***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: UNLABELLED Hip osteoarthritis ( OA ) is a degenerative disease , and total hip arthroplasty ( THA ) is one of the surgical procedures of choice to improve the OA patient 's quality of life . Without a rehabilitation program , THA patients will develop functional limitations . A r and omized double-blind trial was performed between July 2009 and October 2011 to compare in a short follow-up time two groups of patients who underwent THA for OA . The THA protocol ( THAP ) group received verbal instructions and physiotherapy exercise demonstrations , and the THA physiotherapy care protocol ( THAPCP ) group received the same verbal instructions and demonstrations associated with daily exercise practice guided by a physiotherapist . The outcomes that were assessed preoperatively and 15 d postoperatively in 106 patients were muscle strength force , goniometry , Medical Outcomes Study 36-Item Short Form Health Survey , and Merle d'Aubigné and Postel score . Higher muscle strength force scores and degrees in range of motion were found in the THAPCP group . Higher improvements were also observed for the THAPCP group compared with the THAP group in the Merle d'Aubigné and Postel score . At the end of the follow-up period , the intervention in the THAPCP group improved functional capacity , quality of life , mobility , muscle strength , goniometry , and pain . It appears to be a safe tool for accelerating recovery in THA patients . CLINICAL TRIAL REGISTRATION Clinical Trials.gov ; NCT01491048 Background In-hospital progressive resistance training ( PRT ) has been shown to be an effective method of rehabilitation following hip surgery . The aim of this study was to assess whether a home-based PRT program would be beneficial in improving patients ’ muscle strength and physical function compared to st and ard rehabilitation .  Methods Subjects ( n = 49 ) either received home-based PRT rehabilitation  ( n = 25 ) or  st and ard rehabilitation  ( n = 24 ) in a prospect i ve single blinded r and omized trial carried out over a two-year period . The primary outcome measure was the maximal voluntary contraction of the operated leg quadriceps ( MVCOLQ ) with secondary measures of outcome being the sit to st and score ( ST ) , timed up and go ( TUG ) , stair climb performance ( SCP ) , the 6 min walk test ( 6MWT ) , and lean mass of the operated leg ( LM ) . Results Twenty-six patients completed follow up at 1 year ( n = 13 per group ) for the final comparative analysis . All the outcome measures showed marked progressive improvements from the baseline measures at 9–12 months post op ( Estimated effect ( std error ) ; p value)- MVCOLQ 26.50 ( 8.71 ) N p = 0.001 ; ST 1.37 ( 0.33 ) p = 0.0001 ; TUG −1.44 ( 0.45 ) s p = 0.0001 ; SCP −3.41(0.80)s p = 0.0001 ; 6MWT 45.61 (6.10)m p = 0.0001 ; LM 20 (204)g p = 0.326 ) following surgery for both groups . Overall , there was no significant effect for participation in the exercise regime compared with st and ard care for all outcomes assessed . Conclusions Overall , this study demonstrated that there is no significant difference between the two groups for participation in the home-based PRT exercise programme when compared to st and ard care for all outcomes .Trial registration IS RCT N 1309951 . Registered February 2011 OBJECTIVE To examine the physical function , gait , and quality of life of patients after total hip replacement ( THR ) r and omly assigned to either a targeted home- or center-based exercise program . DESIGN R and omized controlled trial . SETTING Rehabilitation research center in Australia . PARTICIPANTS Twenty-three patients with unilateral THR were r and omly assigned to a supervised center-based exercise group ( n=11 ) or an unsupervised home-based exercise group ( n=12 ) . INTERVENTION The center-based group completed an 8-week targeted exercise program while under the direct supervision of a physiotherapist . After initial instruction , the home-based group completed the 8-week targeted exercise program at home without further supervision . MAIN OUTCOME MEASURES Quality of life , physical function , and spatiotemporal measures of gait . RESULTS No significant interaction ( group by time ) or main effects of grouping were found . Within each group , quality of life , and stair climbing improved significantly ( P<.05 ) as did Timed Up & Go test and 6-minute walk test performances ( P<.05 ) . Walking speed increased by 16 cm/s ( P<.01 ) , cadence by 8 steps/min ( P<.05 ) , step length by 4.7 cm ( P<.05 ) , and double-support time reduced by a factor of 16 % . Step