Clinic-Based Physical Therapy Treatment for Knee Osteoarthritis Provides Twice as Much Initial Improvement as Home-Based Treatment

Press Release
Source: American Physical Therapy Association
Friday December 2, 11:02 am ET

Patients More Satisfied Overall and Less Likely to Use Pain Medication One Year Later
ALEXANDRIA, VA–(MARKET WIRE)–Dec 2, 2005 — Clinic-based physical therapy programs provide quicker improvement and better overall satisfaction for patients with osteoarthritis of the knee than home-based physical therapy programs do, according to a study published in the December issue of Physical Therapy (Journal of the American Physical Therapy Association). The study indicates that although both types of physical therapy programs proved to be beneficial, clinic treatment programs including manual therapy applied by physical therapists combined with physical therapist-supervised exercise had better overall results.

Physical therapist Gail D Deyle, PT, DPT, of Brooke Army Medical Center in Ft Sam Houston, TX, and colleagues conducted the study.

“In this study, we sought to find the best intervention program for patients with osteoarthritic knees,” said Deyle. “We looked at improvement in stiffness, pain, function, dependency on pain medication, and overall patient satisfaction.”

The study consisted of 134 patients with osteoarthritis of the knee who were randomly assigned to either a clinic treatment group or a home exercise group. 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 over the same period, reinforced at 2 weeks with a clinic visit.Outcomes of both groups were measured at 4 weeks using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), which measures the patient’s perception of pain, stiffness, and dysfunction, and by a six-minute walking test. Although both groups showed clinically and statistically significant improvement, the clinic treatment group had a 52% improvement rate in WOMAC scores compared with 26% of the home exercise group. The average distance walked in six minutes improved about 10% in both groups.After 4 weeks, subjects in both groups participated in identical home exercise programs, with no clinic treatment intervention. At 1 year, both groups remained substantially improved, and the difference between the groups was no longer evident. Subjects who were in the clinic treatment group, however, were found less likely to be taking medications for their arthritis and were more satisfied with the overall outcome of their rehabilitative treatment. The investigators concluded that adding clinic physical therapy visits for manual therapy and supervised exercise provides greater symptom relief for patients with osteoarthritis of the knee.

“We were excited to find an intervention program that not only improved overall comfort and function but also had patients using less pain medication,” said Deyle. “We believe that the benefit associated with the clinic-based physical therapy intervention is large and important, especially because there is no known associated risk or potential for harm. The potential or evidence for harm is an important factor in clinical decision making according to the principles of evidence-based practice.”


Stephen C Allison, PT, PhD, of Elon University in North Carolina; Robert L Matekel, PT, DScPT, of Madigan Army Medical Center in Lewis, WA; Michael G Ryder PT, DScPT, of Brooke Army Medical Center in Ft Sam Houston, TX; John M Stang, PT, DScPT, of Ireland Army Community Hospital in Knox, KY; David D Gohdes, PT, MPT, of Tripler Army Medical Center, Ft Tripler AMC, HA; Jeremy P Hutton, PT, MPT, of Eisenhower Army Medical Center in Gordon, GA; Nancy E Henderson, PT, PhD, of Steilacoom, WA; and Matthew B Garber, PT, DScPT, of Brooke Army Medical Center in Ft. Sam Houston, TX, also contributed to the study.
Deyle, Allison, Henderson, and Garber are members of the American Physical Therapy Association (APTA).
Previous work by Deyle, Henderson, Matekel, Ryder, Garber, and Allison published in Annals of Internal Medicine showed that the combination of manual therapy and exercise can reduce the need for total knee replacement and steroid injections.
The American Physical Therapy Association (APTA) is a national professional organization representing more than 68,000 physical therapists, physical therapist assistants, and students. Its goal is to foster advancements in physical therapy practice, research, and education.

Katie Kissal

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