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Exercises are helpful for neck pain
November 17, 2017

Strong evidence to support the use of these exercises is lacking

Neck pain ranks as one of the most common painful disorders out there. At least 15% of the population is affected by it, and it occurs more frequently in women than men and in middle-age individuals. Neck pain can restrict movement and interfere with normal activities, making it a burden to many of those affected by it. In some cases, problems with the neck can lead to what’s called a cervicogenic headache, which means the neck issues need to be addressed to fix it. There are several different strategies for treating neck pain and other disorders, but most consist of various types of exercises to improve flexibility and increase strength in the region. Although these exercises are commonly used to treat neck pain, some recent studies have only found low-quality evidence to support their use. For this reason, stronger evidence is needed to more firmly recommend different types of exercise for neck disorders. Researchers, therefore, decided to conduct a Cochrane review on the topic. Cochrane reviews collect all the highest-quality research available in order to provide guidance for treatment, and this particular review focused on the effectiveness of different types of exercise for neck disorders.

Researchers identify 27 studies to use for the review

To conduct this review, researchers looked for studies that investigated the use of various exercises for neck disorders. They only accepted randomized-controlled trials (RCTs), which are the most powerful type of individual studies conducted, where patient are randomly assigned to different treatment groups to determine which is most effective. This search process led to a total of 27 RCTs being accepted for the review. The results of each RCT were graded based on the effect of each treatment studied as either small, medium or large. All studies were also assessed for their level of quality to determine how reliable the information they provided was.

Exercises that improve strength and endurance are found to be effective

On the whole, there was not much strong evidence to support the use of exercises as researchers had hoped to find. Nonetheless, they identified studies of moderate quality that showed how effective various exercises can be for neck disorders. In particular, they found moderate evidence that showed strengthening exercises and endurance training for the neck and surrounding muscles were effective for both neck pain and cervicogenic headaches. There was also low-quality evidence that using stretching exercises only was not very effective for neck disorders. Based on these findings, it appears that exercises that increase strength and endurance may be beneficial for patients with neck disorders. Since the overall quality of evidence in the review was low, researchers suggest that additional studies are conducted to investigate this topic further. While results from these studies are anticipated, patients with neck disorders should be encouraged to see a physical therapist for exercise recommendations and other guidance to properly address their condition.

-As reported in the August ’16 issue of Manual Therapy

Strengthening exercises are beneficial for arthritis
November 9, 2017

Release of new research calls for an updated review

Osteoarthritis is a painful condition in which cartilage that normally serves as protection for joints gradually wears away over time. Eventually, this causes bones to rub against one another and results in pain and disability that make it difficult to function normally. Osteoarthritis can occur in any joint, but it’s most common in the knees and the hips. There are a number of strategies that can be used to treat knee osteoarthritis, including exercises guided by a physical therapist, known as exercise therapy. One component of exercise therapy is called resistance exercise, which uses some form of resistance—such as body weight, elastic bands or machines—to force muscles to contract. It has been found to reduce pain and is commonly used in many physical therapy programs. Some studies have evaluated the use of resistance exercise for treating knee osteoarthritis, but there have been flaws in the research that makes it inconclusive. In addition, new research has emerged on the topic recently that calls for an updated review to analyze. With this in mind, researchers conducted a powerful pair of studies called a systematic review and meta-analysis. The systematic review gathered all of the highest-quality evidence on the topic available, and the meta-analysis compared the findings of these studies to one another with the goal of reaching a conclusion.

Researchers search five databases for relevant studies

To perform the review, investigators searched through five major medical databases to find studies on the use of resistance exercises to treat knee osteoarthritis. They only accepted randomized-controlled trials (RCTs)—which are considered to be the highest quality of individual study available—that compared resistance exercise to a control treatment. This could include no treatment or something basic like an educational course that did not include resistance exercises. The search led to a total of 17 RCTs, which included information on 1,705 patients with an average age of 63.5 years. Investigators than analyzed each of these studies and then compared their findings with one another to identify similarities and trends.

