Starting aquatic therapy early led to better physical function in patients having total knee replacement, although early water-based exercise did not appear to be beneficial in patients undergoing hip arthroplasty, a German randomized study suggested.
Early institution of the pool-based therapy after knee replacement was associated with improved physical function, with effect sizes ranging from .22 after six months (absolute difference d=3.9, P=0.45) to .39 after two years (absolute difference d=6.9, P=0.12), according to Thoralf R. Liebs, MD, of the University of Schleswig-Holstein in Kiel, and colleagues.
But for hip replacement, improvements were greater if aquatic therapy was delayed until after wound healing, with effect sizes ranging from .01 at three months (absolute difference d=.30, P=0.80) to .19 six months later (absolute difference d=3.1, P=0.52), the researchers reported online in the Archives of Physical Medicine and Rehabilitation. While these differences were not statistically significant, the results of early therapy after knee replacement were considered “clinically important,” because the effect sizes were similar to those seen in a meta-analysis for the use of nonsteroidal anti-inflammatory drugs in osteoarthritis, Liebs and colleagues explained.
Aquatic therapy is popular in Europe for patients undergoing joint replacement, and is thought to help patients regain balance and muscle strength.
Several studies have confirmed these benefits, but whether starting earlier than the conventional time of 14 days after surgery has been uncertain. To explore this, Liebs and colleagues conducted a multicenter study that included 465 patients undergoing total knee or hip arthroplasty (280 hip, 185 knee). Patients randomized to treatment beginning on day six wore waterproof dressings over the wound, and all participants spent 30 minutes, three times weekly, for a month doing pool-based exercises.
Two-thirds of the patients were women, and mean age was 68. The primary endpoint was patient-reported physical function as measured on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) after three, six, 12, and 24 months.
Secondary endpoints included stiffness and pain, also measured on the WOMAC, the short form-36 health survey, and patient satisfaction.
By Nancy Walsh, Staff Writer, MedPage Today
Published: December 22, 2011
Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner