low-risk patients who experienced an AMI were r and omized into 2 groups : ( 1 ) a control group ( CG ) ( n = 43 )  entailing usual care and ( 2 ) an intervention group ( IG ) ( n = 45 ) entailing outpatient ( unsupervised ) CR primarily centered on a progressive walking program . Initially , all patients underwent a supervised exercise program with early mobilization beginning 12 hours after an AMI . On hospital discharge , all patients were classified according to cardiovascular risk . Quality of life was evaluated by the MacNew Heart Disease HRQL question naire 30 days after discharge . Functional capacity was determined by a 6-minute walk test ( 6MWT ) distance on the day of inpatient discharge as well as 30 days afterward . RESULTS The HRQL global score was higher in the IG compared with the CG 30 days after discharge ( P < 0.001 ) ; physical and emotional domain scores were both significantly higher in the IG ( P < 0.001 ) . Furthermore , the IG showed a greater 6MWT distance compared with the CG ( P < 0.001 ) . CONCLUSIONS A CR program based on early progressive exercises , initiated by supervised inpatient training and followed by an unsupervised outpatient program , improved HRQL and functional capacity in patients at low cardiovascular risk who recently experienced an AMI The aim of this study was to determine if weekly , supervised , outpatient-based exercise plus unsupervised home exercise following an 8-week pulmonary rehabilitation programme would maintain functional exercise capacity and quality of life at 12 months better than st and ard care of unsupervised home exercise training . Chronic obstructive pulmonary disease ( COPD ) subjects completed an 8-week pulmonary rehabilitation programme  , were r and omised to an intervention group ( IG ) of weekly , supervised , exercise plus home exercise or to a control group ( CG ) of unsupervised home exercise and followed for 12 months . Outcome measurements at baseline ( after pulmonary rehabilitation ) , and 3 , 6 and 12 months included the 6-min walk test and St George 's Respiratory Question naire ( SGRQ ) .  59 subjects with moderate COPD ( Global Initiative for Chronic Obstructive Lung Disease stage II ) were recruited and 48 subjects completed the study . 12-month mean difference showed no significant change from baseline in 6-min walk distance ( IG -11 m , 95 % CI -21–10 m ; CG -6 m , 95 % CI -34–11 m ) or total SGRQ score ( IG 3 , 95 % CI -0.8–7 ; CG -3 , 95 % CI -7–3 ) . 12 months following pulmonary rehabilitation both weekly , supervised , outpatient-based exercise plus unsupervised home exercise and st and ard care of unsupervised home exercise successfully maintained 6-min walk distance and quality of life in subjects with moderate COPD Objectives : To compare the effects of a physiotherapist-supervised exercise programme in an exercise unit and self-supervised home exercise programme on quality of life in patients with Parkinson ’s disease . Design : Assessor-blinded , quasi-r and omized trial ( alternate allocation ) . Setting : An outpatient exercise unit ; home setting s. Participants : Thirty patients with idiopathic Parkinson ’s disease , Hoehn & Yahr I — III , stable medication use . Interventions : Patients were included in the physiotherapist-supervised or home group . The exercise programme was performed for 10 weeks , three times/week either under the supervision of a physiotherapist or at home without supervision . Main outcome measures : Parkinson ’s Disease Quality of Life Question naire ( PDQLQ ) , Nottingham Health Profile ( NHP ) , Unified Parkinson ’s Disease Rating Scale ( UPDRS ) , Beck Depression Inventory ( BDI ) . Results : Patients in the supervised physiotherapy group improved more than the home exercise group in Parkinson ’s Disease Quality of Life Question naire ( total score , Parkinson ’s symptoms , emotional function ) , Nottingham Health Profile total , Unified Parkinson ’s Disease Rating Scale ( all domains ) and Beck Depression Inventory scores . Conclusions : The exercise programme under physiotherapist supervision was found to be more effective at improving activities of daily living , motor , mental , emotional functions and general health quality in patients with Parkinson ’s disease compared with a self-supervised home programme Objective : To evaluate the effect of home versus in-hospital exercise ( under supervision ) programmes on hip strength , gait speed and cadence in patients with total hip arthroplasty at least one year after operation . Setting : Physical therapy and rehabilitation department . Subjects : Twenty-six patients who had had a total hip arthroplasty operation 12—24 months prior to the study were enrolled . Interventions : The