Manual physical therapy and perturbation exercises in knee osteoarthritis

Abstract

Objectives:Knee osteoarthritis (OA) causes disability among the elderly and is often associated with impaired balance and proprioception. Perturbation exercises may help improve these impairments. Although manual physical therapy is generally a well-tolerated treatment for knee OA, perturbation exercises have not been evaluated when used with a manual physical therapy approach. The purpose of this study was to observe tolerance to perturbation exercises and the effect of a manual physical therapy approach with perturbation exercises on patients with knee OA.Methods:This was a prospective observational cohort study of 15 patients with knee OA. The Western Ontario and McMaster Universities Arthritis Index (WOMAC), global rating of change (GROC), and 72-hour post-treatment tolerance were primary outcome measures. Patients received perturbation balance exercises along with a manual physical therapy approach, twice weekly for 4 weeks. Follow-up evaluation was done at 1, 3, and 6 months after beginning the program.Results:Mean total WOMAC score significantly improved (P = 0.001) after the 4-week program (total WOMAC: initial, 105; 4 weeks, 56; 3 months, 54; 6 months, 57). Mean improvements were similar to previously published trials of manual physical therapy without perturbation exercises. The GROC score showed a minimal clinically important difference (MCID)≥+3 in 13 patients (87%) at 4 weeks, 12 patients (80%) at 3 months, and 9 patients (60%) at 6 months. No patients reported exacerbation of symptoms within 72 hours following each treatment session.Discussion:A manual physical therapy approach that also included perturbation exercises was well tolerated and resulted in improved outcome scores in patients with knee OA.

Manual Therapy Versus Closed Kinematic Exercises—The Influence on the Range of Movement in Patients with Knee Osteoarthritis: A Pilot Study

“…In our studies we have found significant functional improvement and decreased pain in the patients. The conclusions of Rhon et al [39] are similar, as they reported marked improvement in patients following both manual therapy and exercises. According to Courtney et al [30] impaired suppression of central nociceptive pathways occurs in the abnormal joint, which considerably improves with manual therapy.…”

Efectividad de la Distracción Tibiofemoral en la Funcionalidad Adicionada al Tratamiento Convencional en Pacientes Mayores de 50 Años con Osteoartritis de Rodilla. Un Estudio Piloto

“…Finalmente, Rhon et al (2013) muestran la efectividad de adicionar ejercicios de perturbación a la "terapia manual" obteniendo una disminución del puntaje WOMAC de 53 % al mes de tratamiento, 51 % a los tres meses, porcentaje mantenido a los seis meses.…”

The use of various interventions to reduce falls and improve balance in knee osteoarthritis patients: a narrative review

“…1-3, 9, 11, 13, 19-23, 26, 29, 34, 36, 37 There is also 1 randomized trial 12 and 1 pilot cluster-randomized trial. 38 In addition, there are 9 pre/post-assessment studies, 7, 14, 17, 18, 24, 25, 27, 28, 32 3 pilot studies, 15, 16, 35 1 prospective observational cohort study, 31 2 comparative studies 8, 30 and experiment group and a control group. 33 20,25 Dance-based interventions have also been used in these studies.…”