The relationships between physical impairments, functional limitations and movement asymmetries before and after total hip arthroplasty: a longitudinal study
Date
2014
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Publisher
University of Delaware
Abstract
Total hip arthroplasty (THA) is the treatment of choice for advanced hip osteoarthritis (OA). Despite pain reduction and functional improvement compared to the pre-operative levels, patients after THA continue to have physical impairments, functional limitations and altered movement patterns when compared to healthy-aged matched samples. The underlying impairments that may contribute to functional limitations and abnormal movement strategies in THA population are not known. The overall goal of this dissertation was two-fold. First, we intended to identify the primary physical impairments that contribute to functional limitations and abnormal movement patterns in patients undergoing THA. Second, we evaluated the utility of using the real-time visual feedback for reducing asymmetrical movements in patients before and after THA. In this work, we found that pain and strength measures differently contributed to self-reported and performance-based function in patients 3 months after THA. The results of this work indicate that patients before and after surgery move with asymmetrical movement patterns that unload the operated limb and shift the load to the non-operated limb during a sit-to-stand task (STS), and that weakness in the operated limb was related to lower load on the operated limb. We found that subjects moved with more inter-limb symmetry in the sagittal and frontal planes when they were given weight bearing visual feedback during a STS task, but this single instance of feedback did not eliminate all asymmetries. We examined whether the Wii balance board (WBB) can be used as a clinical tool to accurately assess weight bearing asymmetry during standing from and sitting to a chair, in comparison to laboratory-grade force plates as "gold-standard". The results indicate that WBB and laboratory force plates have high agreement for measuring peak VGRF and the inter-limb symmetry ratio. This dissertation lays down the foundation of using the real time visual feedback to reduce interlimb asymmetries. Albeit feedback did not perfectly normalize symmetrical patterns, it could be that developing structured program that utilizes higher intensity and longer duration of visual feedback, combined with addressing underlying physical impairments may have beneficial effects on mitigating movement asymmetries and subsequently improving functional abilities.