Resistance exercise found to reduce pain, relieve stiffness and improve function

Results showed that resistance exercise led to significant benefits when compared to control treatments. In particular, these types of exercises were found to reduce pain, relieve stiffness and improve overall function for patients with knee osteoarthritis. Further analysis showed that exercises with a higher intensity led to greater improvements in pain and function than those that were performed at a lower intensity. Based on these findings, it appears that utilizing resistance exercises can be beneficial in a number of ways for patients with knee osteoarthritis. Common exercises that may be helpful in this capacity include seated leg presses, leg extensions, leg curls and hip adduction and abduction exercises. Many physical therapists typically use these types of exercises when treating this group of patients, and those with the condition should, therefore, seek out their services in order to achieve an outcome that will help them move and function more easily.

-As reported in the October ’16 issue of Clinical Rehabilitation

Program reduces rate of diabetes
November 3, 2017

Obesity-related problems represent a national health crisis that must be addressed

Obesity, along with many other diseases related to it, is a major health crisis in the U.S. that requires a lo of effective efforts to address. Almost 2/3 of Americans are currently overweight or obese, which is a figure that has increased by more than 10% within the past decade and is only expected to keep growing. As a result, more than 300,000 people die every year due to obesity and obesity-related diseases like diabetes, even though obesity is the second leading cause of an illness that can be prevented. For this reason, several medical organizations have developed specific programs designed to decrease the rate of obesity and diabetes in the country, but not all programs have been successful in achieving or sustaining their goals. To better guide medical professionals who deal with these types of patients, a paper was released that highlighted the most effective characteristics of one of these prevention programs and offered advice on how to follow it.

Program created by team of experts

Metabolic syndrome, also known as insulin resistance syndrome, is a cluster of health issues that collectively increase the odds for developing heart disease and diabetes. It’s either caused or worsened by consuming more calories than the amount burned and not getting enough exercise. Approximately 34% of the adult population currently has metabolic syndrome, which means lots of individuals could benefit from programs that prevent diabetes. With this in mind, a team of experts that included doctors, nurses and nutritionists developed the Diabetes Prevention Program (DPP) intensive lifestyle intervention program called “Lifestyle Balance.” A total of 3,234 individuals participated in the DPP study, all of which were overweight and had impaired glucose tolerance.

Mediterranean diet, 10,000 steps and increased physical activity

The first part of the program consisted of 16 sessions led by a lifestyle coach, with the first eight dedicated to education, diet and exercise, and the other eight focused on how to overcome the challenges that might get in the way of making changes. The nutritional component of the program consisted of a 24-week Mediterranean-style diet. This encouraged participants to eat lots of fruits, vegetables, whole grains, poultry, and fish, with a breakdown of about 45-50% carbohydrates, 15% protein and 35-40% fat. Monounsaturated fats like olive oil were encouraged, while saturated fats were discouraged. For physical activity, participants were encouraged to get at least 150 minutes each week of moderate-intensity physical activities like brisk walking. In addition, all participants were told to wear a pedometer (step-counter) and increase the number of steps they walked each week until averaging 10,000 steps per day. The two major goals of the program were to have all participants reduce their weight by at least 7% and maintain a reasonable level of physical activity every week.

Program is effective for reducing the rate of diabetes

On the whole, DPP was found to be effective, as there was a 58% reduction in the rate of diabetes that developed in study participants compared to groups that received placebo or medications only. In addition, many of the patients from the initial study participated in a separate follow-up study, and their diabetes rates were once again found to be lower than groups in which only diabetes medications or no treatments were given to patients. When this approach was analyzed, it was also found to be more effective for its cost than other possible treatments and no treatments. Finally, researchers point out that following this type of prevention program will not only reduce the rate for diabetes but also improve the quality of life of patients. This paper shows just how effective a diabetes prevention program can be that includes dietary changes and increases in physical activity. Therefore, individuals who are classified as being prediabetic should strongly consider participating in a program similar to the one described here. Physical therapists can play a major part in this prevention process by offering specific recommendations to increase physical activity levels that are appropriate for each patient and addressing any limitations that may be preventing them from becoming more active. Doing so can significantly reduce the rate of diabetes in the country and ease the burden that the disease causes for so many.

