A Randomized Clinical Trial of Prehabilitation Using Aquatic Exercise in Older Adults with Knee Osteoarthritis Undergoing Total Knee Arthroplasty

Abstract

<jats:title>Abstract</jats:title> <jats:p>Background: With an aging population, knee osteoarthritis (KOA) is increasingly more prevalent. A significant number of patients with advanced KOA require total knee arthroplasty (TKA). Preoperative physical function predicts postoperative outcomes. We hypothesized that preoperative water exercise to improve preoperative physical function will improve postoperative outcomes after TKA.Methods: We conducted a randomized controlled trial in 43 participants who were scheduled for TKA and scored at or below 50th percentile in mobility assessment tool-sf (MAT-sf). All enrolled participants were assessed on 1) clinical osteoarthritis symptom severity using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), 2) physical function using Short Physical Performance Battery (SPPB), 3) self-reported mobility using Mobility Assessment Tool-short form (MAT-sf), 4) depression using Geriatric Depression Scale-short form (GDS-sf), 5) cognitive function using Montreal Cognitive Assessment (MoCA). High-sensitivity-C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) levels were analyzed. Participants were randomly assigned to the aquatic exercise intervention (AEI) or usual care group. The AEI was conducted three times a week for 4-8 weeks, with each session lasting for 60 minutes. Participants in both groups were evaluated within one week before their scheduled surgery, as well as 4 weeks after the surgery. Logistic regressions were used to examine the associations between the intervention and unfavorable outcomes.Results: The mean age was 67.1 (±6.2), 44% were female, 74% were White. There is no statistically significant difference in combined outcome of any complication, unscheduled ER visit, and disposition to nursing home or rehab facility by AEI. However, AEI was associated with more favorable functional outcomes including WOMAC scores, chair-stand, MAT-sf, as better mood and cognition and lower blood pressure in multivariable analyses.Conclusion: 4-8 weeks of aquatic exercise intervention resulted in improved functional outcomes in patients undergoing TKA. A larger study is warranted to explore the role of water exercise in clinical and functional outcomes of TKA.Trial registration: This clinical trial was registered at ClinicalTrials.gov with ClinicalTrials.gov Identifier of NCT02773745. The date of registration was March 16th 2016. The URL of the trial registry record is https://www.clinicaltrials.gov/ct2/show/NCT02773745?term=water&amp;recrs=e&amp;cond=Osteoarthritis%2C+Knee&amp;cntry=US&amp;draw=2&amp;rank=2.</jats:p>

A scoping review of prehabilitation interventions for arthroplasty patients

“…The most common joints targeted were the hip, knee and ankle, whereas the study by Rooks et al ( 2006 ) incorporated single planar motion of the cervical spine, shoulders, elbows, wrists and hands (Rooks et al 2006 ). Aerobic exercises were described in 13 studies and included a warm-up session (Brown et al 2012 ; D’Lima et al 1996 ; Doiron-Cadrin et al 2020 ) of walking (Kim et al 2020 ; McKay, Prapavessis & Doherty 2012 ; Swank et al 2011 ) or used equipment like a stationary bike (Cavill et al 2016 ; Desmeules et al 2013 ; Gill et al 2009 ; McKay et al 2012 ; Moe & Dagfinrud 2014 ; Rooks et al 2006 ; Villadsen et al 2014 ) or arm ergometry (Calatayud et al 2017 ). The main reason behind incorporating an aerobic session was to improve cardiovascular conditioning, maintain heart rate and improve general fitness (D’Lima et al 1996 ; Kim et al 2020 ).…”

“…Aerobic exercises were described in 13 studies and included a warm-up session (Brown et al 2012 ; D’Lima et al 1996 ; Doiron-Cadrin et al 2020 ) of walking (Kim et al 2020 ; McKay, Prapavessis & Doherty 2012 ; Swank et al 2011 ) or used equipment like a stationary bike (Cavill et al 2016 ; Desmeules et al 2013 ; Gill et al 2009 ; McKay et al 2012 ; Moe & Dagfinrud 2014 ; Rooks et al 2006 ; Villadsen et al 2014 ) or arm ergometry (Calatayud et al 2017 ). The main reason behind incorporating an aerobic session was to improve cardiovascular conditioning, maintain heart rate and improve general fitness (D’Lima et al 1996 ; Kim et al 2020 ). The majority of the studies did aerobic exercises for 10 min, increasing to a maximum time of 20 min (Kim et al 2020 ).…”

“…The main reason behind incorporating an aerobic session was to improve cardiovascular conditioning, maintain heart rate and improve general fitness (D’Lima et al 1996 ; Kim et al 2020 ). The majority of the studies did aerobic exercises for 10 min, increasing to a maximum time of 20 min (Kim et al 2020 ).…”

“…Twenty-nine studies used exercise-based interventions. However, two studies (Kosek et al 2013;Topp et al 2009) did not discuss the intervention in detail and two studies et al 1996;Kim et al 2020). The majority of the studies did aerobic exercises for 10 min, increasing to a maximum time of 20 min (Kim et al 2020).…”