The Effectiveness of Manual Therapy and Exercise in Isolation or in Combination

for the Treatment of Hip and Knee Osteoarthritis: A Systematic Review

Bryan Pyrc, SPT; Susan Rhea, SPT; Lauren Ryan, SPT; Chelsea Wolfe, SPT; Justin Zych, SPT;
Dr. Michael Reiman, PT, DPT, OCS, SCS, ATC, FAAOMPT, CSCS

Introduc0on

Conclusion

Results
Article

Osteoarthritis (OA) currently affects over

27 million Americans and is projected to
rise with an increasing aging population.
Symptoms of OA include joint stiffness,
pain, and decreased range of motion.
Manual Therapy (MT) and Exercise
Therapy (EX) have both been suggested
as effective conservative treatments for
hip and knee OA in lower level studies.

Outcome

Most Effective
Intervention

Hip OA
Pain
Hoeksma

MT+stretching vs. EX

VAS: significantly improved in MT+stretching vs. EX

MT+stretching

Abbott

MT vs. EX vs.
MT+EX vs. usual care

Pain intensity: significantly improved in MT vs. EX

MT

MT vs. EX vs.
MT+EX vs. usual care

WOMAC: significant difference at 1 year for MT vs.

no MT

MT

3/3 measures: all groups improved, greatest in EX

EX

Harris Hip Score & Walking Speed: Significantly

improved in MT+stretching vs. EX

MT+stretching

Function
Abbott

Purpose
Hoeksma

Determine the effectiveness of MT, EX, or

the two in combination with respect to the
conservative treatment of hip and knee
OA.

Intervention

MT+stretching vs. EX

Patient Satisfaction
French

Hoeksma

MT+EX vs. EX

MT+stretching vs. EX

Methods

Patient Satisfaction & Patient Perceived Change:

greater in MT+EX vs. EX

MT+EX

Likert Scale: 81% improvement reported with MT +

stretching and only 50% for EX

MT+stretching

Pain
Azlin

Passive knee movement

+PT vs. PT alone

VAS: Significant decrease in Passive knee

movement+PT vs. PT only

MT+EX

Nam

PT+trunk stabilization
+MWM vs. PT+trunk
stabilization

VAS: significant difference with increased pain

control in PT+MWM group

MT+EX

Abbott

MT vs. EX vs.
MT+EX vs. usual care

Pain intensity: significantly improved in MT vs. EX

MT

Deyle

Supervised MT+EX+HEP
vs. HEP alone

WOMAC: Treatment group showed twice as much

improvement at 4 weeks compared to HEP

MT+EX

Ko

Resisted MT+EX vs.

Resisted EX alone

3/3 Functional Performance tests: increased

significantly in the MT+EX

MT+EX

Total # of
Articles 1361

Nam

Korean WOMAC: significant difference with

increased pain control in PT+MWM group

MT+EX

Title/Abstract
Screen
36

PT+trunk stabilization
+MWM vs. PT+trunk
stabilization

Abbott

MT vs. EX vs.
MT+EX vs. usual care

WOMAC: significant difference at 1 year for MT vs.

no MT

MT

3/3 measures: all groups improved, greatest in EX

EX

5-point Likert-type question on overall satisfaction:

Greater patient satisfaction in clinical treatment
group at 4 weeks

MT+EX

Function

Full Text Review

7

Patient Satisfaction
Hip OA
2

Hip & Knee OA

1

Knee OA
4

Deyle

Supervised MT+EX+HEP
vs. HEP alone

Recommenda0ons

Knee OA

A computerized literature database

search in PubMed, Web of Science,
CINAHL, Embase, and Scopus ending
February 24, 2014.
Inclusion criteria: adults greater than 18
years old, hip and/or knee OA, MT and/or
EX, human subjects, & RCT study design.
Exclusion criteria: no prior hip or knee
arthroplasty, no congenital or adolescent
hip or knee disease, no RA, and no hip or
knee surgeries in the past 6 months.
Quality was assessed using PEDro.

Isolated or combined MT and EX are

effective in treating patients with hip and
knee OA.
Pain, self-reported measures, function
and patient satisfaction all improved with
the combined treatment approach.
Isolated use of MT had a greater
positive effect on both patient satisfaction
and pain, while isolated use of EX had
greater increases in physical function.
One study found the combined
treatment to be less effective than either
isolated MT or EX.
Treatment time is a potential limiting
factor in applying the combined
treatments in a single treatment session.

Patient presentation and goals should

be considered when selecting the proper
treatment approach.
The benefits of both therapeutic
interventions should be understood by the
clinician and the patient in order to form a
cohesive program that aligns with patient
and clinician goals.
Further well-conducted studies are
needed to clarify the proper dosage and
precise combination of interventions for
the treatment of patients with hip and
knee OA.

More Informa0on/References
For more information and references,
please visit our website by scanning this
QR code or at our website
http://oatherapy.wix.com/poster.