Land‐based versus water‐based rehabilitation following total knee replacement: A randomized, single‐blind trial

• Published in: Arthritis and rheumatism Vol. 61; no. 2; pp. 184 - 191
• Main Authors: Harmer, Alison R., Naylor, Justine M., Crosbie, Jack, Russell, Tyson
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 15.02.2009
• Subjects: Aged; Arthroplasty, Replacement, Knee - rehabilitation; Exercise Therapy - methods; Female; Humans; Hydrotherapy; Male; Middle Aged; Recovery of Function
• ISSN: 0004-3591; 1529-0131
• DOI: 10.1002/art.24420

Objective To compare outcomes between land‐based and water‐based exercise programs delivered in the early subacute phase up to 6 months after total knee replacement (TKR). Methods Two weeks after surgery (baseline), 102 patients were randomized to participate in either land‐based (n = 49) or water‐based (n = 53) exercise classes. Treatment parameters were guided by current clinical practice protocols. Therefore, each study arm involved 1‐hour sessions twice a week for 6 weeks, with patient‐determined exercise intensity. Session attendance was recorded. Outcomes were measured at baseline and at 8 and 26 weeks postsurgery. Outcomes included distance on the 6‐Minute Walk test, stair climbing power (SCP), the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index (n = 85 English‐proficient patients), visual analog scale for joint pain, passive knee range of motion, and knee edema (circumference). Planned orthogonal contrasts, with an intent‐to‐treat approach, were used to analyze the effects of time and time‐group interactions. Results Compliance in both groups was excellent with 81% attending 8 or more sessions. Loss to followup was 5%. Significant improvements were observed across time in all outcomes at 8 weeks, with further improvements evident in all variables (except WOMAC pain) at 26 weeks. Minor between‐group differences were evident for 4 outcomes (SCP, WOMAC stiffness, WOMAC function, and edema) but these appear clinically insignificant. Conclusion A short‐term, clinically pragmatic program of either land‐based or water‐based rehabilitation delivered in the early phase after TKR was associated with comparable outcomes at the end of the program and up to 26 weeks postsurgery.