patients were r and omized into three groups : group 1 patients were assigned a home exercise programme , group 2 patients exercised under physiotherapist supervision in hospital , and group 3 served as the control group , with no specific intervention . The study duration was six weeks . Main measures : Maximum isometric abduction torque of operated hip muscle , gait speed and cadence were measured before and after the study . Results : Maximum isometric abduction torques of the hip abductor muscles improved in groups 1 and 2 , but not in group 3 ( 30 ± 12 to 38 ± 11 ft.lb in group 1 , 18 ± 10 to 30 ± 9.8 ft.lb in group 2 ) . Gait speed improved from 67.8 ± 23 to 74.35 ± 24 m/min in group 1 , from 48.53 ± 4 to 56.7 ± 5 m/min in group 2 and from 58.01 ± 12 to 59.8 ± 14 m/min in group 3 . Cadence also improved , from 97.7 ± 18 to 111 ± 17 steps/min in group 1 , from 90.75 ± 6 to 104.75 ± 7 steps/min in group 2 , and from 87 ± 16 to 88.22 ± 16 steps/min in group 3 . When the three groups were compared , group 2 showed the best improvement ( P = 0.006 ) only in maximum isometric abduction torque . Conclusion : Our findings suggest that both home and supervised exercise programmes are effective one year after total hip arthroplasty . Home exercise programmes with close follow-up could be recommended Objective : To investigate the effect of supervised and unsupervised pelvic floor muscle exercises utilizing trunk stabilization for treating postpartum urinary incontinence and to compare the outcomes . Design : R and omized , single-blind controlled study . Setting : Outpatient rehabilitation hospital . Subjects : Eighteen subjects with postpartum urinary incontinence . Interventions : Subjects were r and omized  to either a supervised training group with verbal instruction from a physiotherapist , or an unsupervised training group after undergoing a supervised demonstration session . Main measures : Bristol Female Lower Urinary Tract Symptom question naire ( urinary symptoms and quality of life ) and vaginal function test ( maximal vaginal squeeze pressure and holding time ) using a perineometer . Results : The change values for urinary symptoms ( −27.22 ± 6.20 versus −18.22 ± 5.49 ) , quality of life ( −5.33 ± 2.96 versus −1.78 ± 3.93 ) , total score ( −32.56 ± 8.17 versus −20.00 ± 6.67 ) , maximal vaginal squeeze pressure ( 18.96 ± 9.08 versus 2.67 ± 3.64 mmHg ) , and holding time ( 11.32 ± 3.17 versus 5.72 ± 2.29 seconds ) were more improved in the supervised group than in the unsupervised group ( P < 0.05 ) . In the supervised group , significant differences were found for all variables between pre- and post-test values ( P < 0.01 ) , whereas the unsupervised group showed significant differences for urinary symptom score , total score and holding time between the pre- and post-test results ( P < 0.05 ) . Conclusions : These findings suggest that exercising the pelvic floor muscles by utilizing trunk stabilization under physiotherapist supervision may be beneficial for the management of postpartum urinary incontinence CONTEXT Hip fractures are common in the elderly , and despite st and ard rehabilitation , many patients fail to regain their prefracture ambulatory or functional status . OBJECTIVE To determine whether extended outpatient rehabilitation that includes progressive resistance training improves physical function and reduces disability compared with low-intensity home exercise among physically frail elderly patients with hip fracture . DESIGN , SETTING , AND PATIENTS R and omized controlled trial conducted between August 1998 and May 2003 among 90 community-dwelling women and men aged 65 years or older who had had surgical repair of a proximal femur fracture no more than 16 weeks prior and had completed st and ard physical therapy .  INTERVENTION Participants were r and omly assigned to 6 months of either supervised physical therapy and exercise training ( n = 46 ) or home exercise ( control condition ; n = 44 ) . MAIN OUTCOME MEASURES Primary outcome measures were total scores on a modified Physical Performance Test ( PPT ) , the Functional Status Question naire physical function subscale ( FSQ ) , and activities of daily living scales . Secondary outcome measures were st and ardized measures of skeletal muscle strength , gait , balance , quality of life , and body composition . Participants were evaluated at baseline , 3 months , and 6 months . RESULTS Changes over time in the PPT and FSQ scores favored the physical therapy group ( P = .003 and P = .01 , respectively ) . Mean change ( SD ) in PPT score for physical therapy was + 6.5 ( 5.5 ) points ( 95 % confidence interval [ CI ] , 4.6 - 8.3 ) , and for the control condition was + 2.5 ( 3.7 ) points ( 95 % CI , 1.4 - 3.6 points ) . Mean change ( SD ) in FSQ score for physical therapy was + 5.2 ( 5.4 ) points ( 95 % CI , 3.5 - 6.9 ) and for the control condition was + 2.9 ( 3.8 ) points ( 95 % CI , 1.7 - 4.0 ) . Physical therapy also had significantly greater improvements than the control condition in measures of muscle strength , walking speed , balance , and perceived health but not bone mineral density or fat-free mass . CONCLUSION In community-dwelling frail elderly patients with hip fracture , 6 months of extended outpatient rehabilitation that includes progressive resistance training can improve physical function and quality of life and reduce disability compared with low-intensity home exercise BACKGROUND AND PURPOSE Despite a successful surgical procedure , deficits in muscle strength and physical function are documented 1 - 2 years after total hip replacement ( THR ) . There is a lack of evidence concerning which rehabilitation strategy is the most effective after THR . The purpose of this pilot study was to investigate the feasibility of an early-initiated intensified , home-based training regime and to form the basis of future studies with regard to exercises , outcome measures and power calculations . METHODS The trial is a single-blinded , cluster-r and omized controlled trial performed at an orthopaedic physiotherapy department in a public hospital in Denmark . A consecutive sample of 46 patients undergoing primary THR surgery for osteoarthritis between September 2008 and January 2009 was included . Forty-four patients completed the trial ( 96 % follow-up ) . Participants were r and omly assigned to an intervention group ( IG , n = 23 ) receiving 12 weeks of intensified exercises ( e.g. rubber b and resistance ) or a control group ( CG , n = 21 ) receiving st and ard rehabilitation exercises without external resistance . The outcome measurements were maximal gait speed , isometric hip abductor muscle strength , one-legged stance , health-related quality of life ( EuroQol-5 Dimensions ) , patient satisfaction , and patient-evaluated function , stiffness and pain ( Western and Ontario McMasters University Osteoarthritis Index ) . RESULTS There were significant increases in both groups in all the measurements during the 12 weeks of exercises . All participants in the IG were satisfied or very satisfied with the exercises compared with 85 % in the CG ( P = 0.095 ) . In the IG , four participants ( 17.4 % ) had difficulties when performing the intensified exercises at home . Hip abduction strength was significantly weaker in the leg operated compared with the leg not operated on after the intervention in both groups ( P < 0.01 ) . CONCLUSION This pilot study indicates that the majority of THR patients tolerated early-initiated intensified exercises without additional pain and with high patient satisfaction . It seems that some of the patients need supervision to perform intensified exercises Ferrari M , Vangelista A , Vedovi E , Falso M , Segattini C , Brotto E , Brigo B , Lo Cascio V : Minimally supervised home rehabilitation improves exercise capacity and health status in patients with COPD . Am J Phys Med Rehabil 2004;83:337–343 . Objective : The purpose of this study was to investigate the effects on exercise tolerance and quality of life of an outpatient rehabilitation program implemented at home without a physiotherapist 's direct supervision in patients with chronic obstructive lung disease . Design : Patients with moderate chronic obstructive pulmonary disease were studied . The rehabilitation program included lower limb exercise on a stationary bicycle and upper limb exercise and stretching , together with education , and it lasted for 12 wks . Every 2 wks , a physiotherapist contacted patients by phone to evaluate their compliance with the rehabilitation program and any adverse effects . The main measures of outcome were the Health Status Index , cycle ergometer test , forced expiratory volume in 1 sec , and forced vital capacity . Patients were evaluated at the baseline and at 12 wks . Results : A total of 32 patients were recruited and 28 ( mean age , 70.4 yrs ) completed the trial . After pulmonary rehabilitation , a significant improvement was found in seven of the nine Health Status Index quality -of-life subscales . Exercise tolerance also improved significantly , whereas no variation was observed in pulmonary function tests . There was no correlation between the improvement in quality of life and the improvement in exercise tolerance . The improvements in the Health Status Index physical function and general health subscales correlated negatively with forced expiratory volume in 1 sec ( percentage of predicted value ) and positively