Please provide me with the relevant information that needed to be address during a presentation of this chapter:

1 INTRODUCTION
1.1 BACKGROUND OF THE STUDY

Knee osteoarthritis (KOA) is a synovial joint disease marked by increasing joint degeneration and cartilage loss. It is a condition that adversely affects an individual's functional abilities and level of independence by causing chronic impairment and is particularly prevalent in adults and the elderly. Based on Foo (as cited in the Ministry of Health Malaysia, 2010), the prevalence of KOA in Malaysia is estimated to be between 10% to 20% of the elderly population. The growing number of old or natural ageing, and higher body mass index (BMI), are the key factors contributing to KOA, as claimed by Wallace et al. (2017) However, it is common for adults and the elderly to develop knee discomfort or KOA as the cartilage that was supposed to act as a shock absorber for mechanical body weight-bearing movements gradually deteriorates. As a result, KOA can cause chronic progressive pain and disturb the patient’s functional ability. The loss of workforce and other psychological implications can affect a patient's professional life, entertainment, social life, and sleep pattern and significantly reduce the quality of life (QoL) of KOA patients (Askin et al., 2017). This study’s primary concern is to examine the use of manual therapy and exercise therapy in managing the symptoms of KOA, with the primary goal of improving functional ability. Typically, patients with KOA opt for medicine to alleviate pain, oblivious that an active lifestyle is equally required to manage the symptoms of KOA. Pharmaceutical therapies alone will not help patients with KOA improve their functional ability. Therefore, pharmacological therapies should be omitted in this systematic review study. This systematic review study will include all publications and journals describing the effects of manual treatment and exercise therapy on improving the functional ability of KOA patients. This study will then systematically review the medical literature that studied the critical role of manual therapy and exercise therapy as interventions to enhance functional ability and improve QoL. It is necessary to continue this study as the elderly population has a higher risk of developing KOA which cannot be avoided in the natural ageing process that will happen to everyone. Furthermore, Shamsi et al. (2021) studied that age-related diseases such as osteoarthritis will be significantly accelerated in emerging countries and will remain increase in the future, particularly in Asian countries.

1.2 PROBLEM STATEMENT

The world-increasing trend of total knee arthroplasty (TKA) or total knee replacement, as claimed by Gao et al. (2020), is worrying. In the future, it is possible as KOA can be popular among adults as early as 30 years old. Most people would want surgical interventions immediately without opting for conservative treatments due to time constraints and non-adherence to exercises. Furthermore, in the early stage of KOA, surgery should not be an option; however, most patients with KOA would still not adhere to the manual therapy and exercise therapy that has been prescribed. Manual therapy and exercise therapy during that stage should greatly help manage KOA symptoms and prevent rapid deterioration, progressing KOA quicker to the severe stage. Even in the later stage, manual therapy and exercise therapy shall be part of the treatment options while seeking surgical interventions.

1.3 PURPOSE OF STUDY

This systematic review study aims to disclose the efficacy of manual therapy and exercise therapy in improving KOA patients' pain and functional ability. The effectiveness of manual and exercise therapy can be measured using reliable outcome measures of pain and functional ability. A helpful guideline and assistance in advocating for the public to opt for manual therapy and exercise therapy to manage KOA symptoms will be a great success once the efficacy of these treatments has been
proven.

1.4 RESEARCH OBJECTIVE(S)

General Objectives:
To systematically review the efficacy of manual therapy and exercise therapy in reducing pain and improving the functional ability of patients with KOA

Specific Objectives:
To systematically review the efficacy of manual therapy and exercise therapy from the published research works in managing pain symptoms of KOA patients.
To systematically review the efficacy of manual therapy and exercise therapy from the published research works in enhancing the functional ability of KOA patients.

1.5 RESEARCH QUESTION(S)

Does manual therapy and exercise therapy effectively reduce the pain symptoms of patients with KOA?
Does manual therapy and exercise therapy effectively improve the functional ability of patients with KOA?

1.6 RESEARCH HYPOTHESIS

Manual therapy and exercise therapy will reduce pain symptoms for KOA patients.
Manual therapy and exercise therapy will improve the functional ability of KOA patients.

