打开APP

APMR:水上运动有利于膝关节置换者功能恢复

  1. 功能恢复
  2. 水上运动
  3. 膝关节置换

来源:生物谷 2012-11-18 10:41

(图片来源:medpage today) 德国学者近日在《理疗与康复医学集刊》杂志(Archives of Physical Medicine and Rehabilitation)发表论文称,全膝关节置换术后早期开展水上运动有利于患者膝关节功能恢复。 文章指出,膝关节置换术后早期开展水上运动有助于身体机能的恢复,效应值范围为:6个月后0.22,2年后0.39。

(图片来源:medpage today)

德国学者近日在《理疗与康复医学集刊》杂志(Archives of Physical Medicine and Rehabilitation)发表论文称,全膝关节置换术后早期开展水上运动有利于患者膝关节功能恢复。

文章指出,膝关节置换术后早期开展水上运动有助于身体机能的恢复,效应值范围为:6个月后0.22,2年后0.39。而髋关节置换者在伤口愈合后再进行水上运动会更有利,效应值范围为:3个月后0.01,6个月后0.19。

作者称,尽管这些差别没有统计学意义,但由于膝关节置换后早期开展水上运动的效果与使用非固醇类抗炎药治疗骨关节炎的meta分析结果相似,因此该效果显得更具有临床意义。

接受关节置换者进行水上运动进行功能锻炼在欧洲非常流行,并普遍认为该疗法可帮助患者重拾身体的平衡感并增强肌肉力量。之前有研究证实了上述说法,但早于惯用的术后14天开展该疗法是否更有利尚不明确,因此该研究团队对280名接受髋关节置换和185名接受膝关节置换的患者进行了研究。

患者被随即分组,分别采用早期治疗和常规治疗(切口愈合后开始接受水上运动治疗)。接受早期治疗的这些平均年龄为68岁的患者在术后第6天开始进行水上运动治疗,他们在切口上覆盖防水服以保护切口,每周治疗3次,每次30分钟。主要终末点是患者的肢体功能,分别在治疗3个月、6个月、12个月、24个月后使用西安大略大学和麦克马斯特大学骨关节炎指标(WOMAC)来进行测量;次要终末点包括关节僵硬程度和疼痛,同样以WOMAC测量。

接受早期治疗的膝关节置换者,在12个月时其WOMAC得分高于常规治疗者,表明早期治疗略优于常规治疗,效应值为0.03。而髋关节置换者在切口愈合后再接受水上运动治疗者的WOMAC得分较高。

接受膝关节置换的患者中,有5名接受早期治疗者和1名常规治疗者在3个月内因不适当的运动和关节腔积液而再次入院,其中3名早期治疗者和1名常规治疗者被认为与该水上运动治疗有关。

接受髋关节置换的患者中,10名接受早期治疗者和4名接受常规治疗者在3月内因髋关节脱位、伤口破裂和肺栓塞再次入院,其中各组有2名被认为与该治疗有关。

作者指出,许多因素均可影响关节置换术后患者的生活治疗,包括患者年龄、性别、其他基本资料、并发症等,这其中任何一项都无法被看护者改变。(生物谷bioon.com)

Multicenter Randomized Controlled Trial Comparing Early Versus Late Aquatic Therapy After Total Hip or Knee Arthroplasty

Thoralf R. Liebs MD, Wolfgang Herzberg MD, Wolfgang Rüther MD, PhD, Jörg Haasters MD, PhD, Martin Russlies MD, PhD, Joachim Hassenpflug MD, PhD and on behalf of the Multicenter Arthroplasty Aftercare Project.

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.

版权声明 本网站所有注明“来源:生物谷”或“来源:bioon”的文字、图片和音视频资料,版权均属于生物谷网站所有。非经授权,任何媒体、网站或个人不得转载,否则将追究法律责任。取得书面授权转载时,须注明“来源:生物谷”。其它来源的文章系转载文章,本网所有转载文章系出于传递更多信息之目的,转载内容不代表本站立场。不希望被转载的媒体或个人可与我们联系,我们将立即进行删除处理。

87%用户都在用生物谷APP 随时阅读、评论、分享交流 请扫描二维码下载->