with residual volume/total lung capacity ratio . The improvement in exercise tolerance ( expressed in watts or as maximum oxygen uptake ) , but not in quality -of-life indexes , was associated negatively with age and positively with weight , cognitive function , and forced expiratory volume in 1 sec/forced vital capacity ratio . Conclusions : We conclude that an inexpensive home rehabilitation program can improve quality of life and exercise tolerance in patients with moderate chronic obstructive pulmonary disease . Furthermore , our results indicate that exercise tolerance evaluated by cycloergometry and quality of life evaluated by the mean of the Health Status Index question naire are independent outcome measures of pulmonary rehabilitation OBJECTIVE To examine the effects of a 3-month low-intensity exercise program on physical frailty . DESIGN R and omized clinical trial . SETTING Regional tertiary-care hospital and academic medical center with an outpatient rehabilitation fitness center . PARTICIPANTS Eighty-four physically frail older adults ( mean age , 83 + /- 4 yrs ) . INTERVENTION Three-month low-intensity supervised exercise ( n = 48 ) versus unsupervised home-based flexibility activities ( n = 36 ) . MAIN OUTCOME MEASURES Physical performance test , measures of balance , strength , flexibility , coordination , speed of reaction , peripheral sensation . RESULTS Significant improvement was made by the exercise group on our primary indicator of frailty , a physical performance test ( PPT ) ( 29 + /- 4 vs 31 + /- 4 out of a possible 36 points ) , as well as many of the risk factors previously identified as contributors to frailty ; eg , reductions in flexibility , strength , gait speed , and poor balance . Although the home exercise control group showed increases in range of motion , the improvements in flexibility did not translate into improvements in physical performance capacity as assessed by the PPT . CONCLUSIONS Our results suggest that physical frailty is modifiable with a program of modest activities that can be performed by virtually all older adults . They also indicate that exercise programs consisting primarily of flexibility activities are not likely to reverse or attenuate physical frailty . Although results suggest that frailty is modifiable , it is not likely to be eliminated with exercise , and efforts should be directed toward preventing the condition OBJECTIVE To examine if 2 weekly sessions of supervised progressive resistance training ( PRT ) in combination with 5 weekly sessions of unsupervised home-based exercise is more effective than 7 weekly sessions of unsupervised home-based exercise in improving leg-extension power of the operated leg 10 weeks after total hip replacement ( THR ) in patients with lower pre-operative function . METHOD A total of 73 patients scheduled for THR were r and omised ( 1:1 ) to intervention group ( IG , home based exercise 5 days/week and PRT 2 days/week ) or control group ( CG , home based exercise 7 days/week ) . The primary endpoint was change in leg extension power at 10 week follow up . Secondary outcomes were isometric hip muscle strength , sit-to-st and test , stair climb test , 20 m walking speed and patient-reported outcome ( HOOS ) . RESULTS Sixty-two completed the trial ( 85 % ) .  Leg extension power increased from baseline to the 10 week follow up in both groups ; mean [ 95 % CI ] IG : 0.29 [ 0.13 ; 0.45 ] and CG : 0.26 [ 0.10 ; 0.42 ] W/kg , with no between-group difference ( primary outcome ) ( P = 0.79 ) . Maximal walking speed ( P = 0.008 ) and stair climb performance ( P = 0.04 ) improved more in the IG compared to CG , no other between-group differences existed . CONCLUSIONS In this trial , supervised PRT twice a week in addition to 5 weekly sessions of unsupervised exercise for 10 weeks was not superior to 7 weekly sessions of unsupervised home-based exercise for 10 weeks in improving the primary outcome , leg-extension power of the operated leg , at the primary endpoint 10 weeks after surgery in THR patients with lower pre-operative function . TRIAL REGISTRATION NCT01214954 Background Pulmonary rehabilitation programs have been shown to increase functional exercise capacity and quality of life in COPD patients . However , following the completion of pulmonary rehabilitation the benefits begin to decline unless the program is of longer duration or ongoing maintenance exercise is followed . Therefore , the aim of this study is to determine if supervised , weekly , hospital-based exercise compared to home exercise will maintain the benefits gained from an eight-week pulmonary rehabilitation program in COPD subjects to twelve months . Methods Following completion of an eight-week