-As reported in the September ’16 issue of Archives of Physical Medicine and Rehabilitation

Hands-on therapy for shoulder pain helps recovery time
October 28, 2017

Many individuals who develop shoulder pain have long-term issues

Shoulder pain is a fairly common condition. In fact, there’s a one in three chance that you will experience some form of shoulder pain at least once in your lifetime. Although many cases of shoulder pain improve with treatment over time, up to 50% of individuals who develop it go on to still have issues with shoulder function 1-2 years later. This highlights why it is so important to find effective treatments that help patients improve in the long term. Some physical therapists use a technique called cervical manipulation, which consists of the therapist moving the bones in of the neck in various ways with their hands. It’s known to reduce pain and disability in the shoulder, but also comes with a set of risks. Another technique is thoracic manual therapy, which applies similar techniques to the middle portion of the spine. It’s believed that this treatment may lead to comparable improvements without the same risks as cervical manipulation, but there is not enough evidence to clearly support its use. Therefore, a systematic review was conducted on thoracic manual therapy for shoulder pain, which is a powerful study that collects all the available research on the topic with the goal of establishing a conclusion.

Five electronic databases searched for relevant studies

Researchers searched through five electronic databases for studies that investigated the use of thoracic manual therapy to treat patients with shoulder pain. This process led to three randomized-controlled trials (RCTs), which are considered the most powerful type of individual study that can be performed, and four other studies that were of lower quality. These seven studies contained information on 496 patients with shoulder pain, who were treated with a variety of techniques that took place for as long as 12 weeks. Patients were evaluated for several outcomes like pain and disability for up to one year, and the findings of all these studies were compared to one another to determine the true value of this treatment.

Patients experience less pain and disability for up to one year after treatment

Results from the systematic review showed that patients treated with thoracic manual therapy improved significantly more than those who received other treatments. In particular, the three RCTs found that they experienced a quicker recovery with reduced pain and disability for at least 12 weeks, and up to one year after treatment. In addition, a ranking tool found that the evidence provided in the RCTs was of high quality, which makes the information it provides even more reliable. Based on these findings, it appears that thoracic manual therapy is an effective technique for patients with shoulder pain. It can accelerate their recovery and lead to less pain and disability in the long term. Patients dealing with this type of pain should, therefore, seek out a physical therapist that provides these types of services in order to experience significant and lasting improvements.

-As reported in the September ’15 issue of theJournal of Manual and Manipulative Therapy

Non-surgical treatment lead to similar outcomes for back pain
October 20, 2017

Interpretation of study’s findings is misleading

Low back pain is one of the most common painful conditions in the world. Although many individuals who experience low back pain will improve either with or without treatment, some go on to deal with long-term issues. Chronic low back pain (CLBP) is defined as any situation in which pain lasts for more than three months, and it is a major problem for physical therapists and other doctors. In general, it’s recommended that non-surgical treatment that includes various types of exercises should be used first and that surgery should only be considered if these treatments are not available or don’t lead to improvements. Lots of research has supported this type of approach, such as three recent high-quality studies that found no evidence that surgery was any better than non-surgical treatment after 11 years. Unfortunately, one recent study performed in Sweden tried to make the claim that surgery led to superior outcomes compared to non-surgical treatment; however, there were some issues with this analysis. Surgeons performed the study, who may have interpreted information in favor of surgery, even if it actually suggested otherwise. For this reason, a team put forth a commentary that explained the true nature of these findings to better guide patients and medical professionals.

Large sample of patients randomly assigned to different treatments

In the original study, patients with CLBP for at least two years were recruited to participate. This led to a sample of 294 individuals who were randomly assigned to either physical therapy or a surgical procedure called lumbar fusion. All patients were evaluated before these treatments and then monitored for between 9-22 years afterward for pain, disability, and other measures. According to the researchers who conducted the study, patients who had surgery reported better scores in most of the measurements taken, and they recommend that this surgical procedure is a valid treatment option for patients with CLBP. When looking into these results a bit more deeply, though, a different story emerges.

Long-term results really show that there is no difference between treatments

Researchers first pointed out that although patients were randomly assigned to have either surgery or physical therapy, they had a 3-to-1 chance of having surgery. This means that many more patients went on to have surgery versus physical therapy, and makes the results skewed in that direction. In addition to this, the patients that did receive physical therapy were not provided with quality treatments that were based on evidence, which is the norm for reputable physical therapists. Another major difficulty is the fact that although it’s easy to track patients who move from non-surgical treatment to surgical treatment, this is very difficult for patients who do the opposite. Once again, this favors those who have surgery rather than physical therapy. Finally, the long-term results showed that while the surgical group of patients remained stable, the non-surgical group actually continued to improve after two years. Based on these important shortcomings, the original study was biased in its conclusion that surgery was superior to physical therapy. In actuality, it only performed better in certain measures, and non-surgical treatment actually had some advantages of its own. Therefore, the results from that study should be taken with caution, and patients should understand that what it truly shows is that surgery and non-surgical treatment like physical therapy lead to very similar results. The choice is theirs and should be made by evaluating the costs and long-term outcomes of both treatments.

-As reported in the May ’16 issue of The Spine Journal

Specific exercises are beneficial for neck pain
October 12, 2017

This specific combination of treatments has not yet been studied

Neck pain is a major problem that regularly affects millions of Americans. It’s estimated that between 30-50% of the population experiences neck pain each year, and about 11% of people are limited by it when performing daily activities. Although most cases of neck pain improve on their own within a reasonable amount of time, for some individuals it becomes a long-term problem. When pain lasts for more than three months, it’s called chronic neck pain, and it can lead to additional problems like stress, anxiety, reduced quality of life and a tendency to avoid certain behaviors. There are many treatments available for chronic neck pain, but it’s generally accepted that physical therapy and some other treatments are effective for reducing pain and improving function in patients. In particular, doing specific exercises for the neck, increasing physical activity levels and educating patients on their pain and how to cope with it have all been supported by literature as beneficial treatments for patients with chronic neck pain. Despite the fact that all of these treatments are known to be effective, the result of them being using in combination has not been studied. Therefore, a study called a randomized-controlled trial (RCT) was conducted, which is the most powerful type of individual study that can be performed.

Large sample of patients randomly assigned to two separate groups

Individuals with chronic neck pain for at least six months were recruited for the RCT and screened to determine if they were eligible to participate. Of the individuals screened, 200 were accepted and randomly assigned to either the exercise group or the control group. Participants in both groups attended four education sessions, which lasted for 1.5 hours and took place once a month. The sessions focused on explaining ways that patients could understand and accept their pain, and on how to set goals to work towards. In addition to this, the exercise group also received eight 30-minute sessions, which consisted of instructions for specific neck exercises and a physical activity program. The neck exercises were customized to each patient and were to be performed twice a day for four months. The physical activity program was performed three times a week for four months and consisted of either walking or cycling, and increasing the intensity over this span of time. All participants were evaluated before and immediately after the study for a variety of both physical and mental outcomes related to their chronic neck pain.

Patients who perform exercises and physical activity improve much more

After four months, patients in the exercise group reported significantly better scores than the control group in most/many of the outcomes that were measured. In particular, they were found to have better muscle function, neck flexibility, and pain threshold, as well as improved mood and both mental and physical quality of life. In addition, the participants in the exercise group adhered to their program slightly more than the control group, which may have increased the effect of the treatment even more in their favor. Based on these findings, it appears that a treatment program that combines education, specific neck exercises, and a physical training program is rather beneficial for chronic neck pain patients and can lead to a variety of improvements. Patients who have been plagued by neck pain for a long while should, therefore, seek out the services of physical therapists that provide these types of treatments in order to achieve notable benefits.

