Deyle GD, Henderson NE, Matekel RL, Ryder MG, Garber
MB, Allison SC. Effectiveness of manual physical therapy and exercise
in osteoarthritis of the knee. A randomized, controlled trial. Ann
Intern Med. 2000 Feb 1;132:173-81.
Question: In patients with osteoarthritis of the
knee, how effective are manual physical therapy and exercise in decreasing
pain and stiffness and increasing walking distance?
Design: Randomized (allocation concealed), blinded
(outcome assessor), controlled trial with 1-year follow-up.
Setting: Outpatient clinic of a U.S. Army medical
center in Fort Sam Houston, Texas, USA.
Patients: 83 patients (mean age, 61 years; 59% women)
who had osteoarthritis of the knee, had no surgical procedure on
either leg in the previous 6 months, and had no physical impairment
that would preclude study participation. 69 patients (83%) completed the
treatment.
Intervention: Patients were allocated to manual
physical therapy and exercise (n = 42) or placebo
(ultrasound at a subtherapeutic intensity) (n =
41) twice weekly for 4 weeks. Physical therapy consisted of passive
joint movements, muscle stretching, and soft-tissue mobilization
applied to the knee and to the lumbar spine, hip, or ankle, if necessary.
The exercise program involved stretching exercises for the lower
limbs; range-of-motion exercises for the knee, including riding
a stationary bike; and muscle-strengthening exercises for the hip
and knee. Intervention group patients also practiced the exercises
at home.
Main outcome measures: Change in stiffness, pain,
and function subscores on the Western Ontario and McMaster Universities Osteoarthritis
Index (WOMAC [questions corresponded to a visual analog scale])
and the distance covered during a 6-minute walk test.
Results: At 8 weeks, mean WOMAC scores decreased more
in the intervention group than in the placebo group (P < 0.05)
(Table). Intervention
group patients increased their 6-minute walking distance more than
did placebo group patients (P < 0.05) (Table). At 1 year,
fewer treatment group patients had knee surgery than did placebo
group patients (P = 0.039) (Table).
Conclusion: In patients with osteoarthritis of the
knee, manual physical therapy and exercise decreased pain and stiffness
and increased the distance walked in 6 minutes and were associated
with less surgery.