pulmonary rehabilitation program , COPD subjects will be recruited and r and omised ( using concealed allocation in numbered envelopes ) into either the maintenance exercise group ( supervised , weekly , hospital-based exercise ) or the control group ( unsupervised home exercise ) and followed for twelve months . Measurements will be taken at baseline ( post an eight-week pulmonary rehabilitation program ) , three , six and twelve months . The exercise measurements will include two six-minute walk tests , two incremental shuttle walk tests , and two endurance shuttle walk tests . Oxygen saturation , heart rate and dyspnoea will be monitored during all these tests . Quality of life will be measured using the St George 's Respiratory Question naire and the Hospital Anxiety and Depression Scale .  Participants will be excluded if they require supplemental oxygen or have neurological or musculoskeletal co-morbidities that will prevent them from exercising independently . Discussion Pulmonary rehabilitation plays an important part in the management of COPD and the results from this study will help determine if supervised , weekly , hospital-based exercise can successfully maintain functional exercise capacity and quality of life following an eight-week pulmonary rehabilitation program in COPD subjects in Australia UNLABELLED Coulter CL , Weber JM , Scarvell JM . Group physiotherapy provides similar outcomes for participants after joint replacement surgery as 1-to-1 physiotherapy :  a sequential cohort study . OBJECTIVES To compare effectiveness and time efficiency of physiotherapy rehabilitation provided within a group with an individualized program provided at home for improving participants ' outcomes after total joint replacement surgery . DESIGN Quasiexperimental sequential cohort trial with 12-week follow-up . SETTING A tertiary acute care hospital . PARTICIPANTS Consecutive patients ( N=51 ) having hip or knee replacement surgery in an 8-month period and who were able to weight-bear postoperatively . INTERVENTIONS The first group admitted to the study entered the exercise group  , and patients in the following 4 months entered the home physiotherapy group . MAIN OUTCOME MEASURES Primary outcome measures included the Western Ontario McMaster 's University Osteoarthritis Index ( WOMAC ) , Medical Outcomes Study 36-Item Short-Form Health Survey ( SF-36 ) , Timed Up & Go ( TUG ) test , and knee range of motion ( ROM ) . Secondary measures included the 6-m walk test and a patient evaluation question naire . Staff time costs were recorded . Outcomes were recorded preoperatively or at hospital discharge , and 5 and 12 weeks postoperatively . RESULTS There was no difference between the 2 groups for either the WOMAC or SF-36 scores , 6-m walk test , TUG test , or ROM measures at 12 weeks ( P>.05 ) , although both groups of patients improved between hospital discharge and 12 weeks . The class group accessed more frequent physiotherapy than the home group ( mean , 7.5 and 3.96 visits , respectively ) . The physiotherapist 's time was less per patient per visit for the class group ( mean , 27min direct and 10min indirect ) than for the home visits ( mean , 38min direct and 26min indirect ) . CONCLUSIONS This trial suggests that the class-based exercise rehabilitation was the most efficient method of delivery of the physiotherapy service , without cost to patient outcomes Purpose : To determine the opinions and attitudes toward exercise in people with chronic obstructive pulmonary disease ( COPD ) who had completed a r and omised controlled trial of 12‐months maintenance exercise . Methods : Participants were eligible for recruitment to the maintenance exercise study if they had COPD and had completed an 8‐week pulmonary rehabilitation program . They were r and omized into an Intervention Group ( IG ) that consisted of once weekly , supervised hospital‐based maintenance exercise plus home exercise for 12 months or a Control Group that undertook unsupervised home maintenance exercise for 12 months . At the end of the 12 months , participants completed a survey consisting of 23 questions using a visual analogue scale ( VAS ) of 100 mm . Results : Forty‐eight participants completed the 12 month study and 36 participants ( 75 % ) completed the survey [ IG mean ( SD ) : age 65 ( 8) years , FEV1 58 ( 20 ) % predicted ; CG : age 66 ( 8) years , FEV1 67 ( 17 ) % predicted ] . No between group difference was found for the importance of exercise , the benefits of the program or the importance of support from the physiotherapist . However , the IG reported exercising more regularly , having more enjoyment of being involved in the maintenance exercise program , greater benefit in