1.7 SIGNIFICANCE OF THE STUDY

Suppose this study aims to prove manual and exercise therapy's efficacy. In that case, it will be able to make a guideline for health professionals and the public, especially for individuals with KOA. Moreover, a solid guideline can advocate for the public and raise awareness of the conservative treatments they may seek to control the KOA symptoms, especially those in the early stage, and could prevent arthroplasty or joint replacement. Naturally, the human with pain perception will avoid moving; however, it is possible to move the body while in pain with the proper technique. Besides that, manual therapy is also there to help individuals with KOA reduce pain through the hands of health professionals. This study is not solely for individuals with KOA but is also great for those who aim to slow down the natural-ageing degeneration process, which leads to KOA.

1.8 DEFINITION OF TERMS

1.8.1 Knee Osteoarthritis (KOA)

Knee osteoarthritis is a degenerative disorder of articular cartilage. It includes the pathology of wide tissues such as the meniscus, synovial membrane, and subchondral bone constituting the knee joint, ligament, joint capsule, tendon, and muscle (Kanamoto et al., 2020).

1.8.2 Manual Therapy

Manual therapy is an advanced speciality area of physical therapy based on manual examination and treatment techniques integrated with exercise, patient education, and other physical therapy modalities to address pain, loss of function, and wellness. American Academy of Orthopaedic Manual Physical Therapists (AAOMPT) Description of Advanced Specialty Practice (DASP) (2018) as cited from Physiopedia.

1.8.3 Exercise Therapy

Exercise therapy consists of movements and physical activities that increase strength and function and reduce discomfort. (Australian Sports Physiotherapy, 2021)

1.9 CHAPTER SUMMARY

The chapter started with a background study on KOA and manual therapy and exercise therapy as part of interventions done to improve individuals’ functional ability and continued with problem statements and the purpose of the study. Afterwards, this chapter presents the research objectives, questions, and hypothesis, guiding this systematic review study in assessing related articles and providing relevant and solid studies concerning the research's objectives, questions, and hypothesis. It then proceeded with the significance of the study to emphasise why it should be done and, lastly, explain the terms that are primarily used in this research.
user
Sure, here is a response to your questions:

1.1: The prevalence of KOA in Malaysia is estimated to be between 10% to 20% of the elderly population, as cited in the Ministry of Health Malaysia (2010). This data suggests that KOA is a significant health issue in Malaysia, affecting a substantial proportion of the elderly population.

1.2: The increasing trend of total knee arthroplasty (TKA) is a worrisome trend, and it may reflect an underlying issue with the conservative management of KOA. This conservative management includes manual therapy and exercise therapy. Therefore, the study's primary objective is to assess the effectiveness of manual therapy and exercise therapy in managing the symptoms of KOA in both early and later stages.

1.3: The general and specific objectives of the study are to systematically review the efficacy of manual therapy and exercise therapy in both reducing pain symptoms and improving the functional ability of patients with KOA. Specifically, the study aims to quantify the effects through reliable outcome measures.

1.4: The research questions aim to assess whether manual therapy and exercise therapy are effective in managing pain and improving functional ability in patients with KOA. The hypothesis is that manual therapy and exercise therapy will reduce pain symptoms and improve functional ability.

1.5: The study has significance for healthcare professionals and the public, particularly for individuals in the early stage of KOA. The study aims to develop a guideline that advocates for manual therapy and exercise therapy for the management of KOA symptoms. This guideline may help prevent joint replacement surgery in the early stages and help manage pain in later stages. The study is relevant not only for individuals with KOA but also for those who want to slow down the ageing process.

1.8: In summary, KOA is a degenerative disorder of the articular cartilage in the knee joint, while manual therapy and exercise therapy are charismatic interventions for implementing pain, loss of function, and wellness. Manual examination and therapy, combined with these previous therapies, are advanced types of physical therapy. Exercise therapy is a type of physical activity that focuses on increasing function, strength, and improving overall well-being.

