The HIHO 2 Study: Hospital Inpatient versus Home-based Rehabilitation after Total Hip Replacement

INTERVENTION: Intervention (Arm ‐ 1) ‐ Hospital Inpatient Rehabilitation followed by a Monitored HOme‐based programme (HI) Comparator (Arm ‐ 2) ‐ Standard treatment which is a Monitored HOme‐based programme (HO) Participants will have their elective total hip replacement surgery in an acute hospital.They will be reviewed by the treating team and if assessed as able to be discharged home they will be randomly allocated to one of the two arms of the study. Those allocated to HI will be admitted to a rehabilitation hospital for 10 days. They will receive supervised physiotherapy comprising of 1‐1.5 hours of one:one therapy plus 1‐1.5 hours of class based exercises, a total of 2‐3hours, Monday through Friday. They will receive 1‐1.5 hours of one:one therapy on Saturday and Sunday. The inpatient rehabilitation programme combines general aerobic and functional exercises combined with muscle‐specific exercises that focus on lower limb strengthening, joint range of motion, neuromuscular coordination and restoration of a normal gait pattern. After discharge from the inpatient unit participants will attend the monitored group exercise sessions as per HO (below) for monitoring and progression of the programme. All participants will be required to complete a diary detailing the programme adherence, health care utilisation, health expenditure and social costs related to carer burden. An additional Functional Independence Measure (FIM) will be recorded for this arm on admission and discharge from the inpatient unit. CONDITION: Hip Arthritis PRIMARY OUTCOME: Walking distance at 26 weeks after surgery, as measured by the Six‐Minute Walk Test (6MWT). In comparison to the 6MWT pre‐surgery. ; ; The 6MWT is a measure of functional mobility and is influenced by multiple factors, such as pain, lower limb strength and joint mobility which are altered by total hip surgery. The intervention of rehabilitation aims to address these factors and improve the recipient's ability to walk. The 6MWT is highly reproducible within the individual and is likely to be less susceptible to misinterpretation, cultural sensitivity or be prone to the floor or ceiling effects that are associated with some patient reported outcomes. In addition, the use of this observer‐rated outcome is less likely than a patient rated‐outcome measure to be influenced by patient preference which is a feature of studies where the intervention cannot be blinded from recipient. SECONDARY OUTCOME: Carer Time Absent from Work ; Participant self report in diary provided ; ; Direct Health Care Costs (visits to health professionals) ; ; Patient self report in diary supplied and data linkage to patient medical records Functional Mobility; IBMAT Patient‐rated ; Part of a nested study Functional Mobility; International Classification of Functioning, Disability and Health (ICF) Based Mobility Assessment Tool (IBMAT) ‐ Clinician Rated ; Part of a nested study Health related quality of life; Euroquol‐5D (EQ‐5D) Hip pain and function (patient‐rated); Hip Disability and Osteoarthritis Outcome Score (HOOS) Hip pain and function (patient‐rated); Oxford Hip Score (OHS) Importance of perceived change in mobility ; Part of a nested study ; Investigator asks a direct question designed for the study Patient's perceived change in distance walked in the 6MWT ; Part of a nested study ; ; Investigator asks a direct question designed for the study ; Post Surgical Complications ; ; Patient self report in diary supplied and data linkage to medical records Preference for rehabilitation model ; Investigator direct question Satisfaction with Hip Surgery ; Investigators direct question Satisfaction with model of rehabilitation received ; Visual Analogue Score designed for the study Time absent form work (participant) ; ; Participant self report in diary provided Walking distance; 6MWT INCLUSION CRITERIA: Adults presenting to Fairfield hospital for an initial, single side, planned, total hip replacement for treatment of hip arthritis secondary to, but not limited to, osteoarthritis, avascular necrosis or congenital hip deformity.