AB1500 ASSESSMENT OF CLINICAL PARAMETERS AFTER CLASSIC REHABILITATION VERSUS BALNEOTHERAPY IN GONARTHROSIS

Abstract

Background: Knee osteoarthritis (KOA) is the most common pathology of the lower limb. It is multifactorial and constitutes a real public health problem. Nowadays, in addition to the rehabilitation that is part of the multidisciplinary management of this affection, water gymnastics is increasingly finding its place [1]. Objectives: The main objective of our work was to compare the contribution of aquatic gymnastics compared to classical rehabilitation in patients with knee osteoarthritis through a clinical evaluation. Methods: This is a prospective, comparative and evaluative study carried out in a department of Physical Medicine and Functional Rehabilitation over a period of 15 months between September 2016 and December 2017, including 60 patients with KOA. The patients were randomly divided into 2 groups of 60 patients each one. The frst(G1) benefted from a classic rehabilitation program. The second(G2) benefted from water gymnastics. Two clinical evaluations were carried out: T1 before the start of rehabilitation and T2 at the end of the eight weeks of treatment. Results: The mean age of our patients was 57.2 ± 12.5 years in G1 vs 54.3 ± 7. 1 years in G2 (p = 0.012). The sex ratio was 0.2 in G1 versus 0.37 in G2 (p = 0.011). The duration of knee osteoarthritis was 63.4 ± 4.5 months in G1 vs 56.2±7.5 months in G2 (p=0.172). 55 patients presented with a misalignment of the lower limbs with a varus knee in 33% of cases (G1 25% and G2 42%). 5 patients in G1 and 7 patients in G2 had a valgus knee. In G1, one patient had recurvatum and two patient had knee filexum with no statistically significant difference between the two groups. After classic rehabilitation, Zohlen's sign had disappeared in 6 patients for the right knee and 3 patients for the left knee. However, after water gymnastics, this sign had disappeared in 12 patients for the right knee and in 16 patients for the left knee. A functional mobility sector (>90°) was found in all patients with an average of 120° in G1 and 126° in G2. After rehabilitation, an improvement of 2% in G1 and 5% in G2 was noted with a statistically significant difference between the two groups (p<0.001). Thirty-sex percent of G1 patients had quadriceps amyotrophy versus 32 % of G2, which disappeared in 5 patients after classic rehabilitation and in 6 patients after hydrotherapy. 48 patients of G1 and 56 patients of G2 presented with quadriceps retraction which disappeared in 21 subjects of G1 after classic rehabilitation and in 45 subjects of G2 after hydrotherapy. A retraction of the hamstrings was noted in 13 and 18 patients respectively in G1 and G2 with a total improvement in the 2 groups. Conclusion: Dry rehabilitation has its place in the management of knee oste-oarthritis, but rehabilitation in water has better results. The aquatic environment makes it possible, by reducing the weight of the body, to reduce the stresses exerted on the knee joints, allowing better joint mobility with the added effect of heat on the reduction of pain and muscle relaxation.