Article

OBJECTIVE: To evaluate if the timing of aquatic therapy influences clinical
outcomes after total knee arthroplasty (TKA) or total hip arthroplasty (THA).
DESIGN: Multicenter randomized controlled trial with 3-, 6-, 12-, and 24-month
follow-up. SETTING: Two university hospitals, 1 municipal hospital, and 1 rural
hospital. PARTICIPANTS: Patients (N=465) undergoing primary THA (n=280) or TKA
(n=185): 156 men, 309 women. INTERVENTION: Patients were randomly assigned to
receive aquatic therapy (pool exercises aimed at training of proprioception,
coordination, and strengthening) after 6 versus 14 days after THA or TKA. MAIN OUTCOME MEASURES: Primary outcome was self-reported physical function as measured
by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at
3-, 6-, 12-, and 24-months postoperatively. Results were compared with published
thresholds for minimal clinically important improvements. Secondary outcomes
included the Medical Outcomes Study 36-Item Short-Form Health Survey,
Lequesne-Hip/Knee-Score, WOMAC-pain and stiffness scores, and patient
satisfaction. RESULTS: Baseline characteristics of the 2 groups were similar.
Analyzing the total study population did not result in statistically significant
differences at all follow-ups. However, when performing subanalysis for THA and
TKA, opposite effects of early aquatic therapy were seen between TKA and THA.
After TKA all WOMAC subscales were superior in the early aquatic therapy group,
with effect sizes of WOMAC physical function ranging from .22 to .39. After THA,
however, all outcomes were superior in the late aquatic therapy group, with WOMAC
effect sizes ranging from .01 to .19. However, the differences between treatment
groups of these subanalyses were not statistically significant. CONCLUSIONS:
Early start of aquatic therapy had contrary effects after TKA when compared with
THA and it influenced clinical outcomes after TKA. Although the treatment
differences did not achieve statistically significance, the effect size for early
aquatic therapy after TKA had the same magnitude as the effect size of
nonsteroidal anti-inflammatory drugs in the treatment of osteoarthritis of the
knee. However, the results of this study do not support the use of early aquatic
therapy after THA. The timing of physiotherapeutic interventions has to be
clearly defined when conducting studies to evaluate the effect of
physiotherapeutic interventions after TKA and THA.
CI - Copyright (c) 2012 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS