Efficacy of physiotherapy management of knee joint osteoarthritis: A randomised, double blind, placebo controlled trial

Centre for Health, Exercise and Sports Medicine, School of Physiotherapy, University of Melbourne, Parkville, Victoria 3010, Australia.
Annals of the Rheumatic Diseases (Impact Factor: 10.38). 06/2005; 64(6):906-12. DOI: 10.1136/ard.2004.026526
Source: PubMed


To determine whether a multimodal physiotherapy programme including taping, exercises, and massage is effective for knee osteoarthritis, and if benefits can be maintained with self management.
Randomised, double blind, placebo controlled trial; 140 community volunteers with knee osteoarthritis participated and 119 completed the trial. Physiotherapy and placebo interventions were applied by 10 physiotherapists in private practices for 12 weeks. Physiotherapy included exercise, massage, taping, and mobilisation, followed by 12 weeks of self management. Placebo was sham ultrasound and light application of a non-therapeutic gel, followed by no treatment. Primary outcomes were pain measured by visual analogue scale and patient global change. Secondary measures included WOMAC, knee pain scale, SF-36, assessment of quality of life index, quadriceps strength, and balance test.
Using an intention to treat analysis, physiotherapy and placebo groups showed similar pain reductions at 12 weeks: -2.2 cm (95% CI, -2.6 to -1.7) and -2.0 cm (-2.5 to -1.5), respectively. At 24 weeks, pain remained reduced from baseline in both groups: -2.1 (-2.6 to -1.6) and -1.6 (-2.2 to -1.0), respectively. Global improvement was reported by 70% of physiotherapy participants (51/73) at 12 weeks and by 59% (43/73) at 24 weeks. Similarly, global improvement was reported by 72% of placebo participants (48/67) at 12 weeks and by 49% (33/67) at 24 weeks (all p>0.05).
The physiotherapy programme tested in this trial was no more effective than regular contact with a therapist at reducing pain and disability.

