Study Finds Manual Physical Therapy and Exercise Effective for Osteoarthritis of the Knee

Alexandria, VA, January 31, 2000 – Recent findings from a randomized controlled clinical trial suggest that a combination of manual physical therapy and supervised exercise may be a cost-effective way to delay or prevent the need for surgical intervention for patients with osteoarthritis of the knee, according to the American Physical Therapy Association (APTA).

In a study entitled “Effectiveness of Manual Therapy and Exercise in Osteoarthritis of the Knee,” published today in Annals of Internal Medicine, researchers at Brooke Army Medical Center In Fort Sam Houston, Texas, found that a combination of manual physical therapy and supervised exercise by physical therapists is more effective than no treatment in improving walking distance and decreasing pain, dysfunction, and stiffness in patients with osteoarthritis of the knee. Such treatment may also defer or decrease the need for surgical interventions.

“Arthritis is a degenerative disease of the cartilage and bone that results in pain and stiffness in the affected joint,” said APTA President Jan K. Richardson, PT, PhD, OCS. “There is no cure for arthritis, but physical therapy can make living with arthritis easier and less painful.”

In the study, patients assigned randomly to a treatment group received manual therapy treatment techniques such as joint and spinal mobilization/manipulation, muscle stretching, and soft-tissue mobilization, as indicated by the physical therapist’s examination of each individual. The group also performed a knee exercise program consisting of active range-of-motion exercises for the hip and knee, muscle stretching for the lower limbs, and riding a stationary bike. Exercised were also done at home. The placebo group received treatment by the physical therapist that consisted of subtherapeutic ultrasound for 10 minutes. The physical therapy sessions lasted approximately 30 minutes for both groups. Both groups were treated twice weekly for four weeks, for a total of eight clinical treatments. Outcomes of treatment were determined by scores on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and distance covered during a timed 6-minute walk test.

The study found that patients with osteoarthritis of the knee who were treated with manual physical therapy and exercise experienced clinically and statistically significant improvements in self-perceptions of pain, stiffness, and functional ability in addition to improvements in distance walked in six minutes. The beneficial effects of treatment persisted at a post-treatment retest four weeks later and again after one year. The study also found that, one year later, there were fewer knee replacement surgeries in the treatment group.

“Many patients with osteoarthritis typically receive very little physical therapy before undergoing total joint replacement,” said Richardson. “Because short-term physical therapy can decrease pain and stiffness and increase functional capacity in patients with osteoarthritis of the knee, physical therapy represents a cost-effective way to improve patient function.”