application of manual therapy and supervised exercise adds greater symptomatic relief for osteoarthritis of the knee

Physical Therapy Treatment Effectiveness for Osteoarthritis of the Knee: A Randomized Comparison of Supervised Clinical Exercise and Manual Therapy Procedures Versus a Home Exercise Program
Submitted September 30, 2004; Accepted May 18, 2005

from: PHYS THER Vol. 85, No. 12, December 2005, pp. 1301-1317

Abstract:
Background and Purpose. Manual therapy and exercise have not previously been compared with a home exercise program for patients with osteo-arthritis (OA) of the knee. The purpose of this study was to compare outcomes between a home-based physical therapy program and a clinically based physical therapy program. Subjects. One hundred thirty-four subjects with OA of the knee were randomly assigned to a clinic treatment group (n=66; 61% female, 39% male; mean age [±SD]=64±10 years) or a home exercise group (n=68, 71% female, 29% male; mean age [±SD]=62±9 years). Methods. Subjects in the clinic treatment group received supervised exercise, individualized manual therapy, and a home exercise program over a 4-week period. Subjects in the home exercise group received the same home exercise program initially, reinforced at a clinic visit 2 weeks later. Measured outcomes were the distance walked in 6 minutes and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Results. Both groups showed clinically and statistically significant improvements in 6-minute walk distances and WOMAC scores at 4 weeks; improvements were still evident in both groups at 8 weeks. By 4 weeks, WOMAC scores had improved by 52% in the clinic treatment group and by 26% in the home exercise group. Average 6-minute walk distances had improved about 10% in both groups. At 1 year, both groups were substantially and about equally improved over baseline measurements. Subjects in the clinic treatment group were less likely to be taking medications for their arthritis and were more satisfied with the overall outcome of their rehabilitative treatment compared with subjects in the home exercise group. Discussion and Conclusion. Although both groups improved by 1 month, subjects in the clinic treatment group achieved about twice as much improvement in WOMAC scores than subjects who performed similar unsupervised exercises at home. Equivalent maintenance of improvements at 1 year was presumably due to both groups continuing the identical home exercise program. The results indicate that a home exercise program for patients with OA of the knee provides important benefit. Adding a small number of additional clinical visits for the application of manual therapy and supervised exercise adds greater symptomatic relief.


Key Words: Exercise • Knee Osteoarthritis • Manual therapy • Physical therapy

Gail D Deyle, Stephen C Allison, Robert L Matekel, Michael G Ryder, John M Stang, David D Gohdes, Jeremy P Hutton, Nancy E Henderson and Matthew B Garber
GD Deyle, PT, DPT, is Assistant Professor and Graduate Program Director, Rocky Mountain University of Health Professions, Provo, Utah; Assistant Professor, Baylor University, Waco, Tex; and Senior Faculty, US Army–Baylor University Post Professional Doctoral Program in Orthopaedic Manual Physical Therapy, Brooke Army Medical Center, San Antonio, Tex
SC Allison, PT, PhD, is Professor, Rocky Mountain University of Health Professions, and Adjunct Professor of Physical Therapy Education, Elon University, Elon, NC
RL Matekel, PT, DScPT, is Lieutenant Colonel, Army Medical Specialist Corps, and Chief, Physical Therapy, Madigan Army Medical Center, Ft Lewis, Wash
MG Ryder, PT, DScPT, is Major, Army Medical Specialist Corps, and Officer-in-Charge, Primary Care Physical Therapy, Brooke Army Medical Center, Ft Sam Houston, Tex
JM Stang, PT, DScPT, is Lieutenant Colonel, Army Medical Specialist Corps, and Chief, Physical Therapy, Ireland Army Community Hospital, Ft Knox, Ky
DD Gohdes, PT, MPT, is Lieutenant Colonel, Army Medical Specialist Corps, and Assistant Chief, Physical Therapy, Tripler Army Medical Center, Tripler AMC, Hawaii
JP Hutton, PT, MPT, is Lieutenant Colonel, Army Medical Specialist Corps, and Chief, Physical Therapy, Eisenhower Army Medical Center, Ft Gordon, Ga
NE Henderson, PT, PhD, is Physical Therapist, Steilacoom, Wash
MB Garber, PT, DScPT, is Major, Army Medical Specialist Corps, and Assistant Chief, Physical Therapy, Brooke Army Medical Center

Address all correspondence to Dr Deyle at 3 Sherborne Wood, San Antonio, TX 78218-1771 (USA) (gdeyle@satx.rr.com)