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Available from: Rachelle Buchbinder, Oct 09, 2015
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    • "For example, Veenhof et al. reported that only 37 of 90 (41%) and 37 of 102 (36%) knee OA patients reported to be improved after 13 weeks of following a behavioral graded activity exercise program , respectively a usual care program including exercises (Veenhof et al., 2006). Bennel et al. reported that 59% of knee OA patients indicated to be improved after 12 weeks of receiving a physiotherapy program (including exercises) (Bennell et al., 2005). A sufficiently high adherence , i.e. the number of sessions attended divided by the number of sessions prescribed, has been shown to be an important prerequisite for the exercise-induced benefits (Holden et al., 2014; Marks, 2012; Experimental Gerontology 72 (2015) 29–37 "
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    ABSTRACT: Background: Exercise effectiveness is related to adherence, compliance and drop-out. The aim of this study is to investigate if exercise-induced pain and health status are related to these outcomes during two exercise programmes in knee osteoarthritis patients. Methods: Symptomatic knee osteoarthritis patients were randomly allocated to a walking or strengthening programme (N=19/group). At baseline, patients were categorized according to their health status. Exercise adherence and compliance were calculated and drop-out rate was registered. For exercise-induced pain, patients rated their pain on an 11-point numeric rating scale (NRS) before and after each training session. Before each session the maximal perceived pain of the last 24h (NRSmax24) was assessed. Patients rated their global self-perceived effect (GPE) on a 7-point ordinal scale after the intervention period. Results: 53% of the participants felt they improved after the programme, 6 patients dropped out. The mean adherence and compliance rates were higher than .83 in both groups. Worse health and higher exercise-induced pain were seen in drop-outs. NRSmax24 during the first 3weeks did not significantly increase compared to baseline, but correlated negatively with adherence during the home sessions (-.56, p<.05). Lower adherence during supervised sessions was significantly related with higher pre-exercise pain scores (ρ=-.35, p<.05). Conclusion: Patients who drop-out show a worse health condition and higher exercise-induced pain levels compared to patients that retained the programme.
    Experimental gerontology 09/2015; DOI:10.1016/j.exger.2015.09.009 · 3.49 Impact Factor
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    • "Between group N ¼ 29 Within group N ¼ 28 Between group N ¼ 28 Within group N ¼ 28 Abbott et al., 2013 Aglamis et al., 2008 ✓ ✓ ✓ ✓ Avelar et al., 2011 ✓ # Baker et al., 2001 ✓ ✓ ⃡ ✓ Bautch et al., 1997 ✓ Bennell et al., 2005 ⃡ ✓ ⃡ ✓ Bennell et al. 2010 ✓ ✓ Brismee et al., 2007 ✓ ✓ ✓ ✓ Dias et al., 2003 ✓ ✓ Durmus et al., 2012 ✓ ✓ Ettinger et al., 1997+ ✓ ✓ Farr et al., 2010 ✓ Fitzgerald et al., 2011 ⃡ ✓ Foroughi et al., 2011 ✓ ✓ Foy et al., 2011 ✓ ✓ Hasegawa 2010 ✓ ✓ ✓ ✓ Jenkinson et al., 2009 ✓ ⃡ ✓ ✓ Kawasaki et al., 2008 ✓ ✓ Kawasaki et al. 2009 ⃡ ⃡ Keefe et al., 2004 ⃡ Kirkley et al., 2008 Lim et al., 2008 ✓ ⃡ McCarthy et al., 2004 McKnight et al., 2010 ✓ ✓ Messier et al., 2000 # ✓ Messier et al. 2007 ⃡ # Mikesky et al., 2006 ⃡ Miller et al., 2006 ✓ ✓ Ni et al., 2010 ✓ ✓ Olejerova et al., 2008 O'Reilly et al., 1999 ✓ ✓ ✓ ✓ Osteras et al., 2012 ⃡ Peloquin et al., 1999 ✓ ✓ # # Pisters et al., 2010 ✓ ✓ Rejeski et al., 2002+ # ✓ # # Rogind et al., 1998 ⃡ # ⃡ # Salancinski et al., 2012 ✓ ✓ ⃡ ⃡ Sayers et al., 2012 ⃡ ⃡ ⃡ ⃡ Schlenk et al., 2011 ⃡ ✓ Silva et al., 2008 ✓ ✓ Simao et al., 2012 # ⃡ Somers et al., 2012 ✓ # ✓ # Song et al., 2003 ✓ ✓ Talbot et al., 2003 ⃡ ⃡ ✓ Thomas et al., 2002 ✓ ✓ Topp et al., 2002 ⃡ ✓ ⃡ # Wang et al., 2009 ✓ ✓ ✓ ✓ Wang et al. 2011 ✓ Key: + ¼ findings from primary paper and follow up papers, ✓ ¼ significantly lower pain in physical activity group over time or compared to non-physical activity group/ significantly better physical function in physical activity group over time or compared to non-physical activity group. 4 ¼ no significant difference over time or between groups. "
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    ABSTRACT: To determine whether long-term physical activity is safe for older adults with knee pain. A comprehensive systematic review and narrative synthesis of existing literature was conducted using multiple electronic databases from inception until May 2013. Two reviewers independently screened, checked data extraction and carried out quality assessment. Inclusion criteria for study designs were randomised controlled trials (RCTs), prospective cohort studies or case control studies, which included adults of mean age over 45 years old with knee pain or osteoarthritis (OA), undertaking physical activity over at least three months and which measured a safety related outcome (adverse events, pain, physical functioning, structural OA imaging progression or progression to total knee replacement (TKR)). Of the 8614 unique references identified, 49 studies were included in the review, comprising 48 RCTs and one case control study. RCTs varied in quality and included an array of low impact therapeutic exercise interventions of varying cardiovascular intensity. There was no evidence of serious adverse events, increases in pain, decreases in physical function, progression of structural OA on imaging or increased TKR at group level. The case control study concluded that increasing levels of regular physical activity was associated with lower risk of progression to TKR. Long-term therapeutic exercise lasting three to thirty months is safe for most older adults with knee pain. This evidence supports current clinical guideline recommendations. However, most studies investigated selected, consenting older adults carrying out low impact therapeutic exercise which may affect result generalizability. PROSPERO 2014:CRD42014006913. Copyright © 2015. Published by Elsevier Ltd.
    Osteoarthritis and Cartilage 05/2015; 60(9). DOI:10.1016/j.joca.2015.05.002 · 4.17 Impact Factor
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    • "Despite this recommendation, the evidence supporting physical activity participation on improving HRQoL is limited, variable, and highly dependent on the exercise modality. Bennell and colleagues [23] reported that HRQoL was no different in patients undergoing a 12-week multi-modal physiotherapy program compared to those receiving sham ultrasound. Brosseau and colleagues [24] randomized knee OA patients to walking with behavior intervention, walking with an educational pamphlet, or pamphlet alone. "
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    ABSTRACT: Knee osteoarthritis (OA) has a significant negative impact on health-related quality of life (HRQoL). Identification of therapies that improve HRQoL in patients with knee OA may mitigate the clinical, economic, and social burden of this disease. The purpose of this commentary is to report the impact of knee OA on HRQoL, describe the change in HRQoL attributable to common knee OA interventions, and summarize findings from clinical trials of a promising therapy. Nonsurgical therapies do not reliably modify HRQoL in knee OA patients given their general inability to alleviate physical manifestations of OA. Surgical knee OA interventions generally result in good to excellent patient outcomes. However, there are significant barriers to considering surgery, which limits clinical utility. Therapies that most effectively control OA-related pain with a low risk: benefit ratio will likely have the greatest benefit on HRQoL with greater rates of patient adoption. Initial clinical trial findings suggest that less invasive joint unloading implants hold promise in bridging the therapeutic gap between nonsurgical and surgical treatments for the knee OA patient.
    The Open Orthopaedics Journal 11/2013; 7(7):619-623. DOI:10.2174/1874325001307010619
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