Inpatient rehabilitation for hip or knee osteoarthritis: 2 year follow up study

Abstract

Objective: To examine the course of pain, physical function, and other health dimensions after a comprehensive inpatient rehabilitation intervention in patients with osteoarthritis (OA) of the hip or knee.

Methods: An observational, prospective cohort study with assessments at baseline (entry into clinic), 1 (discharge from inpatient rehabilitation), 3, 6, 9, 12, and 24 months after baseline. Consecutively referred patients to an inpatient rehabilitation centre fulfilling the inclusion criteria were studied. 3-4 week comprehensive rehabilitation intervention, including strengthening exercise, flexibility training, endurance training, relaxation strategies, and consultations for preventive measures, was carried out. Individual home rehabilitation programmes were taught. Generic health status was measured using the SF-36, condition specific health was measured with the WOMAC questionnaire. Effects were analysed with sensitivity statistics (effect size, ES) and non-parametric tests.

Results: Data from 128 patients with complete follow up data were analysed. Both pain and physical function improved moderately (WOMAC pain: ES = 0.56, WOMAC function ES = 0.44) until discharge. Although the effect in pain reduction remained significant by month 24 (WOMAC: ES = 0.26), physical function deteriorated close to baseline values after 12 months.

Conclusions: Comprehensive inpatient rehabilitation of patients with OA of the hip or knee may improve pain and physical function in the mid-term, and pain in the long term.

Figure 1

Global health status of patients with hip and knee OA by the SF-36 scales at baseline and at discharge (n = 128). Baseline = entry into the clinic. Discharge of the clinic = about 1 month after baseline. A larger "spider" figure represents a better health status. 0 = worst health; 100 = best health.

Figure 2

A 2 year follow up of patients with hip and knee OA by WOMAC scales (n = 128). Patients were assessed with the WOMAC at baseline ( = entry into the clinic), at discharge (1 ?month after baseline), and at months 3, 6, 9, 12, and 24. 0 = no symptoms; 10 = maximal symptoms.

Figure 3

A 2 year follow up of patients with hip and knee OA by the SF-36 scales for physical health (n = 128). The times of assessment are listed in the legend to fig 2. 0 = worst health; 100 = best health.

Figure 4

A 2 year follow up of patients with hip and knee OA by the SF-36 scales for mental health (n = 128). The times of assessment are listed in the legend to fig 2. 0 = worst health; 100 = best health. The intake of NSAIDs or analgesics or both declined from 66.4% at baseline to 11.0% at the end of rehabilitation. Until month 12 the level of the intake of drugs climbed to the baseline values (67.2%) and did not change significantly until month 24 (63.3%).