-As reported in the August ’16 issue of Manual Therapy

Specific exercises and hands-on therapy is helpful for ankle sprains
October 6, 2017

Many patients who experience one ankle sprain go on to have long-term issues

Ankle sprains are the most common injury in athletes and those who are physically active. These injuries can occur anywhere in the ankle, but sprains to the outside of the ankle (lateral ankle sprains) are most typical and account for about 85% of sprains. In addition to the initial pain and disability that these injuries cause, up to 40% of patients who sprain their ankle once will go on to develop a condition called chronic ankle instability. Individuals with chronic ankle instability tend to experience continual pain and soreness, and a sensation that the ankle is “giving way.” As a result, they are more likely to sprain their ankle again, which can lead to serious long-term issues. Two strategies used by physical therapists for treating these patients are manual therapy and exercise therapy. Manual therapy consists of different types of mobilizations being applied to the patient’s ankle by the therapist, while exercise therapy involves various exercises designed to improve balance and increase strength. Both treatments have been found to lead to benefits, but it’s not completely clear what effect they have when used together. Therefore, a randomized-controlled trial (RCT) was conducted to investigate the combination of these treatments for patients with chronic ankle instability. An RCT randomly places participants in different treatment groups to see which is more effective and is considered the most powerful type of individual study.

Sample of patients randomly assigned to one of two groups

Individuals who reported having recurring ankle sprains were recruited for the study and screened to determine if they were eligible. Out of 68 people screened, 56 fit the necessary criteria and were randomly assigned to one of two treatment groups. Both treatment groups 1 and 2 followed an exercise therapy treatment program that was given during two sessions per week for four weeks. Sessions consisted of six different exercises that were designed to increase strength and improve proprioception, which is the body’s ability to sense its position in space during movements. These exercises were supervised by two physical therapists and progressed each week based on patients’ abilities. In addition to exercise therapy, treatment group 2 also received manual therapy over the course of four weeks. This consisted of therapists performing a series of mobilizations of the ankle joint with the goal of improving patients’ ankle mobility. Each technique lasted 20-30 seconds and was repeated 10 times each by the therapists. All patients were evaluated for pain, ankle stability, pain threshold, strength and flexibility before the study, immediately after treatment and then again one month later.

Adding manual therapy leads to even greater outcomes

Results showed that although both groups reported better overall scores in all the measurements taken, those in treatment group 2 experienced greater improvements than treatment group 1. This was based on lower levels of pain, better ankle stability and greater flexibility, pain threshold and strength in participants who had the treatment combination. These findings suggest that exercises for strength and proprioception can be very effective on their own for helping patients with chronic ankle instability, but adding manual therapy to the treatment program may likely lead to even greater outcomes for them. Therefore, patients with chronic ankle instability who continue to sprain their ankle should seek out physical therapy services to address their condition. By combining exercise therapy for strength and proprioception and manual therapy, physical therapists can produce noticeable improvements in these patients and help them to function better with a reduced risk for additional ankle sprains.

-As reported in the August ’16 issue of Manual Therapy

Seeing physical therapists early for neck pain is better than waiting
September 28, 2017

New strategies are needed to improve healthcare system

Under the current system, the majority of healthcare in the U.S. is delivered in a fee for service, volume-based model. This means that healthcare providers like doctors have an incentive to handle a large number of patients since they will receive payment for their services regardless of each patient’s outcome. Using this type of system is one of the main reasons that healthcare costs continue to increase in the country. Clearly, new strategies are needed to improve the system so that patients can receive the best and most appropriate care possible at a reasonable cost. One way to do this is by identifying treatments that are effective for the patient, priced reasonably and given at the appropriate time. The use of physical therapy early on is one treatment that is studied in this regard.

