Authors (including presenting author) :
Ng HY(1), Li LMK(1), Leung CSM(1), Siu EHK(1), Mak RWF(2), Ong MTY(3), Yung PSH(3)
Affiliation :
(1)Physiotherapy Department, Prince of Wales Hospital
(2)Department of Orthopaedics and Traumatology, Prince of Wales Hospital
(3)Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong
Introduction :
The Structured Non-Surgical Treatment Programme (SNTP) is a four-year physiotherapy-led exercise programme for knee osteoarthritis (KOA) patients awaiting for knee replacements. While hydrotherapy alone has shown to be effective in improving physical function in KOA patients, the combined effects of hydrotherapy and land-based exercises remains inconclusive.
Objectives :
(1) To evaluate the effectiveness of hydrotherapy plus land-based exercises versus land-based exercise on pain and physical function for KOA patients in SNTP; (2) To compare its therapeutic effects among patients with different baseline disease severity.
Methodology :
A retrospective cohort study was conducted on patients enrolled in SNTP in Prince of Wales Hospital from October 2021 to April 2024. Participants were allocated to the hydrotherapy group (n=100) if not contraindicated, otherwise the conventional group (n=1406). Random sampling (n=100) was taken in the conventional group for analysis. All participants completed four to five weekly land-based exercise sessions. The hydrotherapy group completed additional four weekly exercise sessions in a heated pool. Outcomes (before and post-treatment) included Numerical Pain Rating Scale (NPRS), functional tests, Knee Society Score (KSS) and Knee Injury and Osteoarthritis Outcome Score (KOOS). Changes for outcomes within groups were compared using paired T-test and between groups using ANOVA. Subgroup analysis by KSS at baseline: 0-64 (poor), 65-76 (fair) and 77-100 (good/excellent) were also performed.
Result & Outcome :
Baseline demographics and KSS were homogenous between groups. Both groups revealed significant improvements in 30-second chair stand, KSS and NPRS scores (all p<0.05) over time, of which improvement in NPRS (-1.2) in the hydrotherapy group achieved the minimum clinically important difference threshold of 1.0. Compared to land-based exercises, the hydrotherapy group also achieved greater improvements in the Numerical Global Rating of Change Scale (NGRCS) (p<0.001), Time Up And Go (p=0.04) and functional reach (p=0.04). Significant within-group improvements in KOOS-Pain (p=0.001) and KOOS-Activity of Daily Living (p=0.04) were observed in the hydrotherapy group only. In the subgroup analysis, patients categorized as KSS 'poor' (0-64) and‘fair' (65-76) at baseline benefited more from hydrotherapy regarding KOOS-Pain, KSS, and NGRCS (all p<0.05).
Both hydrotherapy and land-based exercises improved pain and physical performance in KOA patients. Adding hydrotherapy to land-based exercise in SNTP provided superior gains in pain and functional outcomes, particularly for patients with higher disease severity.
