Independent home versus supervised rehabilitation following arthroscopic knee surgery--a prospective randomized trial. Two- to 4-Year Follow-up to a Comparison of Home Versus Physical Therapy-Supervised Rehabilitation Programs After Anterior Cruciate Ligament Reconstruction 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. Effectiveness of Manual Physical Therapy and Exercise in Osteoarthritis of the Knee Exercise for people with cancer: a clinical practice guideline. Effectiveness of supervised physical therapy in the early period after arthroscopic partial meniscectomy. Comparison of 6- and 7-day physical therapy coverage on length of stay and discharge outcome for individuals with total hip and knee arthroplasty. The effectiveness of self‐management educational interventions for osteoarthritis of the knee Effectiveness and efficiency of an 11-week exercise intervention for patients with hip or knee osteoarthritis: a protocol for a controlled study in the context of health services research Circular instead of hierarchical: methodological principles for the evaluation of complex interventions Rehabilitation for people with multiple sclerosis: an overview of Cochrane Reviews. Manual for guided home exercises for osteoarthritis of the knee. Long-term clinical benefits and costs of an integrated rehabilitation programme compared with outpatient physiotherapy for chronic knee pain. Comparative Effectiveness of Tai Chi Versus Physical Therapy for Knee Osteoarthritis Comparison of Home versus Physical Therapy-Supervised Rehabilitation Programs after Anterior Cruciate Ligament Reconstruction Finnish Degenerative Meniscal Lesion Study (FIDELITY): a protocol for a randomised, placebo surgery controlled trial on the efficacy of arthroscopic partial meniscectomy for patients with degenerative meniscus injury with a novel ‘RCT within-a-cohort’ study design Comparison of Clinic- and Home-Based Rehabilitation Programs After Total Knee Arthroplasty A walking programme and a supervised exercise class versus usual physiotherapy for chronic low back pain: a single-blinded randomised controlled trial. (The Supervised Walking In comparison to Fitness Training for Back Pain (SWIFT) Trial) Comparison of neuromuscular and quadriceps strengthening exercise in the treatment of varus malaligned knees with medial knee osteoarthritis: a randomised controlled trial protocol Design of the Physical exercise during Adjuvant Chemotherapy Effectiveness Study (PACES):A randomized controlled trial to evaluate effectiveness and cost-effectiveness of physical exercise in improving physical fitness and reducing fatigue Aquatic Physical Therapy for Hip and Knee Osteoarthritis: Results of a Single-Blind Randomized Controlled Trial Assessing the comparative effectiveness of Tai Chi versus physical therapy for knee osteoarthritis: design and rationale for a randomized trial A rehabilitation intervention to promote physical recovery following intensive care: a detailed description of construct development, rationale and content together with proposed taxonomy to capture processes in a randomised controlled trial
This prospect i ve study compared 30 patients r and omly assigned to either a home exercise program or supervised outpatient physical therapy following arthroscopic partial medial meniscectomy . Their knee functions were assessed at 2 , 4 , and 8 weeks postoperatively using isokinetic analysis and subjective question naires . At each evaluation , the home exercise group performed as well or better than the supervised physical therapy group . There were no statistically significant differences between the two groups . At 4 weeks postoperation , the mean percent deficit in torque ( strength ) between the affected and unaffected limbs was 22.1 % in the supervised rehabilitation group and 22.0 % in the home exercise . The percent deficit in terms of endurance was 7.7 % in the supervised group and 3.6 % in the home group . Similar results were noted with regard to the patients ' subjective evaluations of their knee function and ability to resume work and recreational activities . We conclude that a well-planned , unsupervised home exercise knee rehabilitation program can produce equally good postoperative recovery as compared to a supervised outpatient physical therapy regimen in properly selected patients following arthroscopic partial meniscectomy of the knee Background : There have been no long-term follow-up studies comparing a predominantly home-based rehabilitation program with a st and ard physical therapy program  after anterior cruciate ligament ( ACL ) reconstruction . Demonstrating the long-term success of such a cost-effective program would be beneficial to guide future rehabilitation practice . Purpose : To determine whether there were any differences in long-term outcome between recreational athletes who performed a physical therapy-supervised rehabilitation program  and