Manual
Therapy for osteoarthritis of the hip or knee – A systematic review.
French H., Brennan A., White B., Cusack T.
Manual Therapy; 2011, 16, 109 – 117.
Knee osteoarthritis is characterised by
loss of articular cartilage, osteophyte formation, joint space narrowing and
sclerosis of subchondral bone. Contracture and fibrosis of the soft tissues
such as capsule, is also present. As a consequence, patients with knee OA
experience reduced quality of life due to pain, impaired mobility and loss of
muscle strength. Treatment approach usually combines education, weight loss,
physical therapies and exercises. Recent clinical guidelines on the management
of OA, recommend manual therapy techniques as an adjunctive therapy. No
systematic reviews has examined the effect of MT on knee OA therefore authors
decided to conduct one to determine whether MT is beneficial for patients with
knee OA.
Three randomized controlled trials were
eligible for inclusion. One study had a medium – term follow – up of 16 weeks
while two other had short – term follow – ups. Only one study undertook power
calculation to estimate sample size. The types of manual therapy differed
between studies. Two used chiropractic manipulation and in one study
Swedish full-body therapeutic massage was provided by massage therapists. One
study compared manual therapy to Meloxicam (NSAID), one compared to placebo
intervention and the last one compared massage therapy to a wait-list control
group where treatment was delayed for an 8-week period. Despite all studies
were randomized, allocation concealment was unclear in all of them and no study
blinded the care provider. Therefore, risk bias assessment revealed that one
study had low risk of bias, while in two other, this risk was high.
In one study, results indicated that
massage therapy significantly reduced pain and improved function in patients
with mild to moderate OA compared to no – intervention group. Another study
comparing MT to placebo showed significantly better function in favour of MT
group but no significant change was reported for pain. Last study which
compared MT to Meloxicam found to significant difference between groups in
terms of pain and function. Authors concluded that the findings might suggest
that manual therapy may have a beneficial short-term effect in reducing pain
and improving physical function for patients with knee OA compared with no
intervention. Due to high risk of bias, it can not be stated that manual
therapy is no better than placebo or Meloxicam medication.
Do you find manual therapy successful in
the treatment of knee OA patients? Do you find any particular technique most
beneficial for those patients?
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All rights reserved to the Manual Therapy.
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