Correspondence (reply): In Reply

Sports rehabilitation (SR) is a measure to support reintegration and self-help which is financed by the healthcare payers. The primary goal of sports rehabilitation is to strengthen people’s own responsibility for their health and to motivate them to engage in long-term independent exercise training by continuing with sporting activities, e.g. in the existing group or in another sports therapy offerings at their own expense (1).

We consider SR as complementary rather than as an alternative to rehabilitation programs and physiotherapy. Therefore, as described in the study protocol, all patients had completed a prior outpatient or inpatient rehabilitation program. We did not discuss the effectiveness and content of rehabilitation programs—a point criticized by Dr. Brons—, because it was not part of our research question.

As Dr. Krakor (2, 3), we found in our daily routine that the benefits of sports rehabilitation for patients who underwent total hip replacement surgery not only included improved motor function and a more active lifestyle, but also social integration in the group. Our motivation to conduct this study was to prove these effects in a long-term, controlled, prospective and randomized trial, as there were no comparable studies available in the literature.

Even though we did not succeed in demonstrating a significant improvement in the primary endpoint—strength capacity of the muscles surrounding the hip joint—one year after hip replacement surgery, the study did show positive trends for its secondary endpoints. For example, health-related quality of life was found significantly improved 6 months after surgery and the WOMAC pain score one year after surgery was found to be significantly reduced. We are aware of the methodological limitations of our study and have discussed them in detail in our article. The protocol violations were not taken into consideration—a point criticized by Dr. Krakor—, because our analysis was based on an intention-to-treat approach in order to reflect the reality of care provision.

In summary, we see a need for further prospective controlled studies to increase the robustness of our results or disprove our findings. On the other hand, there seems to be a need to optimize the frequency of training sessions, especially when taking the current recommendations on the required level of physical exercising into account (4). For example, further studies could evaluate whether a second weekly training unit—alternatively an additional home exercise program—augments these effects or how sports rehabilitation influences the long-term everyday activity of patients beyond the first postoperative year.