length symmetry showed significant improvement ( P<.05 ) over time . Step length differential between the affected and unaffected limbs reduced from 4.0 to 2.7 cm . CONCLUSIONS The targeted strengthening program was effective for both the home- and center-based groups . No group differences were found in the majority of the outcome measures . This finding is important because it shows that THR patients can achieve significant improvements through a targeted strengthening program delivered at a center or at home Abstract Purpose : The purpose of this study was to investigate the effects of an exercise program focusing on hip external rotator muscle on physical recovery in the early post-operative period of total hip arthroplasty ( THA ) . Methods : Patients who underwent THA were r and omized to an exercise group ( n = 14 ) or a control group ( n = 14 ) . In exercise group , the hip external rotator exercise program was performed 5 times per week for four weeks . Outcome measures were hip pain , hip range of motion , muscle strength of lower extremity and Timed Up and Go ( TUG ) test . Results : Both the hip abductor strength ( effect size = 0.60 ) and TUG test ( effect size= −0.53 ) in the exercise group improved significantly after the intervention . Conclusions : The results of the present study demonstrated that exercise program focusing on hip external rotator muscle was an effective intervention , especially in improving both hip abductor strength and walking ability in the acute post-THA stage . Implication for Rehabilitation After THA , in order to safely progress patients back to their desired activity level , there is a need to develop rehabilitation strategies to expedite and promote the recovery during the acute postoperative period . Exercise program focusing on hip external rotator muscle may lead to significant improvement of hip abductor muscle strength and gait ability in the acute post-THA stage OBJECTIVES To better underst and how immobilization and surgery affect muscle size and function in the elderly and to identify effective training regimes . DESIGN A prospect i ve r and omized , controlled study . SETTING Bispebjerg University Hospital , Copenhagen , Denmark . PARTICIPANTS Thirty-six patients ( aged 60 - 86 ) scheduled for unilateral hip replacement due to primary hip osteoarthrosis . INTERVENTION Patients were  r and omized to st and ard home-based rehabilitation ( 1 h/d x 12 weeks ) , unilateral neuromuscular electrical stimulation of the operated side ( 1 h/d x 12 weeks ) , or unilateral resistance training of the operated side ( 3/wk x 12 weeks ) . MEASUREMENTS Hospital length of stay ( LOS ) , quadriceps muscle cross-sectional area ( CSA ) , isokinetic muscle strength , and functional performance . Patients were tested presurgery and 5 and 12 weeks postsurgery . RESULTS Mean+/-st and ard error LOS was shorter for the resistance training group ( 10.0+/-2.4 days , P<.05 ) than for the st and ard rehabilitation group ( 16.0+/-7.2 days ) . Resistance training , but not electrical stimulation or st and ard rehabilitation , result ed in increased CSA ( 12 % , P<.05 ) and muscle strength ( 22 - 28 % , P<.05 ) . Functional muscle performance increased after resistance training ( 30 % , P<.001 ) and electrical stimulation ( 15 % , P<.05 ) but not after st and ard rehabilitation . CONCLUSION Postoperative resistance training effectively increased maximal muscle strength , muscle mass , and muscle function more than a st and ard rehabilitation regime . Furthermore , it markedly reduced LOS in elderly postoperative patients OBJECTIVE To examine if 2 weekly sessions of supervised progressive resistance training ( PRT ) in combination with 5 weekly sessions of unsupervised home-based exercise is more effective than 7 weekly sessions of unsupervised home-based exercise in improving leg-extension power of the operated leg 10 weeks after total hip replacement ( THR ) in patients with lower pre-operative function . METHOD A total of 73 patients scheduled for THR were r and omised ( 1:1 ) to intervention group ( IG , home based exercise 5 days/week and PRT 2 days/week ) or control group ( CG , home based exercise 7 days/week ) . The primary endpoint was change in leg extension power at 10 week follow up . Secondary outcomes were isometric hip muscle strength , sit-to-st and test , stair climb test , 20 m walking speed and patient-reported outcome ( HOOS ) . RESULTS Sixty-two completed the trial ( 85 % ) .  