Exercise, education, manual-therapy and taping compared to education for patellofemoral osteoarthritis

Patellofemoral joint osteoarthritis (PFJ OA) adds substantially to knee OA symptoms. This study sought to determine the effectiveness of a PFJ-targeted exercise, education manual-therapy and taping program compared to OA education alone, in participants with PFJ OA. A randomised, participant-blinded and assessor-blinded clinical trial was conducted in primary-care physiotherapy. 92 people aged ≥40 years with symptomatic and radiographic PFJ OA took part. Physiotherapists administered the PFJ-targeted exercise, education, manual-therapy and taping program, or the OA-education (control condition) in eight sessions over 12 weeks. Primary outcomes at 3-month (primary) and 9-month follow-up: (1) patient-perceived global rating of change (2) pain visual analogue scale (VAS) (100 mm); and (3) activities of daily living (ADL) subscale of the Knee injury and Osteoarthritis Outcome Score (KOOS). 81 people (88%) completed the 3-month follow-up and data analysed on an intention-to-treat basis. Between-group baseline similarity for participant characteristics was observed. The exercise, education, manual-therapy and taping program resulted in more people reporting much improvement (20/44) than the OA-education group (5/48) (number needed to treat 3 (95% confidence interval (CI) 2 to 5)) and greater pain reduction (mean difference:-15.2 mm, 95% CI-27.0 to-3.4). No significant effects on ADL were observed (5.8; 95% CI-0.6 to 12.1). There were no significant effects for self-report of improvement, pain (-10.5 mm, 95% CI-22.7 to 1.8) or ADL (3.0, 95% CI-3.7 to 9.7) at 9 months.

Exercise, education, manual-therapy and taping can be recommended to improve short-term patient rating of change and pain severity. Although over a 9 month period, both options were equivalent.

Pharmacology and Physiotherapy

This online course will review the effects, side effects, potential drug interactions and how these will influence ideal physical therapy management with a specific focus on antidepressants and exercise.

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