Prehabilitation improves physical function for hip and knee arthritis
For some osteoarthritis patients, waiting too long for surgery may make matters worse.
Osteoarthritis (OA) is the wearing away of cartilage in joints that leads to pain and reduced function. It is the most common type of arthritis and it currently affects more than 20 million Americans. Unfortunately, the cause of OA is not known and there is no definitive cure for the disorder, but strategies to treat it focus on reducing pain and improving function. When this type of treatment is unsuccessful over time, total joint arthroplasty (TJA), or replacement of the affected joint, is usually recommended. Sadly, many patients in this predicament experience long wait times before surgery can be performed, and during this time the function of their hip or knee OA can get even worse. One possible strategy to prevent this from occurring is to give these patients prehabilitation, which is a program of exercise and education to help maintain function. To evaluate this type of program, a study was performed on patients with severe OA waiting for TJA.
Patients are assessed and placed in three different categories
A group of 650 patients with severe OA were evaluated by a physical therapist and assigned to one of three categories: Stream 1 (minimal need for surgical preparation), Stream 2 (moderate need) or Stream 3 (maximal need). From here, 28 patients with the greatest disability were selected from Streams 2 & 3 to participate in the supervised prehabilitation program. Each program was specifically designed by a physical therapist based on the individual needs of each patient, but the overall goal of each program was to improve the function of the affected joint through stretching, strengthening and range of motion exercises. Most programs lasted about nine weeks, and all patients were instructed to also exercise independently at least once a day on their own and to continue taking any medications prescribed for their OA.
Significant improvements observed in most measures taken
Patients were assessed once again after the conclusion of the prehabilitation intervention. Results from these assessments were positive, as they showed that the program led to significant improvements in physical function for patients in the program. This was seen in both self-reported function and in physical performance measures, both of which showed statistically significant improvements after the intervention. These outcomes therefore support the use of prehabilitation for patients with severe OA waiting for surgery that may otherwise lose function of their affected joint. This may be due to the fact that these programs were each tailored specifically to each patient with their needs and abilities in mind. Furthermore, other evidence shows that the better the physical function of a patient is before going into surgery, the better their chances recovering successfully. For these reasons, prehabilitation is recommended as an effective strategy to improve function and reduce pain for patients with severe hip or knee OA while awaiting TJA, and may lead to a better outcome after surgery.
-Summarized by Greg Gargiulo -As reported in the Fall ’13 edition of Physiotherapy Canada