Manual Therapy or Exercise Effective for Hip or Knee Osteoarthritis
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Michael A. Seffinger
Abbott JH, Robertson MC, Chapple C, et al. Manual therapy, exercise therapy, or both, in addition to usual care, for osteoarthritis of the hip or knee: a randomized controlled trial—1: clinical effectiveness. Osteoarthritis Cartilage. 2013;21(10):525-534. doi:10.1016/j.joca.2012.12.014.
Researchers in New Zealand carried out a rigorous randomized controlled trial that evaluated the effectiveness of manual therapy and exercise in addition to usual care in alleviating symptoms and improving function in patients with hip or knee osteoarthritis (OA).
The researchers randomly allocated 206 adults (92 men, 114 women; mean [range] age, 66 [37-92] years) with diagnosed OA of the hip or knee into 1 of 4 groups: manual therapy plus usual care (n=54), multimodal exercise therapy plus usual care (n=51), manual therapy and exercise therapy plus usual care (n=50), or usual care only (n=51). Western Ontario and McMaster osteoarthritis index scores were obtained at baseline and after 1 year. In addition, pain levels, global assessment, and physical function were measured. Six trained physiotherapists performed the manual therapy and exercise therapy interventions, which were provided 7 times during the first 9 weeks and twice during week 16. Protocols allowed for individualization of the interventions on the basis of physical examination findings. Manual therapy included thrust and nonthrust joint mobilization, soft tissue manipulation, and stretching of the hip, knee, ankle, lumbar, and pelvic regions. The manual therapy protocol did not include aerobic, strengthening, or neuromuscular control exercises.
Using intention-to-treat analysis, the authors found that participants in the manual therapy group had significant (P<.03) and clinically important sustained improvements in symptoms at 1 year. Those in the exercise therapy group also had sustained benefit with respect to physical performance tests. No added benefit was found in the group who underwent both therapies.
To my knowledge, no randomized controlled trials have assessed the effectiveness of osteopathic manipulative treatment (OMT) for this cohort. However, because the techniques used in this study were similar to OMT techniques, it is likely that OMT effectiveness would be similar to the manual therapy effectiveness demonstrated in this study. Studies assessing the effectiveness of OMT for patients with hip or knee OA are warranted.
© 2014 The American Osteopathic Association
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
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Artikel in diesem Heft
- Abstracts
- 2013 SOMA Abstracts and Poster Competition
- 2013 BIOM Abstracts and Poster Competition
- Editorial
- Our Past, Present, and Future Are in Our Hands
- Letters
- Osteopathic Manual Treatment and Ultrasound Therapy for Chronic Low Back Pain: An Illustration of Osteopathic Semantic Confusion
- Original Contribution
- The Persistence of Lumbar Somatic Dysfunction and Its Association With Bone Mineral Density
- Medical Education
- Patterns of Misrepresentation of Clinical Findings on Patient Notes During the COMLEX-USA Level 2-PE
- Special Communication
- A Degree of Difference: The Origins of Osteopathy and First Use of the “DO” Designation
- A Research Primer, Part 2: Guidelines for Developing a Research Project
- Case Report
- A Case of Seasonal Recurrent Myopericarditis
- A Case of Idiopathic Colonic Varices
- The Somatic Connection
- OMT Relieves Severe Chronic Low Back Pain
- Abdominal Muscles Are the Front Side of the Low Back
- Systematic Review Paints Incomplete Picture of OMT Research
- Manual Therapy or Exercise Effective for Hip or Knee Osteoarthritis
- Review of Severe Adverse Events From Spinal Manipulative Therapy of the Lumbopelvic Area
- A Chiropractic Perspective: Spinal Manipulative Therapy Is Not Causally Related to Stroke
- Clinical Images
- Abducens Palsy
- In Your Words
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