Gail D Deyle, Stephen C Allison, Robert L Matekel, Michael G Ryder, John M Stang, David D Gohdes, Jeremy P Hutton, Nancy E Henderson and Matthew B Garber
Background and Purpose. Manual therapy and exercise have notpreviously been compared with a home exercise program for patientswith osteo-arthritis (OA) of the knee. The purpose of this studywas to compare outcomes between a home-based physical therapyprogram and a clinically based physical therapy program. Subjects.One hundred thirty-four subjects with OA of the knee were randomlyassigned to a clinic treatment group (n=66; 61% female, 39%male; mean age [±SD]=64±10 years) or a home exercisegroup (n=68, 71% female, 29% male; mean age [±SD]=62±9years). Methods. Subjects in the clinic treatment group receivedsupervised exercise, individualized manual therapy, and a homeexercise program over a 4-week period. Subjects in the homeexercise group received the same home exercise program initially,reinforced at a clinic visit 2 weeks later. Measured outcomeswere the distance walked in 6 minutes and the Western Ontarioand McMaster Universities Osteoarthritis Index (WOMAC). Results.Both groups showed clinically and statistically significantimprovements in 6-minute walk distances and WOMAC scores at4 weeks; improvements were still evident in both groups at 8weeks. By 4 weeks, WOMAC scores had improved by 52% in the clinictreatment group and by 26% in the home exercise group. Average6-minute walk distances had improved about 10% in both groups.At 1 year, both groups were substantially and about equallyimproved over baseline measurements. Subjects in the clinictreatment group were less likely to be taking medications fortheir arthritis and were more satisfied with the overall outcomeof their rehabilitative treatment compared with subjects inthe home exercise group. Discussion and Conclusion. Althoughboth groups improved by 1 month, subjects in the clinic treatmentgroup achieved about twice as much improvement in WOMAC scoresthan subjects who performed similar unsupervised exercises athome. Equivalent maintenance of improvements at 1 year was presumablydue to both groups continuing the identical home exercise program.The results indicate that a home exercise program for patientswith OA of the knee provides important benefit. Adding a smallnumber of additional clinical visits for the application ofmanual therapy and supervised exercise adds greater symptomaticrelief.
GD Deyle, PT, DPT, is Assistant Professor and Graduate Program Director, Rocky Mountain University of Health Professions, Provo, Utah; Assistant Professor, Baylor University, Waco, Tex; and Senior Faculty, US Army–Baylor University Post Professional Doctoral Program in Orthopaedic Manual Physical Therapy, Brooke Army Medical Center, San Antonio, Tex
SC Allison, PT, PhD, is Professor, Rocky Mountain University of Health Professions, and Adjunct Professor of Physical Therapy Education, Elon University, Elon, NC
RL Matekel, PT, DScPT, is Lieutenant Colonel, Army Medical Specialist Corps, and Chief, Physical Therapy, Madigan Army Medical Center, Ft Lewis, Wash
MG Ryder, PT, DScPT, is Major, Army Medical Specialist Corps, and Officer-in-Charge, Primary Care Physical Therapy, Brooke Army Medical Center, Ft Sam Houston, Tex
JM Stang, PT, DScPT, is Lieutenant Colonel, Army Medical Specialist Corps, and Chief, Physical Therapy, Ireland Army Community Hospital, Ft Knox, Ky
DD Gohdes, PT, MPT, is Lieutenant Colonel, Army Medical Specialist Corps, and Assistant Chief, Physical Therapy, Tripler Army Medical Center, Tripler AMC, Hawaii
JP Hutton, PT, MPT, is Lieutenant Colonel, Army Medical Specialist Corps, and Chief, Physical Therapy, Eisenhower Army Medical Center, Ft Gordon, Ga
NE Henderson, PT, PhD, is Physical Therapist, Steilacoom, Wash
MB Garber, PT, DScPT, is Major, Army Medical Specialist Corps, and Assistant Chief, Physical Therapy, Brooke Army Medical Center
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Physical Therapy Treatment Effectiveness for Osteoarthritis of the Knee: A Randomized Comparison of Supervised Clinical Exercise and Manual Therapy Procedures Versus a Home Exercise Program
Key Words: Exercise • Knee Osteoarthritis • Manual therapy • Physical therapy