The benefits of early treatment for neck pain have not been studied

Recent studies have shown that early physical therapy for lower back pain is recommended to improve the outcomes of patients better than prescription medications and other treatments. It has also been found associated with less use of healthcare resources and lower costs overall. Neck pain is the second most common disorder that affects the body’s movements behind lower back pain, and physical therapy is commonly used to treat it; however, the effects of early physical therapy for neck pain have not been studied. For this reason, a study was conducted that compared patients with neck pain who received physical therapy at an earlier date with those that waiting a period of time before beginning physical therapy.

Information from a large database used to compare both patient groups

A large database with detailed information about patients who received physical therapy for neck pain was used to conduct the comparison of early and delayed users. Patients were categorized as using early physical therapy if they reported their pain in less than four weeks, while those who waited longer than four weeks were classified as delaying physical therapy. A total of 1,531 patients were identified from the database and fit the necessary criteria. This included 451 patients who received early physical therapy and 1,080 who received delayed physical therapy.

Early physical therapy leads to several benefits over delaying

After comparing both groups of patients, it was found that those who received early physical therapy experienced better outcomes with less disability and pain than those who delayed it. This was found to be the case not only in their actual outcomes but in their value as well since patients got more out of each dollar they spent with early physical therapy over delayed physical therapy. Since patients improved more and required less treatment, there was also a benefit in cost for the physical therapists and insurance companies. Finally, the overall efficiency of treatment was found to be superior in the group that received early rather than delayed physical therapy. These findings clearly show that seeing a physical therapist for neck pain within four weeks will lead to much better outcomes than waiting longer to do so. More research is needed to confirm these findings and eventually make policy changes to reflect them, but in the meantime, patients who have neck pain are encouraged to see a physical therapist early instead of delaying treatment in order to experience the best possible benefits.

-As reported in the July ’16 issue of BMC Health Services Research

Getting physical activity significantly reduces the risk of arthritis
September 21, 2017

The specific benefits of different amounts of physical activity are not completely clear

It should be commonly known by now that being physically active on a regular basis is beneficial and has a protective effect against many diseases and health conditions. Despite this, it’s not completely clear how this protective effect differs based on the exact amount of physical activity an individual gets. In other words, what amount of physical activity is necessary to experience specific effects, and how does this change with greater amounts of activity? The World Health Organization (WHO) currently recommends getting 600 metabolic equivalents (MET) minutes of total activity each week in order to obtain health benefits. A MET is a unit of measurement used to describe the amount of energy exerted when performing physical tasks or activities, and 600 MET minutes in a week is approximately equal to walking (4 METs) for 150 minutes or running (8 METs) for 75 minutes total. Totals for MET-minutes are calculated by multiplying the METS for the activity by the number of minutes it’s performed, so five hours of gardening (4 METs) in a week equates to 4 x 300 = 1,200 MET minutes. Though these values are commonly used for physical activity recommendations, it’s not completely understood to what degree they reduce the risk for certain health conditions and if greater amounts reduce this risk even more. Therefore, a powerful pair of studies called a systematic review and meta-analysis was conducted. The systematic review gathered all of the highest-quality evidence on the topic available, and the meta-analysis compared the findings of these studies to one another to establish a conclusion.

Researchers identify 174 studies for the systematic review and meta-analysis

Researchers searched through two databases for studies that examined the connection between physical activity and the risk of any of the following five health conditions: breast cancer, colon cancer, diabetes, heart disease and stroke. In particular, they were interested in the total MET-minutes per week of individuals and how that affected their risk for any of those five conditions. After screening 6,965 studies, researchers identified 174 that fit the necessary criteria and were used for the meta-analysis.

