Manual therapy and exercises for knee and hip OA patients.

Manual therapy, exercise therapy, or both, in addition to usual care, for osteoarthritis of the hip or knee: a randomized controlled trial. 1: clinical effectiveness.

Abbott, J., Robertson, M., Chapple, C., et al.. Osteoarthritis and Cartilage, 2013; 8: 525 – 534.

http://www.ncbi.nlm.nih.gov/pubmed/23313532

Physiotherapy, in the form of exercise therapy and/or manual therapy is considered to be first line treatment, excluding pharmacological interventions, for knee and hip osteoarthritis. Nevertheless, there is lack of evidence supporting its long – term  effectiveness. Therefore, authors conducted this study to evaluate the clinical effectiveness of manual physiotherapy and/or exercise physiotherapy in addition to usual care for patients with osteoarthritis (OA) of the hip or knee.

206 adults participated in the study. The primary outcome was change in the Western Ontario and McMaster osteoarthritis index (WOMAC) at 1-year follow – up. Secondary outcome measures were physical performance tests reults at 1-year follow – up.

Results showed that, in regards to primary outcome, all intervention groups improved but only usual care plus manual therapy and usual care plus exercise therapy achieved clinically significant reductions of >28 WOMAC points from baseline. Outcomes of the physical performance tests (timed up and go, 30 s sit to stand, 40 m self-paced walk) favoured exercise therapy in addition to usual care. Interestingly, the combination of exercise and manual therapy did not produce additional benefit.  In conclusion, study showed that that both manual physiotherapy and exercise physiotherapy in addition to usual care produce significant improvements in symptoms and physical function, respectively, in patients with moderate to severe OA of the hips or knees at one year follow - up.

This study proves that both manual therapy and exercises seem to be an effective tool against knee and hip OA, and this is also in agreement with my clinical experience. Usually, I combine manual therapy and specific exercises and as long as the patient is willing to continue the treatment for several sessions, the results appear. Nevertheless, I find that patients with severe OA (osteophytes, joint space narrowing and subchondral bone sclerotisation) require longer treatment and more time to respond well. I found it interesting that that combined MT and exercises were less effective that any of them alone.

What are your experiences with knee and hip OA patients? Do you have any gold standard for treating them?

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