Background: Individuals with either knee or hip osteoarthritis are at risk of experiencing pain and developing functional limitations (Bennell 2005). In many cases, to alleviate pain and improve one's quality of life, an individual may require a total joint replacement. Despite advances in surgical technique and joint replacement hardware, surgical procedures are not without risk. Conservative treatments, including therapeutic exercise programmes, may improve a patient's status while avoiding the potential risks associated with surgery (pain, medication utilisation, long bouts of rehabilitation, and/ or death). Researchers have demonstrated that some patients may experience improvements in pain and functional abilities after participating in either land-based or aquatic-based exercise programmes (Maurer et al 1999, Hinman et al 2007). However, according to Gill et al (2009), there is paucity of literature addressing post-exercise outcomes in individuals who are scheduled for either hip or knee joint replacement surgery.
Aim: To assess self-reported and performance-based functional measures in individuals (who were scheduled to have either a hip or knee joint replacement) after the completion of either a land-based or pool-based exercise programme.
Methods: The authors implemented a randomised controlled trial, allocating subjects to either the land-based (n=40) or pool-based (n=42) exercise programme, stratified by the involved joint. Subjects were recruited from a waiting list of patients who were scheduled for either a knee replacement or hip replacement. Each exercise session was performed for one hour over a total period of 12 sessions (2 times a week for 6 weeks). In addition, the authors instructed the subjects to exercise 3 days a week at home (for 30 minutes each session) performing a combination of walking, stationary bicycling, and/or other exercises they performed in class. Self-reported function (as measured by Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), performance-based outcomes (50-foot timed walk and 30-second chair stand test), and psychosocial status (SF-36 MCS) measures were collected prior to treatment, at the end of the 6-week training session, and finally two months later. These data were collected by a blinded assessor. Additionally, daily pre- and post-exercise pain levels were recorded during each session.
Results: The authors reported that both pool-based and land-based exercise programmes were effective in reducing pain and increasing function in patients with a diagnosis of either knee or hip arthritis. However, there were no differences between groups for WOMAC pain (p = .614), WOMAC function (p = .739), 50-foot timed walk test p = .173), the 30-second chair stand test (p = .179), or the SF-36 MCS (p = .205). Those who participated in the land-based programme experienced improvements in pain at both assessment periods (p = .000; .015) whereas the participants in the pool-based programme only demonstrated improvements at the first assessment (p = .011; .431). Both groups demonstrated significant functional improvements at the first testing session for performance-based tests as well as demonstrating significant improvement in WOMAC function scores and the 30-second chair stand test at the final assessment session. Those who participated in the pool-based programme experienced a significantly lower daily pain score (p = .005) when compared to those in the land-based programme.
Conclusion: The authors report that both training programmes may lead to positive functional outcomes in individuals who are awaiting a joint replacement surgery. In addition, the authors report that those who participated in the pool programme may tolerate the treatment with less post-exercise pain.
New Zealand Journal of Physiotherapy. All rights reserved. 2009; 37(3): 160. https://pnz.org.nz/journal