The effectiveness of aquatic exercises added physical therapy on pain, balance and muscle strength in patients with knee osteoarthritis

Objective: This study aims to evaluate the efficacy of aquatic therapy on pain, balance and muscle strength in patients with knee osteoarthritis. Materials and Methods: A total of 73 patients with knee OA were included in the study and were randomly divided into two groups as aquatic exercise (AQE) (n = 35) and land-based exercise (LBE) group (n = 38). Demographic data of the patients were recorded. For both groups, a total of 15 sessions, 5 sessions per week HP, TENS, SWD (short wave diathermy) were aplied to the symptomatic knee for 3 weeks. 5 days a week, 15 sessions and 30 minutes (warm-up, walking, EHA exercises, quadriceps strengthening exercises, balance, stretching exercises on lower extremity muscles) aquatic exercise program applied for AQE group and 5 days a week, 15 sessions and 30 minutes (warm-up, walking, eha exercises, quadriceps strengthening exercises, balance, stretching exercises to the lower extremity muscles and cooling) were applied to the LBE group with the physical therapy program. Before and after treatment, ROM, VAS, WOMAC, 6MWT(six-minute walking test), static and dynamic evaluation with kinesthetic balance device, knee flexor and knee extensor peak torque values were recorded with isokinetic dynamometer at 90 and 150 degree / second angular velocities. Statistical analysis was performed with SPSS 18 developed for Windows. In the evaluation of the data, the mean distribution of the test was done by Shapiro-Wilk test. The Mann-Whitney U test was used to test the descriptive statistics and significance of the median difference between the groups. Wilcoxon test was used to evaluate recurrent measurements of the same group and Chi-square test was used to evaluate two categorical data. P <0.05 was considered statistically significant. Results: The demographic characteristics and the radiological stages of the groups were similar. VAS associated with motion, WOMAC function and WOMAC total score were lower in AQE, knee extensor peak torque measured at 90 deg/s angular velocity was higher in the AQE group and all the other parameters ( ROM, VAS-R , VAS-N, WOMAC pain, WOMAC stiffness, 6MWT, SBI, and DBI, and isokinetic measurements were similar. After treatment, there was a significant decrease in VAS and WOMAC scores, 6MWT, SBI and DBI improved and a significant increase in isokinetic values at all angles and velocities in both groups, there was only an increase in ROM in the LBE. There was significant improvement in favor of the AQE on VAS-H, WOMAC pain, WOMAC function, WOMAC total, SBI, knee extensor peak torque at 90 deg/s angular velocity and knee flexor peak torque at angular velocity of 150 deg/s. Conclusion: Aquatic exercises added to physical therapy applications may be more effective in short-term compared to land-based exercise program in reducing pain, increasing static balance and muscle strength.