Leg extension power increased from baseline to the 10 week follow up in both groups ; mean [ 95 % CI ] IG : 0.29 [ 0.13 ; 0.45 ] and CG : 0.26 [ 0.10 ; 0.42 ] W/kg , with no between-group difference ( primary outcome ) ( P = 0.79 ) . Maximal walking speed ( P = 0.008 ) and stair climb performance ( P = 0.04 ) improved more in the IG compared to CG , no other between-group differences existed . CONCLUSIONS In this trial , supervised PRT twice a week in addition to 5 weekly sessions of unsupervised exercise for 10 weeks was not superior to 7 weekly sessions of unsupervised home-based exercise for 10 weeks in improving the primary outcome , leg-extension power of the operated leg , at the primary endpoint 10 weeks after surgery in THR patients with lower pre-operative function . TRIAL REGISTRATION NCT01214954 Husby VS , Helgerud J , Bjørgen S , Husby OS , Benum P , Hoff J : Early postoperative maximal strength training improves work efficiency 6–12 months after osteoarthritis induced total hip arthroplasty in patients younger than 60 years . Objective : To assess physical outcome of early maximal strength training after total hip arthroplasty . Design : Six- and 12-mo follow-up of 24 ( 22 ) total hip arthroplasty patients r and omly assigned to 4 wks of maximal strength training and conventional rehabilitation and to conventional rehabilitation only was conducted . After the intervention period , all patients attended conventional rehabilitation . Outcome measures were hip abduction and leg press strength , gait patterns , work efficiency , maximal oxygen consumption , and health-related quality of life . Results : Work efficiency was significantly higher in the strength training and conventional rehabilitation group compared with the conventional rehabilitation – only group after 6 and 12 mos by 29 % and 30 % , respectively . Leg press for the healthy leg and rate of force development for the operated leg were significantly higher in the strength training and conventional rehabilitation group compared with the conventional rehabilitation – only group 12 mos postoperatively by 36 % and 74 % , respectively . Conclusions : This study demonstrates higher work efficiency after 6 and 12 mos and improved rate of force development after 12 mos in total hip arthroplasty patients who performed early maximal strength training combined with conventional rehabilitation after total hip arthroplasty surgery compared with total hip arthroplasty patients receiving conventional rehabilitation only . However , the study indicates that a prolonged maximal strength training program and aerobic endurance training are required to fully recover total hip arthroplasty patients Background Total Hip Arthroplasty ( THA ) is being used more commonly in younger higher dem and patients . The purpose of this r and omized pilot study was to explore a ) feasibility of comprehensive postoperative rehabilitation compared to usual care  following primary THA in subjects < 65 years , b ) appropriate outcome measures including performance-based measures and c ) timing of assessment s. Methods 21 subjects who underwent primary THA were r and omized to receive a three-month out-patient rehabilitation program ( Intervention ) or usual postoperative care ( Control ) . Subjects were assessed preoperatively , six-weeks postoperatively ( Pre-intervention ) and four and 12 months postoperatively ( Post-intervention ) . Self-report measures were the Western Ontario McMaster Osteoarthritis Index ( WOMAC ) and R and 36-Item Health Survey ( R AND -36 ) . Performance-based measures included lower extremity strength , walking speed and endurance , and gait laboratory assessment . Results Ten Control and 11 Intervention subjects with an average age of 53.4 ( SD9.3 ) years were r and omized . All Intervention subjects completed the program without adverse effects . Although no statistically significantly results were reported , four months postoperatively , Intervention subjects had clinical ly important differences ( CID ) in strength compared with Control subjects . Walking endurance , WOMAC and R AND scores improved significantly with no CID noted between groups . Ten ( 48 % ) subjects reported a ceiling effect on the WOMAC ( 9 ( 43 % ) subjects on Pain ; 1 ( 5 % ) subject on 
    Output:
    
Because of the wide variety in characteristics of the physiotherapeutic exercise and control interventions , follow-up length and outcome measures , limited evidence was found on the effectiveness of physiotherapeutic exercise following THA .
The insufficient therapeutic validity and potentially high risk of bias in studies involving physiotherapeutic exercise interventions limit the ability to assess the effectiveness of these interventions following THA .