those who performed a primarily home-based rehabilitation program  in the first 3 months after ACL reconstruction . Study Design : R and omized clinical trial ; Level of evidence , 1 . Methods : Patients were r and omized before ACL reconstruction surgery to either the physical therapy-supervised ( 17 physical therapy sessions ) or home-based ( 4 physical therapy sessions ) program . Eighty-eight of the original 129 patients returned 2 to 4 years after surgery to assess their long-term clinical outcomes . Primary outcome was the ACL quality of life question naire ( ACL QOL ) . Secondary outcomes were bilateral difference in knee extension and flexion range of motion , sagittal plane knee laxity , relative quadriceps and hamstring strength , and objective International Knee Documentation Committee score . Unpaired t tests and a chi-square test were used for the comparisons . Results : The home-based group had a significantly higher mean ACL QOL score ( 80.0 ± 16.2 ) than the physical therapy-supervised group ( 69.9 ± 22.0 ) a mean of 38 months after surgery ( P = .02 , 95 % confidence interval [ CI ] : 1.7 , 18.4 ) . The mean change in ACL QOL score from before surgery to follow-up was not significantly different between the groups ( physical therapy = 40.0 , home = 45.8 , P = .26 , 95 % CI : −15.8 , 4.4 ) . There were no significant differences in the secondary outcome measures . Conclusion : This long-term study upholds the short-term findings of the original r and omized clinical trial by demonstrating that patients who participate in a predominantly home-based rehabilitation program in the first 3 months after ACL reconstruction have similar 2- to 4-year outcomes compared with those patients who participate in a more clinical ly supervised program BACKGROUND AND PURPOSE Manual therapy and exercise have not previously been compared with a home exercise program for patients with osteoarthritis ( OA ) of the knee . The purpose of this study was to compare outcomes between a home-based physical therapy program and a clinical ly based physical therapy program . SUBJECTS One hundred thirty-four subjects with OA of the knee were r and omly assigned to a  clinic treatment group ( n=66 ; 61 % female , 39 % male ; mean age [+/-SD]=64+/-10 years ) or a home exercise group ( n=68 , 71 % female , 29 % male ; mean age [+/-SD]=62+/-9 years ) . METHODS Subjects in the clinic treatment group received supervised exercise , individualized manual therapy , and a home exercise program over a 4-week period . Subjects in the home exercise group received the same home exercise program initially , reinforced at a clinic visit 2 weeks later . Measured outcomes were the distance walked in 6 minutes and the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) . RESULTS Both groups showed clinical ly and statistically significant improvements in 6-minute walk distances and WOMAC scores at 4 weeks ; improvements were still evident in both groups at 8 weeks . By 4 weeks , WOMAC scores had improved by 52 % in the clinic treatment group and by 26 % in the home exercise group . Average 6-minute walk distances had improved about 10 % in both groups . At 1 year , both groups were substantially and about equally improved over baseline measurements . Subjects in the clinic treatment group were less likely to be taking medications for their arthritis and were more satisfied with the overall outcome of their rehabilitative treatment compared with subjects in the home exercise group . DISCUSSION AND CONCLUSION Although both groups improved by 1 month , subjects in the clinic treatment group achieved about twice as much improvement in WOMAC scores than subjects who performed similar unsupervised exercises at home . Equivalent maintenance of improvements at 1 year was presumably due to both groups continuing the identical home exercise program . The results indicate that a home exercise program for patients with OA of the knee provides important benefit . Adding a small number of additional clinical visits for the application of manual therapy and supervised exercise adds greater symptomatic relief Arthritis has been identified as the most common cause of disability in the United States ( 1 , 2 ) . Thirty-three percent of persons 63 to 94 years of age are affected by osteoarthritis of the knee , which often limits the ability to rise from a chair , st and comfortably , walk , and use stairs ( 3 , 4 ) . Acetaminophen and nonsteroidal anti-inflammatory drugs ( NSAIDs ) are commonly used to treat osteoarthritis . Use of NSAIDs can lead to gastric complications , increased risk for hospitalization , and death ( 5 ) . Other treatment options for persons with osteoarthritis of the knee include physical therapy exercise and treatment programs , cortisone injections , and joint replacement surgery . Puett and Griffin ( 6 ) review ed 15 controlled trials of nonmedicinal , noninvasive therapies for hip and