Harmer (2009) Land- based versus water-based rehabilitation following total knee replacement

Introduction to Rehabilitation Modalities

This study by Harmer, Naylor, Crosbie, and Russell explores the effectiveness of land-based versus water-based exercise programs in the early subacute phase, up to 6 months following Total Knee Replacement (TKR). The research aims to identify which rehabilitation method offers superior outcomes in improving patient mobility and reducing symptoms of osteoarthritis post-surgery.

Research Methodology

The study enrolled 102 patients who were randomized into two groups: one undergoing land-based exercises in a gymnasium and the other participating in water-based exercises in a therapeutic pool. Each group attended one-hour sessions twice a week for six weeks, with exercises tailored to patient-determined intensity. The effectiveness of the interventions was measured using the 6-Minute Walk test, Stair Climbing Power (SCP), WOMAC Osteoarthritis Index, and assessments of joint pain, knee range of motion, and edema.

Results and Findings

Both groups showed significant improvements in all measured outcomes at 8 weeks, with further enhancements observed at 26 weeks, except for WOMAC pain. Minor differences between the groups were noted in SCP, WOMAC stiffness, function, and edema, but these were deemed clinically insignificant. The study concluded that both land-based and water-based rehabilitation programs offer comparable benefits to patients recovering from TKR.

Implications for Rehabilitation Practices

The findings suggest that the choice between land-based and water-based rehabilitation should be based on availability, patient preference, and cost considerations, rather than expected outcomes. Both methods provide significant improvements in physical function and quality of life for TKR patients. The study underscores the importance of incorporating regular, supervised exercise into post-TKR rehabilitation regimens to optimize recovery.

Keywords: Total Knee Replacement, Physiotherapy, Hydrotherapy, Exercise Rehabilitation, Post-Surgical Recovery