2. The Question What are the effects 0f early physical therapy with ambulation after hip replacement surgery on length of hospitalization and cost, compared to patients with delayed physical therapy with ambulation?

6. Levels of Evidence Both articles were written about randomized controlled trials. These are Level II evidence.

7. Findings Evidence shows that the intensity of therapy, as measured by amount of time performed per day, in addition to when intensive therapy is begun, has significance in regards to positive outcomes. Patients who began intensive therapy earlier than the standard protocol (3 days vs 7 days post-op), experienced decreased hospital stays (11.7±2.3 days vs 14.5±1.9, P<.001) and lower costs ($25891±$3648 vs $27762±$3626, P<.03). (Munin et al).

8. Findings Larsen et al compared the results of an accelerated protocol to those of a standard protocol. The accelerated protocol included: 1) starting mobilization and exercise on the day of surgery and 2) eight hours of daily mobilization in teams after preset daily goals. The standard protocol included: 1) starting exercise and mobilization on first post-op day and 2) four hours of daily mobilization at intensity per individualized tolerance. Significant cost savings (approximately $4000 US, p=0.036) were found to exist for those who engaged in the accelerated protocol.

11. clinical site policy clinical site policy “ Starting the afternoon after surgery you will have Physical Therapy and twice a day after that, which includes exercises, learning to sit, stand and walk with your new total joint. Patients usually take a few steps the first day, then walking around your room, and so on. After you leave the hospital, you will have a list of the exercises you have learned to continue yourself at home. Many patients will receive Physical Therapy at home.” http://healthcare.utah.edu/orthopaedics/patients/education/hipreplacement.html

12. Summary Starting intensive therapy earlier leads to fewer days in the hospital and lower cost. It is our recommendation that patients who undergo total hip replacement surgeries should ambulate immediately and frequently following surgery in order to decrease recovery time. We also recommend that further research be done to verify the reliability of the study results.