knee osteoarthritis from 1966 through 1993 ( 6 ) . The authors concluded that exercise reduces pain and improves function in patients with osteoarthritis of the knee , but the optimal exercise regimen has not been determined . Fitness walking , aerobic exercise , and strength training have all been reported to result in functional improvement in patients with osteoarthritis of the knee ( 6 - 12 ) . Unweighted treadmill walking has not been shown to decrease pain associated with osteoarthritis of the knee ( 13 ) . Other research ers ( 14 , 15 ) have concluded that exercise may benefit patients with osteoarthritis but advise that long-term studies are required to determine the appropriate amounts of exercise to avoid accelerating the underlying process of arthritis . Active and passive range-of-motion exercise is considered an important part of rehabilitation programs for patients with osteoarthritis ( 16 - 18 ) . Physical therapists frequently use manual therapy procedures as part of comprehensive rehabilitation programs to help patients regain joint mobility and function ( 19 ) . We evaluated the effectiveness of manual physical therapy for osteoarthritis of the knee , as applied by physical therapists with formal training in such an approach ( 20 ) . Our hypothesis was that physical therapy consisting of manual therapy to the knee , hip , ankle , and lumbar spine combined with range-of-motion , strengthening , and cardiovascular exercises would be more effective than placebo for improving function , decreasing pain and stiffness , and increasing the distance walked in 6 minutes . Methods Patients Eighty-three patients with osteoarthritis of the knee were r and omly assigned to receive treatment ( n=42 ; 15 men and 27 women [ mean age , 60 11 years ] ) or placebo ( n=41 ; 19 men and 22 women [ mean age , 62 10 years ] ) . All patients were referred by physicians to physical therapy for osteoarthritis of the knee . Physicians at the various clinics in the medical center who normally see patients with osteoarthritis of the knee were informed of the study so that appropriate referrals could be made . If the patients met our inclusion criteria , they were offered the opportunity to participate . The main inclusion criterion was a diagnosis of osteoarthritis of the knee based on fulfillment of one of the following clinical criteria developed by Altman and colleagues [ 21 ] : 1 ) knee pain , age 38 years or younger , and bony enlargement ; 2 ) knee pain , age 39 years or older , morning stiffness for more than 30 minutes , and bony enlargement ; 3 ) knee pain , crepitus on active motion , morning stiffness for more than 30 minutes , and bony enlargement ; or 4 ) knee pain , crepitus on active motion , morning stiffness for more than 30 minutes , and age 38 years or older . Altman and colleagues found this criteria to be 89 % sensitive and 88 % specific ( 21 - 23 ) . Patients were required to be eligible for military health care , have had no surgical procedure on either lower extremity in the past 6 months , and have no physical impairment unrelated to the knee that would prevent safe participation in a timed 6-minute walk test or any other aspect of the study . Patients had to have sufficient English- language skills to comprehend all explanations and to complete the assessment tools . They were also required to live within a 1-hour drive of the physical therapy clinic . Patients who could not attend the required number of visits or had received a cortisone injection to the knee joint within the previous 30 days were not enrolled . Patients were instructed to keep taking any current medications and not to start taking new medications for osteoarthritis during the clinical treatment and 8-week follow-up . Therapy with any osteoarthritis medication must have been initiated at least 30 days before participation in the study . The study was approved by the institutional review board of Brooke Army Medical Center , Fort Sam Houston , Texas . All patients completed an informed consent form and were advised of the risks of the study , including increased symptoms , injuries from falls , and cardiovascular events . No external funding was received for this study . Procedure Patients who met the inclusion criteria were r and omly assigned to one of two groups . Blank folders were numbered from 1 to 100 and were given concealed codes for the group of assignment , determined by a r and om-number generator . When a patient was eligible and gave consent to participate , the treating therapist drew the next folder from the file , which determined the group of assignment . The treatment group received a combination of manual physical therapy and supervised exercise . The placebo group received ultrasound at a subtherapeutic intensity . Neither group was aware of the treatment that the other group was receiving . Demographic data collected for each patient included age , sex , occupation , height , weight , duration of symptoms , presence of symptoms in one or both knees , previous knee surgery , medications , and present activity level . Knee radiographs were obtained and read by a radiologist who assigned a radiographic severity rating for osteoarthritis ( 24 ) . Dependent variables measured in this study were the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) score ( 25 ) and distance covered during a timed 6-minute walk test . The WOMAC Osteoarthritis Index consists of 24 questions , each corresponding to a visual analogue scale . This test has been shown to be a reliable , valid , and responsive multidimensional outcome measure for evaluation of patients with osteoarthritis of the hip or knee ( 26 ) . The timed 6-minute walk test measures the distance a patient walks in 6 minutes and has been demonstrated to be a reliable measurement of functional exercise capacity ( 27 ) . All measurements of dependent variables were obtained by a trained research assistant who was blinded to group assignment . After research assistants obtained pretreatment values for the dependent variables , patients returned to the treating physical therapist for thorough st and ardized clinical examination of the knee , hip , ankle , and lumbar spine . Treatment was initiated according to group assignment . The treatment group received manual physical therapy as indicated by the results of the examination . The manual therapy treatment techniques , consisting of passive physiologic and accessory joint movements , muscle stretching , and soft-tissue mobilization , were applied primarily to the knee . The same treatments were also administered to the lumbar spine , hip , or ankle if these areas showed limitation in active or passive movement , were symptomatic , or were contributing to overall lower limb dysfunction ( 28 - 31 ) . A minimal pain level was not exceeded in any treatment . The treatment group also performed a closely supervised st and ardized knee exercise program at each of the eight treatment sessions . This program consisted of active range-of-motion exercises for the knee , muscle strengthening exercises for the hip and knee , muscle stretching for the lower limbs , and riding a stationary bike . All of the activities were mutually reinforcing , with repeated gentle challenges to the end ranges of movement . An outline of the exercise program is shown in the Appendix Figure . The physical therapist increased the number of strengthening exercise bouts and the stationary bike riding time on the basis of patient tolerance . The current literature provides efficient methods to produce the desired effects of increasing strength , flexibility , and range of motion ( 32 - 35 ) . At each session , the physical therapist examined the patient for adverse signs and symptoms , such as increased pain , joint effusion , and increased skin temperature over knee joints . These signs and symptoms of osteoarthritis had to be stable or decreasing before manual therapy or exercise was progressed . Patients exercised in a painless or minimally painful manner . If any post-treatment or exercise soreness lasted more than a few hours , the regimen was decreased accordingly for that patient . The placebo group received treatment by the physical therapist that consisted of subtherapeutic ultrasound for 10 minutes at an intensity of 0.1 W/cm2 and 10 % pulsed mode ( lowest setting and greatest cycle interruption ) to the area of knee symptoms . The placebo group received the same subjective and h and s-on objective reevaluation before and after each session as the treatment group . The amount of time directly spent with the treating therapist was approximately 30 minutes for both groups . The treatment group required an additional 30 to 45 minutes to perform their exercises in the clinic . Both groups were treated twice weekly for 4 weeks , for a total of eight clinic treatments . Patients in the treatment group also performed the same exercises at home , except for the closed-chain strengthening exercises , on the days on which they were not treated in the physical therapy clinic . They also walked at home each day at a comfortable pace and distance . The treating physical therapist instructed each patient in the performance of the exercises and provided a detailed h and out containing instructions and photographs of the exercises . Each patient maintained a home exercise BACKGROUND Development of this guideline was undertaken by the Exercise for People with Cancer Guideline Development Group , a group organized by Cancer Care Ontario 's Program in Evidence -Based Care ( pebc ) . The purpose of the guideline was to provide guidance for clinicians with respect to exercise for patients living with cancer , focusing on the benefits of specific types of exercise , recommendations about screening requirements for new referrals , and safety concerns . METHODS