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
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   . 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. "
ABSTRACT: Osteoarthritis (OA) is a chronic disabling disease that generates many impairments of functional health status. Impairments of balance are recognized in patients with knee OA. This study investigated the short term effect of sensorimotor training on balance in elderly patients with knee OA, and whether these changes were associated with impairment of functional performance. In addition the possible independent predictors of impaired balance were determined. Forty female patients with knee OA were divided into two equal groups. The control group received a traditional exercise programme and the study group received sensorimotor training in addition to traditional exercises. Blind assessment was conducted at the beginning of the study and after 6weeks of training to measure balance [in the form of overall stability index (OSI), medial/lateral stability index (MLSI), anterior/posterior stability index (APSI)], perceived pain, proprioception acuity, knee extensor muscle torque, and functional disability. For the sensorimotor group, statistically significant improvements were recorded in all measured parameters, while the traditional exercise group recorded significant improvement only on measures of perceived pain, proprioception acuity, muscle torque, and functional disability, and non-significant changes on all balance measurements. Furthermore, the sensorimotor group produced significantly better improvement than the traditional group. The main predictor of balance was proprioception. The classic traditional exercise programme used in the management of knee OA is not enough for improving balance. Addition of sensorimotor training to the rehabilitation programme of these patients could produce more positive effects on balance and functional activity levels. The association between balance, proprioception and functional activity should be considered when treating knee OA.Journal of Advanced Research 10/2011; 2(4):305-311. DOI:10.1016/j.jare.2011.02.001
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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) "
ABSTRACT: La artrosis de rodilla es una de las enfermedades articulares más frecuentes, sus síntomas principales son dolor e incapacidad física. La regeneración del cartílago es un tratamiento todavía en desarrollo, por lo que los tratamientos actuales se centran en aliviar los síntomas. El ejercicio físico se presenta como una alternativa u opción de tratamiento barata y efectiva. Sin embargo, todavía no está claro qué tipo de ejercicio, cantidad, intensidad, etc. son más recomendables. Por lo tanto, el objetivo de esta revisión es integrar toda la información posible de cara al diseño de programas de entrenamiento para el tratamiento de la artrosis de rodilla. Todos los artículos seleccionados tras la revisión, salvo el de Talbot et al1, mostraron mejoras significativas en el dolor de la rodilla, en la capacidad física o en ambas variables. Sin embargo, muchos autores obvian elementos cruciales del programa, por lo que no es posible la aplicación con fines terapéuticos o para contrastar los resultados en otras muestras.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). "
ABSTRACT: Is four weeks of home-based balance training more effective than four weeks of home-based strength training at decreasing pain in patients with knee osteoarthritis? Randomised trial with concealed allocation and assessor blinding. 48 community volunteers with knee osteoarthritis. Two groups undertook home-based exercise programs: one group performed balance training and the other performed strength training. Participants performed 30 repetitions/leg/day, 5 days/week for four weeks. Outcome measures: The Knee injury and Osteoarthritis Outcome Score was used to evaluate pain, which was the primary outcome. Secondary outcomes were the other subscales of the Knee injury and Osteoarthritis Outcome Score (other symptoms, function in daily living, function in sport and recreation, knee-related quality of life), strength, and mobility. There was no significant difference between groups for pain (mean difference -3 points out of 100, 95% CI -10 to 5). The only between-group difference in the Knee injury and Osteoarthritis Outcome Score was in knee-related quality of life, where the strength group improved 17 points out of 100 (95% CI 5 to 28) more than the balance group. There was no significant difference between groups for strength. The only between-group difference in mobility was in the time taken to walk downstairs, where the strength group improved by 2 s (95% CI 0 to 3) more than the balance group. There was no difference in pain between home-based strength training and home-based balance training in patients with knee osteoarthritis. Trial registration: NCT 00687726.The Australian journal of physiotherapy 02/2009; 55(1):25-30. DOI:10.1016/S0004-9514(09)70057-1 · 3.48 Impact Factor