Contrôle postural dans la gonarthrose : variations chronobiologiques et effets de différents protocoles de rééducation

Abstract : Background and Objective – Increasing evidence supports balance control impairment in elderly patients with knee osteoarthritis (OA). Current guidelines recommend non-pharmacologic methods as first-line options in the management of OA. Hydrotherapy is a beneficial training medium for rehabilitation in elderly knee OA patients. However, few indications at present are available concerning the effect of hydrotherapy combining with targeted individual rehabilitation programs to improve balance control. Meanwhile, there is limited data on diurnal variation of balance control in these patients. This study aimed to investigate postural stability in elderly patients with symptomatic knee OA during different periods in a daytime before the spa therapy, then to study the results obtained before and after hydrotherapy to compare the improvement of balance control in these patients in two different water-based rehabilitation programs. Materials and Methods – Two-hundred and eighty-four knee OA patients were enrolled in this study. Static posturography using a vertical force platform was performed one week before spa therapy in simple (eyes open, firm support) and conflicting sensory (vision altered or unavailable, proprioception altered) conditions. To assess diurnal postural variations, patients were randomized to four testing sessions in a daytime defined as follows: 8-10am, 10-12am, 1pm-3pm, 3pm-5pm. Influence of sex, age, height, weight, and body mass index on postural stability was evaluated. Knee pain was also assessed in four testing sessions. Patients were then randomized to two different rehabilitated groups to receive spa therapies. Classic treatment group as a control received the efficacy proven spa water therapy, and active treatment group received spa water therapy combining with targeted individual rehabilitation programs. Static posturographies were carried out respectively in 21 days, 42 days and 90 days after the beginning of hydrotherapy. Results – Posturographic tests were completed for 241 patients (mean age: 64.8 + 8.7 years; 82 males). Balance control was more efficient in the afternoon than in the morning both in simple (p = 0.012) and conflicting sensory conditions (p = 0.047), especially in early afternoon when vision and proprioception were available (p = 0.026) or disturbed (p = 0.019). Patients’ knee pain was more pronounced in the morning than in the afternoon (p < 0.001). Diurnal variation of balance control was more noticeable in older, heavier, and male patients under different testing conditions (p < 0.05). Both the water-based therapies had considerable curative effect on balance control restoration. Better postural sway precision were found in active group than classic group 42 days after the beginning of hydrotherapy (p = .020), especially when proprioception was interfered with (p = .028) or without (p = .025) an available vision. Both of the groups have been observed a comparable postural stability in a three-month term. Conclusions – This study showed that better postural stability was observed in patients with knee OA in early afternoon than in late morning in simple and conflicting sensory situations. These variations appeared also to be related to age, sex, and weight and could be explained by fluctuant joint pain in a daytime. As feasible and recommended non-pharmacologic treatment, hydrotherapy is beneficial to the improvement of postural stability in elderly patients with knee OA, especially combining with targeted individual rehabilitation programs. These findings are important for future studies aiming at enhancing postural stability in knee OA patients and should be taken into account in the management of knee OA to generate applicative approaches to prevent the occurrence of adverse events in patient’s daily life.
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Zheng Zhang. Contrôle postural dans la gonarthrose : variations chronobiologiques et effets de différents protocoles de rééducation. Médecine humaine et pathologie. Université de Lorraine, 2014. Français. ⟨NNT : 2014LORR0096⟩. ⟨tel-01750836⟩

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