Consistent with the pebc 's st and ardized approach , a systematic search was conducted for existing guidelines , and systematic literature search es were performed in medline and embase for both systematic review s and primary literature . Content and methodology experts performed an internal review , which was followed by an external review by targeted experts and intended users . RESULTS The search identified three guidelines , eighteen systematic review s , and twenty-nine r and omized controlled trials with relevance to the topic . The present guideline provides recommendations for the duration , frequency , and intensity of exercise appropriate for people living with cancer . It also provides recommendations for pre-exercise assessment , safety concerns , and delivery models . CONCLUSIONS There is sufficient evidence to show that exercise provides benefits in quality of life and muscular and aerobic fitness for people with cancer both during and after treatment , and that it does not cause harm . The present guideline is intended to support the Canadian Society for Exercise Physiology 's Canadian physical activity guidelines . The recommendations are intended for clinicians and institutions treating cancer patients in Ontario , and for policymakers and program planners involved in the delivery of exercise programs for cancer patients BACKGROUND AND PURPOSE Controversy exists about the effectiveness of physical therapy after arthroscopic partial meniscectomy . This r and omized controlled trial evaluated the effectiveness of supervised physical therapy with a home program versus a home program alone . SUBJECTS Eighty-four patients ( 86 % males ; overall mean age=39 years , SD=9 , range=21 - 58 ; female mean age=39 years , SD=9 , range=24 - 58 ; male mean age=40 , SD=9 , range=21 - 58 ) who underwent an uncomplicated arthroscopic partial meniscectomy participated . METHODS Subjects were r and omly assigned to either a group who received 6 weeks of supervised physical therapy with a home program or a group who received only a home program . Blinded test sessions were conducted 5 and 50 days after surgery . Outcome measures were : ( 1 ) Hughston Clinic question naire , ( 2 ) Medical Outcomes Study 36-Item Short-Form Health Survey ( SF-36 ) and EuroQol EQ-5D ( EQ-5D ) question naires , ( 3 ) number of days to return to work after surgery divided by the Factor Occupational Rating System score , ( 4 ) kinematic analysis of knee function during level walking and stair use , and ( 5 ) horizontal and vertical hops . RESULTS No differences between groups were found for any of the outcomes measured . DISCUSSION AND CONCLUSION The results indicate that the supervised physical therapy used in this study is not beneficial for patients in the early period after uncomplicated arthroscopic partial meniscectomy Providing physical therapy service on Sundays is a much debated topic among hospital administrators . The purpose of this study was to determine if 7 days per week of physical therapy coverage results in shorter lengths of stay and differing discharge status than 6 days per week . A total of 140 subjects with hip or knee arthroplasty participated ; there were 80 in the 6-day groups and 60 in the 7-day groups . Data on postoperative length of stay , discharge destination , and discharge disposition were collected by retrospective medical record review . The Mann-Whitney U test was used to test for differences in length of stay data , and the chi-squared test was used to test for differences in discharge disposition and discharge destination . No significant differences in postoperative length of stay , discharge destination , nor discharge disposition existed between the 6- and 7-day physical therapy coverage hip or knee arthroplasty groups . However , the power of the statistical tests applied was low . This study provides no evidence that 7-day per week physical therapy results in shortened postoperative length of stay , differing discharge destination , nor differing discharge disposition for patients undergoing hip or knee arthroplasty Background Osteoarthritis ( OA ) is a common cause of pain and disability , and is the most common form of arthritis in the Western world . The most common joint to be affected is the knee . Pain and functional disability are common symptoms , which can lead to reduced quality of life and increase the risk of further morbidity . Current treatment aims to educate patients about the management of OA , reduce pain , improve function , decrease disability and reduce the progression of the disease . Education with clients has been described as a set of planned educational activities design ed to improve patients ' health behaviours and /or health status . The purpose of self‐education is to maintain or improve health , or , in some cases , to slow deterioration by increasing participant 's perception of self efficacy defined as