general well‐being , and better physical fitness . Conclusions : At the completion of the 12 month exercise study , the survey results showed that all participants reported positive attitudes towards both supervised and unsupervised maintenance exercise programs , with the IG reporting greater benefits This prospect i ve study compared 30 patients r and omly assigned to either a home exercise program or supervised outpatient physical therapy following arthroscopic partial medial meniscectomy . Their knee functions were assessed at 2 , 4 , and 8 weeks postoperatively using isokinetic analysis and subjective question naires . At each evaluation , the home exercise group performed as well or better than the supervised physical therapy group . There were no statistically significant differences between the two groups . At 4 weeks postoperation , the mean percent deficit in torque ( strength ) between the affected and unaffected limbs was 22.1 % in the supervised rehabilitation group and 22.0 % in the home exercise . The percent deficit in terms of endurance was 7.7 % in the supervised group and 3.6 % in the home group . Similar results were noted with regard to the patients ' subjective evaluations of their knee function and ability to resume work and recreational activities . We conclude that a well-planned , unsupervised home exercise knee rehabilitation program can produce equally good postoperative recovery as compared to a supervised outpatient physical therapy regimen in properly selected patients following arthroscopic partial meniscectomy of the knee Supervised , hospital-based exercise rehabilitation programs are effective for improving functional status for patients with claudication due to peripheral arterial occlusive disease . However , it has been suggested that unsupervised , home-based exercise programs , which have been relatively little evaluated , would be equally efficacious as compared with hospital-based programs . The authors tested the hypothesis that a hospital-based exercise rehabilitation program would improve treadmill exercise perfor mance more than a home-based program . Of 20 consecutively enrolled patients with claudication , 10 were r and omly placed into a supervised , hospital-based program and 10 into an unsupervised , home-based program for a three-month period .  Exercise perfor mance was evaluated by treadmill testing using a grade d protocol . In addition , func tional status was evaluated by the Walking Impairment Question naire ( WIQ ) and the Medical Outcomes Study SF-20 question naire ( MOS ) . Patients in the hospital-based program were treated with treadmill walking three times a week for one hour/visit . Patients in the home-based program were instructed to walk at least three times a week and were contacted weekly to provide encouragement and to record compliance with ( continued on next page ) the program . Patients in the hospital-based group improved peak walking time by 137 % , pain-free walking time by 150 % , and peak oxygen consumption by 19 % ( all P<0.05 ) . Patients reported an improved walking distance and speed according to WIQ data ( both P<0.05 ) . In addition , the MOS physical functioning score in the hospital-based group improved by 20 percentage points ( P<0.05 ) . In contrast , patients in the home-based program did not improve exercise performance measured on the treadmill . Improvement in the ability to walk on the treadmill was greater in the hospital-based than the home- based program ( P<0.05 ) . The ability to walk distances was the only question naire measure that improved in persons who received the home-based program ( P<0.05 ) . Preliminary results suggest that a supervised , hospital-based program is more effective for improving treadmill exercise performance than an unsupervised , home-based program The feasibility and efficacy of an additional progressive home-based strengthening exercise program ( PHSEP ) on subjects that already attended supervised institutional exercise therapy  was investigated . Thirty-six hip patients with hip osteoarthritis ( OA ) and /or total hip replacement in at least one hip joint were r and omly assigned to an intervention group ( IG ) or a control group ( CG ) . IG ( 18 patients , mean age 64.9 , st and ard deviation ( SD ) 7.5 ) followed an 8-week PHSEP in addition to their weekly institutional exercise therapy , while CG ( 18 patients , mean age 64.7 , SD 9 ) solely continued the weekly institutional exercise sessions . Before and after the intervention period , strength of hip muscles was quantified applying isokinetic concentric and isometric measurements , and health-related quality of life was monitored using the SF36 question naire . Adherence to the