Hip dysplasia: Adult patients’ movement patterns during walking, single limb stance and squatting and patients’ experience of rehabilitation: A quantitative study

Alrasheedi, Fawaz 2022. Hip dysplasia: Adult patients’ movement patterns during walking, single limb stance and squatting and patients’ experience of rehabilitation: A quantitative study. PhD Thesis, Cardiff University. Item availability restricted.

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Abstract

Background Rehabilitation programmes for patients with Developmental Dysplasia of the Hip (DDH) differ across hospitals. When patients with hip dysplasia are diagnosed, they are usually advised to undergo hip preservation surgery. The most common hip preservation surgery that patients with DDH undergo is Periacetabular Osteotomy (PAO). The effect of exercises prescribed during rehabilitation postoperative mainly focuses on hip muscles and postoperative rehabilitation experience of patients with DDH is unknown. This was a quantitative study consisting of three parts guided by Evidence Based Practice (EBP) framework. Part 1 explored the existing clinical expertise papers, editorials, guidelines, case reports and case series to identify the main elements of clinical guidelines. Part 2 involved exploring patients with hip dysplasia movements during exercises that represent functional activities as part of their daily lives in an observational laboratory-based study. In Part 3, the patients’ value was targeted by exploring the patients’ rehabilitation experience Methods Literature search was done first to explore the existing clinical expertise papers, editorials, guidelines, case reports and case series. Hip dysplasia movements during exercises that represent functional activities as part of their daily lives were explored in an observational laboratory-based study, from an objective biomechanical point of view. Three functional exercises were measured using the Gait Real-time Analysis Interactive laboratory (GRAIL) and Vicon motion capture systems: walking, squat and single limb balance (SLB). Patients’ rehabilitation experience was explored with an online questionnaire, investigating general demographic, rehabilitation theme which contains types of exercises recommended, intensity and frequency of the exercises, rehabilitation period and movement compensation theme which contains strategies to avoid pain, the patients’ opinion around the rehabilitation they had, the University of California and Los Angles (UCLA) activity scale and modified Harris Hip Score (mHHS). Results Even though the literature was explored in Part 1, through three different areas, the surgical area, rehabilitation of DDH postoperative area and the movement patterns during activities area, there are several areas that were not yet addressed. In Part 2, a total of 30 participants, 15 patients diagnosed with DDH and 15 control, participated in the laboratory-based study. The groups were well matched in relation to age, gender, height, weight and BMI. There were significant differences in movement between groups in all exercises explored. While walking, differences were observed in trunk lateroflexion and rotation, hip Range of Motion (ROM) in all planes and peak hip moments. Squat results showed differences in pelvis rotation, trunk rotation, hip abduction/adduction ROM, peak hip external rotation and knee abduction moments. During SLB, patients had forward trunk lean and reduced peak knee abduction moment. In Part 3, questionnaire data results showed that patients used numerous types of exercises. Mean UCLA activity scale was 5.04±2.39 and 18.8% of the respondents reported that they did not have pain or were able to ignore it. Finally, more than half of the patients were unsatisfied with their rehabilitation experience. Conclusion This doctoral thesis has explored the available research evidence in the literature, patients with DDH activity levels and return to sports post-operative, compensatory movements during three functional activities and patients’ values. It was shown by this research data that the literature around DDH lack strong evidence regarding rehabilitation, lack of clarity whether participation of patients with DDH postoperative is adequately measured, and patients may not be sufficiently achieving their goals in this domain; patients with DDH had compensatory movements during gait, less compensatory movements during squat, and even less compensatory movements during SLB, patients values in regard to overall rehabilitation experience was unsatisfactory and variety of exercises has been used at clinics and patients sought additional exercises. The clinical guidelines found in the literature could be adopted at the clinics, however, with caution, patients with DDH post PAO show compensatory movements across walking, squat and less compensatory movements during SLB which might be better targeted during rehabilitation. Finally it seems that patient with DDH have poor satisfaction regarding rehabilitation received post-operative.

Item Type:	Thesis (PhD)
Date Type:	Completion
Status:	Unpublished
Schools:	Healthcare Sciences
Date of First Compliant Deposit:	12 December 2022
Last Modified:	06 Jul 2023 02:33
URI:	https://orca.cardiff.ac.uk/id/eprint/154806

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