Effects of orthopaedic manual therapy in knee osteoarthritis: a systematic review and meta-analysis

Physiotherapy. 2018 Sep;104(3):264-276. doi: 10.1016/j.physio.2018.05.003. Epub 2018 Jun 2.

Abstract

Objective: This systematic review to aimed to evaluate the effects of orthopaedic manual therapy (OMT) on pain, improving function, and physical performance in patients with knee osteoarthritis (OA).

Data sources: Four databases (PubMed, Web of Science, CENTRAL, and CINAHL) were searched.

Study selection: Trials were required to compare OMT alone or OMT in combination with exercise therapy, with exercise therapy alone or control.

Data extraction: Data extraction and risk assessment were done by two independent reviewers. Outcome measures were visual analogue scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain score, WOMAC function score, WOMAC global score, and stairs ascending-descending time.

Results: Eleven randomized controlled trials were included (494 subjects), four of which had a PEDro score of 6 or higher, indicating adequate quality. The results of the meta-analysis indicated that reduction of VAS score in OMT compared with the control group was statistically insignificant (SDM: -0.59; 95% CI: -1.54 to -0.36; P=0.224). The reduction of VAS score in OMT compared with exercise therapy group was statistically significant (SDM: -0.78; 95% CI: -1.42 to -0.17; P=0.013). The reduction of WOMAC pain score in OMT compared with the exercise therapy group was statistically significant (SDM: -0.79; 95% CI: -1.14 to -0.43; P=0.001). Similarly, the reduction of WOMAC function score in OMT compared with the exercise therapy group was statistically significant (SDM: -0.85; 95% CI: -1.20 to -0.50; P=0.001). However, the reduction of WOMAC global score in OMT compared with the exercise therapy group was statistically insignificant (SDM: -0.23; 95% CI: -0.54 to -0.09; P=0.164). The reduction of stairs ascending-descending time in OMT compared with the exercise therapy group was statistically significant (SDM: -0.88; 95% CI: -1.48 to -0.29; P=0.004).

Conclusions: This review indicated OMT compared with exercise therapy alone provides short-term benefits in reducing pain, improving function, and physical performance in patients with knee OA.

Review registration: PROSPERO 2016:CRD42016032799.

Keywords: Exercise; Function; Knee; Orthopaedic manual therapy; Osteoarthritis; Pain.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Exercise Therapy / methods*
  • Humans
  • Musculoskeletal Manipulations / methods*
  • Osteoarthritis, Knee / therapy*
  • Pain Management / methods
  • Randomized Controlled Trials as Topic
  • Range of Motion, Articular
  • Risk Factors
  • Severity of Illness Index