exercise program was evaluated using exercise logs . The PHSEP was feasible for all subjects in IG with an adherence of 99 % . Exercise logs reported that pain result ing from the PHSEP was low . Increased strength in isokinetic concentric hip adduction ( 13 % ) and isometric hip abduction ( 9 % ) , adduction ( 12 % ) , and flexion ( 7 % ) was found in IG in comparison to CG . The results of the SF36 did not change during the intervention period . Consequently , supervised institutional exercise therapy supplemented by a PHSEP could increase hip muscle strength in patients with hip OA and /or total hip replacement . However , further research should evaluate the optimal frequency and duration of such supplementary sessions and their potential to increase physical function and reduce pain This observer-blinded , r and omized controlled trial compared the short- and long-term effects of 4 months of supervised strength training ( ST ) in a local fitness center , supervised Nordic Walking ( NW ) in a local park , and unsupervised home-based exercise ( HBE , control ) on functional performance in 60 + -year-old persons ( n = 152 ) with hip osteoarthritis ( OA ) not awaiting hip replacement .  Functional performance [ i.e. , 30-s chair st and test ( primary outcome ) , timed stair climbing , and 6-min walk test ] and self-reported outcomes ( i.e. , physical function , pain , physical activity level , self-efficacy , and health-related quality of life ) were measured at baseline and at 2 , 4 , and 12 months . Based on intention-to-treat-analyses improvements [ mean ( 95 % CI ) ] after intervention in number of chair st and s were equal in all three groups at 4 months [ ST : 0.9 ( 0.2 - 1.6 ) , NW : 1.9 ( 0.8 - 3.0 ) , HBE : 1.1 ( 0.1 - 2.0 ) ] but greater in the NW group [ 1.4 ( 0.02 - 2.8 ) ] than in the ST group at 12 months . Generally , improvements in functional performance were greater ( P < 0.001-P < 0.03 ) after NW compared with HBE and ST at all follow-up time points . Furthermore , NW was superior ( P < 0.01 ) to HBE for improving vigorous physical activity and to both ST and HBE for improving ( P < 0.01 ) mental health . These data suggest that NW is the recommended exercise modality compared with ST and HBE Background Osteoarthritis of the knee involving predominantly the medial tibiofemoral compartment is common in older people , giving rise to pain and loss of function . Many people experience progressive worsening of the disease over time , particularly those with varus malalignment and increased medial knee joint load . Therefore , interventions that can reduce excessive medial knee loading may be beneficial in reducing the risk of structural progression . Traditional quadriceps strengthening can improve pain and function in people with knee osteoarthritis but does not appear to reduce medial knee load . A neuromuscular exercise program , emphasising optimal alignment of the trunk and lower limb joints relative to one another , as well as quality of movement performance , while dynamically and functionally strengthening the lower limb muscles , may be able to reduce medial knee load . Such a program may also be superior to traditional quadriceps strengthening with respect to improved pain and physical function because of the functional and dynamic nature . This r and omised controlled trial will investigate the effect of a neuromuscular exercise program on medial knee joint loading , pain and function in individuals with medial knee joint osteoarthritis . We hypothesise that the neuromuscular program will reduce medial knee load as well as pain and functional limitations to a greater extent than a traditional quadriceps strengthening program . Methods / Design 100 people with medial knee pain , radiographic medial compartment osteoarthritis and varus malalignment will be recruited and r and omly allocated to one of two 12-week exercise programs : quadriceps strengthening or neuromuscular exercise . Each program will involve 14 supervised exercise sessions with a physiotherapist plus four unsupervised sessions per week at home . The primary outcomes are medial knee load during walking ( the peak external knee adduction moment from 3D gait analysis ) , pain , and self-reported physical function measured at baseline and immediately following the program . Secondary outcomes include the external knee adduction moment angular impulse , electromyographic muscle activation patterns , knee and hip muscle strength , balance , functional ability , and quality -of-life . Discussion The findings will help determine whether neuromuscular exercise is superior to traditional quadriceps strengthening regarding effects on knee load , pain and physical function in