Stair negotiation as a rehabilitation intervention for enhancing recovery following orthopaedic surgery: a systematic review.

This source preferred by Tom Wainwright and James Gavin

Authors: Gavin, J., Immins, T. and Wainwright, T.W.

Start date: 24 June 2016

Background: Over 205,000 people had hip and knee replacement surgery in England in 2014 (Registry, 2014) and patients requiring orthopaedic surgery are increasing with increasing lifespan (Learmonth et al., 2007). Optimal programmes for patient rehabilitation post-orthopaedic surgery are unclear. Stair negotiation is an activity of daily living, used as an outcome measure for functional recovery, yet as a physical rehabilitation intervention it’s efficacy remains inconclusive.

Aim: The purpose of this systematic review was to investigate the effectiveness of stair climbing as a rehabilitation intervention for total hip- (THR) and total knee replacement (TKR) patients. Methods: MEDLINE, PsycINFO, Science Citation Index, CINAHL, SPORTDiscus, and the Cochrane Database were searched. Trials involving stair climbing as a rehabilitation exercise were compared against standard care (or other relevant exercise physiotherapies); prehabilitation was also considered pre-surgery.

Outcomes measures: Functional recovery (e.g., 6 min walk time), ii) self-reported recovery (e.g., the Oxford hip score), iii) self-perceived pain (e.g., the visual analogue scale), and iv) life quality indexes (e.g., Assessment of Quality of Life).

Results: Of 650 articles identified, ten studies were eligible for review. A predefined data table to extract information from selected studies was used. Of the ten identified reports, two prehabilitation and eight rehabilitation studies included stair negotiation exercises as part of multi-modal physical interventions. Outcome measures were classified as: functional self-reported, perceptual, psychological and those relating to quality of life. Conclusion: Methodologies were heterogeneous and lacked adequate control groups. Therefore, it was not possible to determine the impact of stair negotiation exercise on the positive outcomes of interventions. Future research must determine i) the individual-effect of stair negotiation, ii) the safety and practicality, and iii) how potential functional improvements translate on to fundamental daily activities (i.e., transfers, standing and walking).

References: Learmonth, I.D., Young, C., Rorabeck, C., 2007 The operation of the century: total hip replacement. Lancet 370 (9597): 1508-1519.

National Joint Registry, 2014 NJR StatsOnline. Retrieved from on Thursday 22nd October, 2015.

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