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

Rocky Mountain University of Health Professions, Provo, Utah, USA.
Physical Therapy (Impact Factor: 3.25). 01/2006; 85(12):1301-17.
Source: PubMed

ABSTRACT Manual therapy and exercise have not previously been compared with a home exercise program for patients with osteoarthritis (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.
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).
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).
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.
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.

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    • "Regarding all other measured parameters, although both groups produced statistically significant improvements at post-exercise compared with pre-exercise, statistically significant positive changes were detected in the sensorimotor group compared with the traditional exercises group. There are many studies that have investigated the effect of standard traditional exercises in the management of knee OA and reported decreased pain and increased muscle power with consequent improvement in proprioception and functional level [10] [11] [33]. However, according to the results of the current study, it is thought that this type of exercise programme is not enough and cannot achieve optimal functional capacity levels. "
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    • "de los programas de entrenamiento empleados en los estudios clínicos revisados Estudios Silva (2008) Jan (2008) Lin (2007) Durmus (2007) Deyle (2005) Talbot (2003) Gür (2002) Topp (2002) Eyigor (2004) Baker(2001) Messier (2000) Mangione (1999) "
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    Reumatología Clínica 05/2010; DOI:10.1016/j.reuma.2008.11.021
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    • "When all the participants were considered together, improvements in pain, other symptoms, function in daily living, knee-related quality of life, and mobility were in line with other studies using home-based exercises where physiotherapists supervised an initial exercise session (Deyle et al 2005). A simple home-based exercise program was shown to have beneficial effects on function and pain (Evcik and Sonel 2002). "
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