title: Land-based versus water-based rehabilitation following total knee replacement: a randomized, single-blind trial.
abstract: OBJECTIVE
  To compare outcomes between land-based and water-based exercise programs delivered in the early subacute phase up to 6 months after total knee replacement (TKR).
  
  
  METHODS
  Two weeks after surgery (baseline), 102 patients were randomized to participate in either land-based (n = 49) or water-based (n = 53) exercise classes. Treatment parameters were guided by current clinical practice protocols. Therefore, each study arm involved 1-hour sessions twice a week for 6 weeks, with patient-determined exercise intensity. Session attendance was recorded. Outcomes were measured at baseline and at 8 and 26 weeks postsurgery. Outcomes included distance on the 6-Minute Walk test, stair climbing power (SCP), the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index (n = 85 English-proficient patients), visual analog scale for joint pain, passive knee range of motion, and knee edema (circumference). Planned orthogonal contrasts, with an intent-to-treat approach, were used to analyze the effects of time and time-group interactions.
  
  
  RESULTS
  Compliance in both groups was excellent with 81% attending 8 or more sessions. Loss to followup was 5%. Significant improvements were observed across time in all outcomes at 8 weeks, with further improvements evident in all variables (except WOMAC pain) at 26 weeks. Minor between-group differences were evident for 4 outcomes (SCP, WOMAC stiffness, WOMAC function, and edema) but these appear clinically insignificant.
  
  
  CONCLUSIONS
  A short-term, clinically pragmatic program of either land-based or water-based rehabilitation delivered in the early phase after TKR was associated with comparable outcomes at the end of the program and up to 26 weeks postsurgery.
authors.affiliation: University of Sydney, Sydney, New South Wales, Australia. A.Harmer@usyd.edu.au
authors.forename: Alison R
authors.initials: AR
authors.lastname: Harmer
authors.forename: Justine M
authors.initials: JM
authors.lastname: Naylor
authors.forename: Jack
authors.initials: J
authors.lastname: Crosbie
authors.forename: Tyson
authors.initials: T
authors.lastname: Russell
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000534:rehabilitation*; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D006875:Hydrotherapy; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function