Multicenter Randomized Controlled Trial Comparing Early Versus Late Aquatic Therapy After Total Hip or Knee Arthroplasty
Multicenter Randomized Controlled Trial Comparing Early Versus Late Aquatic Therapy After Total Hip or Knee Arthroplasty
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DOI：
10.1016/j.apmr.2011.09.011
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发表时间：
2012-02-01
影响因子：
4.3
通讯作者：
Hassenpflug, Joachim
中科院分区：
文献类型：
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作者：
Liebs, Thoralf R.;Herzberg, Wolfgang;Hassenpflug, Joachim
Liebs TR, Herzberg W, Ruther W, Haasters J, Russlies M, Hassenpflug J，代表多中心关节置换术术后护理项目。多中心随机对照试验比较全髋关节或膝关节置换术后早期和晚期水疗法。Arch Phys Med Rehabil 2012；93: 192 - 9。目的：评价水疗法的时机是否影响全膝关节置换术（TKA）或全髋关节置换术（THA）后的临床结果。设计：多中心随机对照试验，随访3个月、6个月、12个月和24个月。单位：2所大学医院，1所市立医院，1所农村医院。参与者：接受原发性THA （N= 280）或TKA （N= 185）的患者（N=465）：男性156人，女性309人。干预：患者被随机分配在THA或TKA后6天和14天后接受水中疗法（旨在训练本体感觉、协调和强化的泳池运动）。主要结局指标：主要结局是术后3、6、12和24个月的自我报告的身体功能，由西安大略和麦克马斯特大学骨关节炎指数（WOMAC）测量。将结果与公布的最小临床重要改善阈值进行比较。次要结局包括医学结局研究36项简短健康调查、lequesne -髋关节/膝关节评分、womac -疼痛和僵硬评分以及患者满意度。结果：两组患者基线特征相似。在所有的随访中，对总研究人群的分析没有发现统计学上的显著差异。然而，当对THA和TKA进行亚组分析时，在TKA和THA之间观察到早期水疗法的相反效果。经TKA后，早期水疗组的WOMAC各分量表均较优，WOMAC身体功能的效应量从。22到。39。然而，在THA之后，晚期水生治疗组的所有结果都是优越的，WOMAC效应大小从。01到0.19。然而，这些亚分析的治疗组之间的差异没有统计学意义。结论：与全髋关节置换术相比，全髋关节置换术后早期开始水疗有相反的效果，影响全髋关节置换术后的临床结果。虽然治疗差异没有达到统计学意义，但TKA后早期水产治疗的效应量与非甾体类抗炎药治疗膝关节骨性关节炎的效应量相同。然而，本研究结果并不支持THA术后早期水疗。在进行评估全膝关节置换术和全髋关节置换术后物理治疗干预效果的研究时，必须明确物理治疗干预的时间。
Liebs TR, Herzberg W, Ruther W, Haasters J, Russlies M, Hassenpflug J, on behalf of the Multicenter Arthroplasty Aftercare Project. Multicenter randomized controlled trial comparing early versus late aquatic therapy after total hip or knee arthroplasty. Arch Phys Med Rehabil 2012;93: 192-9.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.