Barriers to Early Aquatic Physical Therapy in the Inpatient Setting After Total Hip and Total Knee Arthroplasty

Abstract

Background and purpose: Aquatic physical therapy has been shown to improve outcomes following total hip arthroplasty (THA) and total knee arthroplasty (TKA). However, despite evidence supporting its safety, commencement is often delayed until 14 days after surgery. The aims of this study were to: 1) Explore perceptions of early immersion of physical therapy and medical staff; and 2) Evaluate feasibility of early immersion following THA or TKA in the inpatient rehabilitation setting. Methods: Medical and physical therapy staff completed a cross-sectional survey to establish their perception of ideal times for commencement of aquatic physical therapy following THA and TKA. Patients anticipated to require a greater than 10-day inpatient admission after THA and TKA were screened for enrollment into a randomized controlled trial comparing aquatic physical therapy commencing 6 days after surgery to aquatic physical therapy commencing 14 days after surgery. Results: Of 47 survey responses, 21% indicated earliest commencement of aquatic physical therapy should be 14 days after surgery due to wound healing (35%) and infection risk (32%). Only 12% of patients screened were eligible for enrollment in the randomized controlled trial. The primary barriers for recruitment were surgeon refusal for their patients’ involvement and early discharge from acute hospital. Discussion and conclusions: Early aquatic physical therapy may not be practical during inpatient rehabilitation following THA and TKA. Further work is required to establish the long-term outcomes of early rehabilitation to justify the perceived risks associated with early immersion.