1.9: In this chapter, the study begins with background on KOA and the function of manual therapy and exercise therapy. The study's motivation reflects the underlying reasons for conducting a systematic review, i.e., the worrying trend towards total knee arthroplasties (TKA). The research's importance further focused on the study objectives, questions, and hypothesis, providing synopses relevant to what this systematic review study indeed aimed to accomplish. Additionally, a summary of the terms used in this systemic study can help readers comprehend the significance of each of these terms throughout their study, regulatively, a list of keywords used in electronic searches.
assistant
Please provide me with the relevant information that needed to be address during a presentation of this chapter:

1 INTRODUCTION
1.1 BACKGROUND OF THE STUDY

Knee osteoarthritis (KOA) is a synovial joint disease marked by increasing joint degeneration and cartilage loss. It is a condition that adversely affects an individual's functional abilities and level of independence by causing chronic impairment and is particularly prevalent in adults and the elderly. Based on Foo (as cited in the Ministry of Health Malaysia, 2010), the prevalence of KOA in Malaysia is estimated to be between 10% to 20% of the elderly population. The growing number of old or natural ageing, and higher body mass index (BMI), are the key factors contributing to KOA, as claimed by Wallace et al. (2017) However, it is common for adults and the elderly to develop knee discomfort or KOA as the cartilage that was supposed to act as a shock absorber for mechanical body weight-bearing movements gradually deteriorates. As a result, KOA can cause chronic progressive pain and disturb the patient’s functional ability. The loss of workforce and other psychological implications can affect a patient's professional life, entertainment, social life, and sleep pattern and significantly reduce the quality of life (QoL) of KOA patients (Askin et al., 2017). This study’s primary concern is to examine the use of manual therapy and exercise therapy in managing the symptoms of KOA, with the primary goal of improving functional ability. Typically, patients with KOA opt for medicine to alleviate pain, oblivious that an active lifestyle is equally required to manage the symptoms of KOA. Pharmaceutical therapies alone will not help patients with KOA improve their functional ability. Therefore, pharmacological therapies should be omitted in this systematic review study. This systematic review study will include all publications and journals describing the effects of manual treatment and exercise therapy on improving the functional ability of KOA patients. This study will then systematically review the medical literature that studied the critical role of manual therapy and exercise therapy as interventions to enhance functional ability and improve QoL. It is necessary to continue this study as the elderly population has a higher risk of developing KOA which cannot be avoided in the natural ageing process that will happen to everyone. Furthermore, Shamsi et al. (2021) studied that age-related diseases such as osteoarthritis will be significantly accelerated in emerging countries and will remain increase in the future, particularly in Asian countries.

1.2 PROBLEM STATEMENT

The world-increasing trend of total knee arthroplasty (TKA) or total knee replacement, as claimed by Gao et al. (2020), is worrying. In the future, it is possible as KOA can be popular among adults as early as 30 years old. Most people would want surgical interventions immediately without opting for conservative treatments due to time constraints and non-adherence to exercises. Furthermore, in the early stage of KOA, surgery should not be an option; however, most patients with KOA would still not adhere to the manual therapy and exercise therapy that has been prescribed. Manual therapy and exercise therapy during that stage should greatly help manage KOA symptoms and prevent rapid deterioration, progressing KOA quicker to the severe stage. Even in the later stage, manual therapy and exercise therapy shall be part of the treatment options while seeking surgical interventions.

1.3 PURPOSE OF STUDY

This systematic review study aims to disclose the efficacy of manual therapy and exercise therapy in improving KOA patients' pain and functional ability. The effectiveness of manual and exercise therapy can be measured using reliable outcome measures of pain and functional ability. A helpful guideline and assistance in advocating for the public to opt for manual therapy and exercise therapy to manage KOA symptoms will be a great success once the efficacy of these treatments has been
proven.

1.4 RESEARCH OBJECTIVE(S)

General Objectives:
To systematically review the efficacy of manual therapy and exercise therapy in reducing pain and improving the functional ability of patients with KOA

Specific Objectives:
To systematically review the efficacy of manual therapy and exercise therapy from the published research works in managing pain symptoms of KOA patients.
To systematically review the efficacy of manual therapy and exercise therapy from the published research works in enhancing the functional ability of KOA patients.

1.5 RESEARCH QUESTION(S)

Does manual therapy and exercise therapy effectively reduce the pain symptoms of patients with KOA?
Does manual therapy and exercise therapy effectively improve the functional ability of patients with KOA?

1.6 RESEARCH HYPOTHESIS

Manual therapy and exercise therapy will reduce pain symptoms for KOA patients.
Manual therapy and exercise therapy will improve the functional ability of KOA patients.

