Manual therapy, exercise therapy, or both, in addition to usual care, for osteoarthritis of the hip or knee

The authors conducted this study to examine the clinical efficacy of manual physiotherapy and/or exercise physiotherapy in addition to usual care for patients with osteoarthritis (OA) of the hip or knee.  In this randomised controlled trial, 206 adults (mean age 66 years) who met the American College of Rheumatology criteria for hip or knee OA were randomly allocated to receive manual physiotherapy (n = 54), multi-modal exercise physiotherapy (n = 51), combined exercise and manual physiotherapy (n = 50), or no trial physiotherapy (n = 51). The primary outcome was change in the Western Ontario and McMaster osteoarthritis index (WOMAC) after 1 year. Of 206 participants recruited 93.2% were remaining at follow-up. Mean (SD) baseline WOMAC score was 100.8 on a scale of 0-240. Intention to treat analysis showed adjusted reductions in WOMAC scores at 1 year compared with the usual care group of 28.5 for usual care plus manual therapy, 16.4 for usual care plus exercise therapy, and 14.5 for usual care plus combined exercise therapy and manual therapy. There was an antagonistic interaction between exercise therapy and manual therapy. Physical performance test results leaned towards the exercise therapy group.

This study suggests that manual physiotherapy provided benefits over usual care that were sustained to 1 year. Exercise physiotherapy produced physical performance benefits over usual care as well. There was no added benefit from a mixture of the two therapies.

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