Risk for disease is lowered with more physical activity, but only to a certain point

Results from the meta-analysis showed that higher levels of total physical activity were associated with a lower risk for all five of the health conditions that were looked into. The health benefits that individuals experienced were found to be the greatest once achieving a certain amount of physical activity, but after that point, the decrease in risk for the conditions studied was minimal. One of the main examples to illustrate this point is the following: individuals who got 600 MET-minutes per week of physical activity had a 2% lower risk of diabetes compared with those who did not get any physical activity. When the amount of physical activity increased from 600 to 3,600 MET minutes/week, this risk was reduced by an additional 19%. After this, however, similar increases in physical activity only led to small reductions in the risk for diabetes. Similar trends were found with the other health conditions examined as well.

Individuals should get more physical activity than what is recommended

Based on this, researchers said that getting 3,000-4,000 MET-minutes per week appears to be the ideal range for obtaining the most health benefits and the greatest reduction of risk for the five health conditions. More physical activity than this may not necessarily lead to more benefits or a lower risk. The researchers, therefore, suggest that the physical activity levels of individuals should be significantly higher than what is currently recommended (600 MET-minutes/week) in order experience the greatest reduction in risks for breast cancer, colon cancer, diabetes, heart disease and stroke. Since it may take some time before any recommendations are actually changed, individuals can take matters into their own hands and work towards getting more physical activity for their overall health and risk for a disease.

-As reported in the August ’16 issue of The BMJ

Exercise and physical therapy help patients with knee arthritis
September 15, 2017

Unclear if additional sessions make therapy any more effective

Osteoarthritis (OA) is a common disorder in which cartilage that normally surrounds and protects joints wears away gradually over time. Overweight or obese individuals and those over the age of 65 are also more likely to develop it. There are many treatments available for knee OA, including exercise that may be combined with manual therapy. In this type of therapy, a physical therapist performs manipulations and mobilizations with their hands to reduce pain and improve function. Unfortunately, it’s not clear if the use of manual therapy adds any extra benefits to exercise alone. Some patients may also struggle to retain their improvements in the long term. One suggestion is to include “booster sessions,” in which patients meet with their physical therapist regularly for weeks or months after their initial sessions to discuss their progress and help them with recommendations to keep improving. Once again, research is lacking on whether these booster sessions are actually beneficial for patients. For this reason, a powerful study called a randomized-controlled trial (RCT) was conducted to compare the effects of manual therapy, booster sessions and exercise therapy for patients with knee OA.

Large sample of patients randomly divided into four even groups

Individuals with knee OA were recruited to participate in the RCT and screened to determine if they fit the necessary criteria. A total of 300 patients were accepted for the study and randomly assigned to one of the following four groups: 1) exercise with no booster sessions, 2) exercise with booster sessions, 3) manual therapy with exercise (no booster sessions), and 4) manual therapy with exercise and booster sessions. The exercise program, which all four groups performed, consisted of various strengthening, stretching, agility and balance exercises. In some cases, additional exercises were added for the hip and ankle if patients seemed to need them. For manual therapy, different maneuvers were applied with manual force from the therapist to increase the flexibility of the knee and surrounding muscles. This all took place during 12 sessions, with those who didn’t receive boosters doing all of them in nine weeks, and those with boosters spreading them out more evenly over 11 months. All patients also followed a home-exercise program twice a week or more that included the same exercises that were performed during the program. Participants were evaluated for pain, function and other measures before treatment, and then nine weeks and one year later.

All patients improve, but role of booster sessions and manual therapy not clear

After nine weeks, patients in all four treatment groups experienced significant improvements in all the outcomes measured. By one year, some of these effects had reduced, but for the most part, the improvements lasted. Despite this, the addition of booster sessions or manual therapy was not found to result in any greater benefits for patients after one year. Some positive effects were noticed, but they did not remain in the long term. Based on these findings, it appears that exercise is clearly effective for reducing pain and improving the function of patients with knee OA. Although booster sessions and manual therapy may help patients improve even more, it was not found to be the case in this study. Additional research is needed to investigate the role of booster sessions in more detail, but for now, patients with knee OA should feel confident that a physical therapist can effectively treat their condition with various exercises and help them achieve improvements that last in the long term.

-As reported in the August ’16 issue of Osteoarthritis and Cartilage