1.7 SIGNIFICANCE OF THE STUDY

Suppose this study aims to prove manual and exercise therapy's efficacy. In that case, it will be able to make a guideline for health professionals and the public, especially for individuals with KOA. Moreover, a solid guideline can advocate for the public and raise awareness of the conservative treatments they may seek to control the KOA symptoms, especially those in the early stage, and could prevent arthroplasty or joint replacement. Naturally, the human with pain perception will avoid moving; however, it is possible to move the body while in pain with the proper technique. Besides that, manual therapy is also there to help individuals with KOA reduce pain through the hands of health professionals. This study is not solely for individuals with KOA but is also great for those who aim to slow down the natural-ageing degeneration process, which leads to KOA.

1.8 DEFINITION OF TERMS

1.8.1 Knee Osteoarthritis (KOA)

Knee osteoarthritis is a degenerative disorder of articular cartilage. It includes the pathology of wide tissues such as the meniscus, synovial membrane, and subchondral bone constituting the knee joint, ligament, joint capsule, tendon, and muscle (Kanamoto et al., 2020).

1.8.2 Manual Therapy

Manual therapy is an advanced speciality area of physical therapy based on manual examination and treatment techniques integrated with exercise, patient education, and other physical therapy modalities to address pain, loss of function, and wellness. American Academy of Orthopaedic Manual Physical Therapists (AAOMPT) Description of Advanced Specialty Practice (DASP) (2018) as cited from Physiopedia.

1.8.3 Exercise Therapy

Exercise therapy consists of movements and physical activities that increase strength and function and reduce discomfort. (Australian Sports Physiotherapy, 2021)

1.9 CHAPTER SUMMARY

The chapter started with a background study on KOA and manual therapy and exercise therapy as part of interventions done to improve individuals’ functional ability and continued with problem statements and the purpose of the study. Afterwards, this chapter presents the research objectives, questions, and hypothesis, guiding this systematic review study in assessing related articles and providing relevant and solid studies concerning the research's objectives, questions, and hypothesis. It then proceeded with the significance of the study to emphasise why it should be done and, lastly, explain the terms that are primarily used in this research.
user
In presenting this chapter, the following points should be addressed:

1. Introduction:
   - Briefly mention the prevalence of Knee Osteoarthritis (KOA) and its impact on the quality of life, particularly in the elderly population.
   - Discuss the importance of manual therapy and exercise therapy in managing symptoms and improving functional ability in KOA patients.

2. Background of the Study:
   - Explain the growing concern of KOA due to aging and increased body mass index.
   - Emphasize on the need to focus on non-pharmacological interventions such as manual therapy and exercise therapy in managing KOA symptoms.
   - Discuss the potential benefits of manual therapy and exercise therapy in delaying the progression of KOA and reducing the need for surgical interventions.

3. Problem Statement:
   - Address the rising trend of total knee arthroplasty (TKA) or total knee replacement as a concerning issue.
   - Discuss the importance of exploring conservative treatments before resorting to surgical interventions.
   - Explain the need to address patient non-adherence to manual therapy and exercise therapy in managing KOA.

4. Purpose of the Study:
   - Mention the objective of the systematic review study to assess the efficacy of manual therapy and exercise therapy in managing KOA symptoms and improving functional ability.
   - Discuss the potential impact of the study in providing reliable evidence to support the use of manual therapy and exercise therapy as an effective treatment option for KOA.

5. Research Objectives and Questions:
   - Present the general and specific objectives of the study.
   - State the research questions that the study aims to answer.

6. Research Hypothesis:
   - Explain the proposed hypotheses regarding the effectiveness of manual therapy and exercise therapy in reducing pain and improving functional ability in KOA patients.

7. Significance of the Study:
   - Discuss the implications of the study in providing a guideline for health professionals and the public, particularly for individuals with KOA.
   - Emphasize on the potential benefits of raising awareness about the availability and efficacy of non-surgical treatment options for KOA.

8. Definition of Terms:
   - Clearly define Knee Osteoarthritis, Manual Therapy, and Exercise Therapy to ensure a clear understanding of these concepts.

9. Chapter Summary:
   - Recap the key points discussed in the chapter, including the background, problem statement, purpose, research objectives and hypotheses, significance, and relevant definitions.
   - Emphasize on the importance and potential impact of the study in improving the management of KOA.
assistant