BOSTON—Patients with hip and knee osteoarthritis (OA) may improve their pain, stiffness, and physical function with sustained physical exercise, manual therapy, or both, according to research presented at the 2014 American College of Rheumatology Annual Meeting.
“The aim of this study was to establish whether providing a comprehensive program of exercise or manual therapy results in significant additional benefits, over and above usual medical care,” said lead author J. Haxby Abbott, DPT, PhD, at the University of Otago in Dunedin, New Zealand.
J. Haxby Abbott, DPT, PhD
The participants’ progress was measured using the Western Ontario and McMaster (WOMAC) osteoarthritis index, which calculates scores on a scale of 0 to 240. Lower WOMAC scores indicate improvements in pain, stiffness, and physical function. Participants were also given several physical performance tests, Timed Up and Go, 40-meter fast-paced walk, and a 30-second sit-to-stand. At baseline, the mean age of the osteoarthritis patients in the study was 66, with a mean WOMAC score of 100.8.
After two years, all the participants who engaged in regular exercise, manual therapy, or a combination of both showed improved WOMAC scores that were superior to those who had only the usual medical care for osteoarthritis.
Participants receiving exercise therapy in addition to their usual care showed improvement of 31.7 WOMAC points compared to usual care alone. Participants receiving manual therapy in addition to their usual care showed a relative improvement of 30.1 WOMAC points.
While the difference in WOMAC improvement for participants receiving combined exercise therapy and manual therapy in addition to usual care did not meet the a priori threshold for clinical significance (28 points), there was a trend towards benefit; with this group improving 26.2 WOMAC points more than usual care only. Those participants in the exercise therapy group showed greater mean changes on most physical performance tests than anyone in the other groups.
Adding either exercise therapy or manual therapy to usual medical care is beneficial for people with hip and knee osteoarthritis, the study’s authors concluded. “This study showed that benefits imparted by a comprehensive program of exercise therapy or manual therapy, provided by physical therapists, remain significant to at least two years follow-up,” said Dr. Abbott.