people with medial knee osteoarthritis and varus malalignment . Trial Registration Australian New Zeal and Clinical Trials Registry reference : Background : The value of formal physical therapy after total hip arthroplasty is unknown . With substantial changes that have occurred in surgical and anesthesia techniques , self-directed therapy may be efficacious in restoring function to patients undergoing total hip arthroplasty . Methods : We conducted a single-center , r and omized trial of 120 patients undergoing primary , unilateral total hip arthroplasty who were eligible for direct home discharge . The experimental group followed a self-directed home exercise program for 10 weeks . The control group received the st and ard protocol for physical therapy that included in-home visits with a physical therapist for the first 2 weeks followed by formal outpatient physical therapy for 8 weeks . Functional outcomes were measured using vali date d instruments including the Harris hip score ( HHS ) , the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) , and the Short Form-36 Health Survey ( SF-36 ) preoperatively , at 1 month postoperatively , and at 6 to 12 months postoperatively . Results : Of 120 r and omized patients , 108 were included in the final analysis . Ten patients ( 19 % ) were r and omized to unsupervised home exercise and 20 patients ( 37 % ) were r and omized to formal outpatient therapy crossed over between groups . There was no significant difference in any of the measured functional outcomes between patients receiving formal therapy ( n = 54 ) and those participating in unsupervised home exercise ( n = 54 ) at any time point ( HHS , p = 0.82 ; WOMAC , p = 0.80 ; and SF-36 physical health , p = 0.90 ) . Conclusions : This r and omized trial suggests that unsupervised home exercise is both safe and efficacious for a majority of patients undergoing total hip arthroplasty , and formal physical therapy may not be required . Level of Evidence : Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence CONTEXT AND OBJECTIVE Urinary incontinence is a public health problem that affects more than 200 million people worldwide . Stress incontinence is the most prevalent type . Pelvic floor muscle exercises have been used for treating it , although there is no consensus regarding their application . The aim of this study was to compare the results from treating female stress urinary incontinence with pelvic floor muscle exercises with or without physiotherapist supervision . DESIGN AND SETTING This was a r and omized , prospect i ve , controlled trial in the Urogynecology and Vaginal Surgery Sector , Universidade Federal de São Paulo . METHODS Forty-four women were r and omized to be treated for stress urinary incontinence with pelvic floor exercises for three consecutive months , into two groups : one with and the other without physiotherapist supervision . They were evaluated before and after treatment using a quality -of-life question naire , pad test , micturition diary and subjective evaluation . Descriptive analysis was used to evaluate the population . The homogeneity of the two groups was evaluated using the Kruskal-Wallis and Chi-squared tests . The success of the two groups after treatment was evaluated using the Wilcoxon test . RESULTS The supervised group showed statistically greater improvement in the pad test , micturition diary and quality of life than did the control group . In the subjective evaluation , only 23.8 % of the control group patients were satised with their treatment . In the supervised group , 66.8 % of patients did not want any other treatment . CONCLUSION Supervised pelvic floor muscle exercises presented better results in objective and subjective evaluations than did unsupervised exercises
Function and quality of life could not be meta-analysed due to insufficient data and heterogeneity of measures , but functional measures tended to favour the physiotherapy rehabilitation group .
Most outcomes were similar between outpatient and home-based exercise programs .
Physiotherapy rehabilitation improves hip abductor strength , gait speed and cadence in people who have been discharged from hospital after total hip replacement .
Physiotherapist-directed rehabilitation exercises appear to be similarly effective whether they are performed unsupervised at home or supervised by a physiotherapist in an outpatient setting
QUESTION In people who have been discharged from hospital after a total hip replacement , do rehabilitation exercises directed by a physiotherapist improve strength , gait , function and quality of life ?
Are these exercises as effective in an unsupervised home-based setting as they are in a supervised outpatient setting ?