Background and Purpose. Manual therapy and exercise have not previously
been compared with a home exercise program for patients with osteoarthritis
(OA) of the knee. The purpose of this study was to compare outcomes
between a home-based physical therapy program and a clinically based physical
therapy program. Subjects. One hundred thirty-four subjects with OA of the knee
were randomly assigned to a clinic treatment group (n66; 61% female, 39%
male; mean age [SD]6410 years) or a home exercise group (n68, 71%
female, 29% male; mean age [SD]629 years). Methods. Subjects in the
clinic treatment group received supervised exercise, individualized manual
therapy, and a home exercise program over a 4-week period. Subjects in the
home exercise group received the same home exercise program initially, reinforced
at a clinic visit 2 weeks later. Measured outcomes were the distance
walked in 6 minutes and the Western Ontario and McMaster Universities
Osteoarthritis Index (WOMAC). Results. Both groups showed clinically and
statistically significant improvements in 6-minute walk distances and WOMAC
scores at 4 weeks; improvements were still evident in both groups at 8 weeks. By
4 weeks, WOMAC scores had improved by 52% in the clinic treatment group and
by 26% in the home exercise group. Average 6-minute walk distances had
improved about 10% in both groups. At 1 year, both groups were substantially
and about equally improved over baseline measurements. Subjects in the clinic
treatment group were less likely to be taking medications for their arthritis and
were more satisfied with the overall outcome of their rehabilitative treatment
compared with subjects in the home exercise group. Discussion and Conclusion.
Although both groups improved by 1 month, subjects in the clinic treatment
group achieved about twice as much improvement in WOMAC scores than
subjects who performed similar unsupervised exercises at home. Equivalent
maintenance of improvements at 1 year was presumably due to both groups
continuing the identical home exercise program. The results indicate that a
home exercise program for patients with OA of the knee provides important
benefit. Adding a small number of additional clinical visits for the application of
manual therapy and supervised exercise adds greater symptomatic relief. [Deyle
GD, Allison SC, Matekel RL, et al. Physical therapy treatment effectiveness for
osteoarthritis of the knee: a randomized comparison of supervised clinical
exercise and manual therapy procedures versus a home exercise program. Phys
Ther. 2005;85:1301–1317.]
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