Osteoarthritis (OA) Outcomes Improved With Physical Therapy: Adding
either Manual or Exercise Physical Therapy (PT) to usual care for patients with
osteoarthritis (OA) of the knee and hip can significantly improve pain and
stiffness according to 2-year follow-up of a randomized, controlled trial.
Boston: Adding either manual or exercise physical therapy
(PT) to usual care for patients with osteoarthritis (OA) of the knee and hip
can significantly improve pain and stiffness according to 2-year follow-up of a
randomized, controlled trial.
"Exercise has been recommended for a while now, but
still most people don't get referred. What are the barriers? Some people say
they think it only works for a few weeks and then it's a waste of time -- well,
no, here we have a 2-year follow-up showing it works."
The trial included 206 adults (mean age 66 years) with hip
or knee OA, all of whom were receiving usual care.
Subjects were then randomized to receive additional manual
PT (n=54), multimodal exercise PT (n=51), a combination of exercise and manual
PT (n=50), or no extra PT (n=51).
Both types of therapy were delivered by physical therapists
in a PT clinic. Subjects received seven weekly sessions and were then
instructed to continue prescribed exercises alone with three other booster
visits during the study.
Among the 186 patients who remained in the trial after 2
years of follow-up, there were clinically significant improvements in both pain
and disability in all three groups that received additional therapy compared
with those receiving usual care only, said Abbott.
This translated to improvements in the mean WOMAC score,
which was 100.8 points at baseline, and rose by 31.7 points in the exercise
therapy group, 30.1 in the manual therapy group, and 26.2 points in the
combined exercise and manual therapy group, he said.
"Patients who continued with usual care alone were
viewed to worsen over time, and at the 2-year follow-up they were 20% worse
than they were at baseline," he said.
Improvements from baseline were statistically significant
for both the exercise and manual therapy groups, but did not quite reach
statistical significance for the combined therapy group. However, when compared
with patients who received usual care only, all three intervention groups had
clinically significant improvements, he said.
The effect sizes for all three groups were 0.52 (combined),
0.55 (manual) and 0.57 (exercise) in terms of changes in WOMAC score.
"To give some context, the effects size for medications
such as nonsteroidal anti-inflammatory drugs is around about 0.35 ... so ...
providing these interventions over and above usual care is conferring
additional benefit," said Abbott.
"A key message is that, in people who do not yet need
joint replacement surgery, we found improved pain and physical function in
patients who had our exercise therapy and manual therapy PT intervention
protocols in addition to usual medical care, whereas patients who received
usual medical care only deteriorated significantly over the 2-year follow-up
period," he said.
"These findings should be welcomed by people with
osteoarthritis, doctors, and other clinicians because it shows that, compared
with usual medical care without a referral to PT, the PT interventions of our
exercise therapy and manual therapy protocols were very effective, even at 2
years from when they were commenced. Both of these nondrug interventions are
safe and effective for people with osteoarthritis across the spectrum from
mild, moderate, to near-end-stage joint degeneration."
