Manual Therapy or Exercise Effective for Hip or Knee Osteoarthritis

Abbott JH, Robertson MC, Chapple C, et al. Manual therapy, exercise therapy, or both, in addition to usual care, for osteoarthritis of the hip or knee: a randomized controlled trial—1: clinical effectiveness. Osteoarthritis Cartilage. 2013;21(10):525-534. doi:10.1016/j.joca.2012.12.014.

Researchers in New Zealand carried out a rigorous randomized controlled trial that evaluated the effectiveness of manual therapy and exercise in addition to usual care in alleviating symptoms and improving function in patients with hip or knee osteoarthritis (OA).

The researchers randomly allocated 206 adults (92 men, 114 women; mean [range] age, 66 [37-92] years) with diagnosed OA of the hip or knee into 1 of 4 groups: manual therapy plus usual care (n=54), multimodal exercise therapy plus usual care (n=51), manual therapy and exercise therapy plus usual care (n=50), or usual care only (n=51). Western Ontario and McMaster osteoarthritis index scores were obtained at baseline and after 1 year. In addition, pain levels, global assessment, and physical function were measured. Six trained physiotherapists performed the manual therapy and exercise therapy interventions, which were provided 7 times during the first 9 weeks and twice during week 16. Protocols allowed for individualization of the interventions on the basis of physical examination findings. Manual therapy included thrust and nonthrust joint mobilization, soft tissue manipulation, and stretching of the hip, knee, ankle, lumbar, and pelvic regions. The manual therapy protocol did not include aerobic, strengthening, or neuromuscular control exercises.

Using intention-to-treat analysis, the authors found that participants in the manual therapy group had significant (P<.03) and clinically important sustained improvements in symptoms at 1 year. Those in the exercise therapy group also had sustained benefit with respect to physical performance tests. No added benefit was found in the group who underwent both therapies.

To my knowledge, no randomized controlled trials have assessed the effectiveness of osteopathic manipulative treatment (OMT) for this cohort. However, because the techniques used in this study were similar to OMT techniques, it is likely that OMT effectiveness would be similar to the manual therapy effectiveness demonstrated in this study. Studies assessing the effectiveness of OMT for patients with hip or knee OA are warranted.