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

被引：157

作者：

Abbott, J. H. ^{[1
]}

Robertson, M. C. ^{[2
]}

Chapple, C. ^{[1
]}

Pinto, D. ^{[3
]}

Wright, A. A. ^{[4
]}

de la Barra, S. Leon ^{[5
]}

Baxter, G. D. ^{[6
]}

Theis, J. -C. ^{[1
]}

Campbell, A. J. ^{[2
]}

机构：

[1] Univ Otago, Dunedin Sch Med, Dept Surg Sci, Ctr Musculoskeletal Outcomes Res, Dunedin 9054, New Zealand

[2] Univ Otago, Dunedin Sch Med, Dept Med, Dunedin 9054, New Zealand

[3] Northwestern Univ, Feinberg Sch Med, Chicago, IL 60611 USA

[4] High Point Univ, Dept Phys Therapy, High Point, NC USA

[5] Univ Otago, Dunedin Sch Med, Dept Prevent & Social Med, Dunedin 9054, New Zealand

[6] Univ Otago, Sch Physiotherapy, Ctr Physiotherapy Res, Dunedin 9054, New Zealand

来源：

OSTEOARTHRITIS AND CARTILAGE | 2013年 / 21卷 / 04期

关键词：

Osteoarthritis; knee; hip; Randomized controlled trial; Exercise therapy; Manual therapies; Physical therapy techniques; Arthralgia; PHYSICAL PERFORMANCE-MEASURES; QUALITY-OF-LIFE; IMPORTANT DIFFERENCE; MULTIPLE IMPUTATION; LOWER-EXTREMITIES; HEALTH-STATUS; PAIN; OUTCOMES; CRITERIA; RECOMMENDATIONS;

D O I：

10.1016/j.joca.2012.12.014

中图分类号：

R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学（修复外科学）];

学科分类号：

摘要：

Objective: To evaluate the clinical effectiveness of manual physiotherapy and/or exercise physiotherapy in addition to usual care for patients with osteoarthritis (OA) of the hip or knee. Design: In this 2 x 2 factorial randomized 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. Secondary outcomes included physical performance tests. Outcome assessors were blinded to group allocation. Results: Of 206 participants recruited, 193 (93.2%) were retained at follow-up. Mean (SD) baseline WOMAC score was 100.8 (53.8) on a scale of 0-240. Intention to treat analysis showed adjusted reductions in WOMAC scores at I year compared with the usual care group of 28.5 (95% confidence interval (CI) 9.2-47.8) for usual care plus manual therapy, 16.4 (-3.2 to 35.9) for usual care plus exercise therapy, and 14.5 (-5.2 to 34.1) for usual care plus combined exercise therapy and manual therapy. There was an antagonistic interaction between exercise therapy and manual therapy (P = 0.027). Physical performance test outcomes favoured the exercise therapy group. Conclusions: Manual physiotherapy provided benefits over usual care, that were sustained to 1 year. Exercise physiotherapy also provided physical performance benefits over usual care. There was no added benefit from a combination of the two therapies. Trial registration number: Australian New Zealand Clinical Trials Registry ACTRN12608000130369. (C) 2013 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

引用

页码：525 / 534

页数：10

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