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document
Effectiveness of manual physical therapy and exercise in osteoarthritis of the knee . A randomized , controlled trial . BACKGROUND Few investigations include both subjective and objective measurements of the effectiveness of treatments for osteoarthritis of the knee . Beneficial interventions may decrease the disability associated with osteoarthritis and the need for more invasive treatments . OBJECTIVE To evaluate the effectiveness of physical therapy for osteoarthritis of the knee , applied by experienced physical therapists with formal training in manual therapy . DESIGN Randomized , controlled clinical trial . SETTING Outpatient physical therapy department of a large military medical center . PATIENTS 83 patients with osteoarthritis of the knee who were randomly assigned to receive treatment ( n = 42 ; 15 men and 27 women [ mean age , 60 +/- 11 years ] ) or placebo ( n = 41 ; 19 men and 22 women [ mean age , 62 +/- 10 years ] ) . INTERVENTION The treatment group received manual therapy , applied to the knee as well as to the lumbar spine , hip , and ankle as required , and performed a standardized knee exercise program in the clinic and at home . The placebo group had subtherapeutic ultrasound to the knee at an intensity of 0.1 W/cm2 with a 10 % pulsed mode . Both groups were treated at the clinic twice weekly for 4 weeks . MEASUREMENTS Distance walked in 6 minutes and sum of the function , pain , and stiffness subscores of the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) . A tester who was blinded to group assignment made group comparisons at the initial visit ( before initiation of treatment ) , 4 weeks , 8 weeks , and 1 year . RESULTS Clinically and statistically significant improvements in 6-minute walk distance and WOMAC score at 4 weeks and 8 weeks were seen in the treatment group but not the placebo group . By 8 weeks , average 6-minute walk distances had improved by 13.1 % and WOMAC scores had improved by 55.8 % over baseline values in the treatment group ( P < 0.05 ) . After controlling for potential confounding variables , the average distance walked in 6 minutes at 8 weeks among patients in the treatment group was 170 m ( 95 % CI , 71 to 270 m ) more than that in the placebo group and the average WOMAC scores were 599 mm higher ( 95 % CI , 197 to 1002 mm ) . At 1 year , patients in the treatment group had clinically and statistically significant gains over baseline WOMAC scores and walking distance ; 20 % of patients in the placebo group and 5 % of patients in the treatment group had undergone knee arthroplasty . CONCLUSIONS A combination of manual physical therapy and supervised exercise yields functional benefits for patients with osteoarthritis of the knee and may delay or prevent the need for surgical intervention .
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Intervention_Physical
manual physical therapy and exercise
2527
Intervention_Physical
physical therapy
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Intervention_Physical
treatment
2529
Intervention_Control
placebo
2530
Intervention_Physical
manual therapy
2531
Intervention_Physical
standardized knee exercise program
2532
Intervention_Control
placebo
2533
Intervention_Control
subtherapeutic ultrasound
2534
Intervention_Physical
treatment
2535
Intervention_Control
placebo
2536
Intervention_Physical
treatment
2537
Intervention_Physical
treatment
2538
Intervention_Control
placebo
2539
Intervention_Physical
treatment
2540
Intervention_Control
placebo
2541
Intervention_Physical
treatment
2542
Intervention_Surgical
knee arthroplasty
2543
Intervention_Physical
manual physical therapy and supervised exercise
2544
Outcome_Physical
disability
2545
Outcome_Physical
Distance walked in 6 minutes and sum of the function
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Outcome_Pain
pain
2547
Outcome_Physical
stiffness subscores of the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC )
2548
Outcome_Physical
6-minute walk distance
2549
Outcome_Physical
WOMAC score
2550
Outcome_Physical
6-minute walk distances
2551
Outcome_Physical
WOMAC scores
2552
Outcome_Physical
distance walked in 6 minutes
2553
Outcome_Physical
WOMAC scores
2554
Outcome_Physical
baseline WOMAC scores
2555
Outcome_Physical
walking distance
2556
Outcome_Other
knee arthroplasty
2557
Outcome_Other
functional benefits
2558
Outcome_Other
surgical intervention
2559
Participant_Condition
osteoarthritis of the knee
2560
Participant_Condition
osteoarthritis of the knee
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Participant_Sample-size
83
2562
Participant_Condition
osteoarthritis of the knee
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Participant_Sample-size
42
2564
Participant_Sample-size
15
2565
Participant_Sex
men
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Participant_Sample-size
27
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Participant_Sex
women
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Participant_Age
60 +/- 11
2569
Participant_Sample-size
41
2570
Participant_Sample-size
19
2571
Participant_Sample-size
22
2572
Participant_Age
62 +/- 10
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Participant_Condition
osteoarthritis of the knee