an ability to control or manage various aspects of OA . To date , there is no systematic review of the literature undertaken to identify the effectiveness of self‐management educational activities for osteoarthritis of the knee . Objective The objective of this systematic review is to evaluate the effectiveness of  self‐management educational interventions on function and quality of life for adult subjects with OA of the knee . Search strategy A comprehensive search strategy was undertaken on data bases available from University of South Australia from their inception to January 2007 . Selection criteria R and omised controlled trials or clinical controlled trials were sought which evaluated any self management interventions for osteoarthritis knee . Critical appraisal of study quality was undertaken using Joanna Briggs Institute critical appraisal instruments . Data extraction was via the Joanna Briggs Institute st and ard data extraction form for evidence of effectiveness , and Review Manager Software was used to calculate comparative statistics . Results Thirteen trials were included in the review . Trials were clinical ly and method ologically heterogeneous . Pooled results indicate evidence of a beneficial effect from  self management strategies with reducing pain ( SMD ‐0.25 , 95%CI ‐0.36 to ‐0.13 , 11 trials 1379 participants ) . There was no effect on physical function ( SMD 0.13 , 95%CI ‐0.33 to ‐0.08 , eight trials , 1156 subjects ) . No beneficial effects were found from self management interventions with improving quality of life . We also found the exercise component of self management ( four trials ) demonstrated a benefit with reducing pain , improving function and quality of life . Exercise also offered a benefit over no exercise  . Overall method ological quality was moderate . Discussion Pooled results indicate evidence of a beneficial effect from self management strategies with reducing pain and improving function . Significant heterogeneity was found between trials . This was controlled for in the analysis but may be explained by heterogeneity in both the intervention and control group . The exercise component of self management programmes appears to contribute a significant benefit . Conclusion There is encouraging evidence of a small benefit from exercise in self management programs . Clear guidelines can not be provided for practice regarding the exercise content due to heterogeneity but overall benefit suggests this component should be emphasized and implemented in primary care self management programmes Background Osteoarthritis is the most common reason for pain in older adults , and the individual and economic burden of this disease is immense . The chronic character of osteoarthritis requires a long-term therapeutic treatment . In this regard life-style interventions such as physical exercises that can be carried out by the patient himself are recommended as first line treatment . There is evidence for the short-term benefit of exercise therapy in terms of pain reduction and physical functioning . Nonetheless research agendas highlight the need for multifaceted interventions that incorporate exercise strategies into patient care . Studies should be conducted with appropriate sample sizes and should allow statements on long-term effects as well as cost-utility and safety . These open questions are under the scope of this study . Methods / design This is a controlled study in the context of health services research . The study population consists of n = 1400 subjects with hip or knee osteoarthritis . The  intervention group will be recruited from participants of a country-wide health insurance offer for people with hip or knee osteoarthritis . Potential participants for the control group ( ratio 10:1 ( control vs. intervention ) will be filtered out from the insurance data base according to pre-defined matching criteria and asked by letter for their participation . The final statistical twins from the responders ( 1:1 ) will be determined via propensity score matching . The progressive training intervention comprises 8 supervised group sessions , supplemented by home exercises ( 2/week over 11 weeks ) . Exercises include mobilization , strengthening and training of postural control . Primary outcomes are pain and function measured with the WOMAC Index immediately after the intervention period . Among other things , health related quality of life , self-efficacy , cost utility and safety will be evaluated as secondary outcomes . Participants will be followed up 6 , 12 and 24 month after baseline . Discussion Results of this trial will document the effects of clinical as well as economic outcomes in a regular health care setting on the basis of a large sample size . As such , results of this trial might have great impact on future implementations of group- and home-based exercises in hip or knee osteoarthritis . Trail registration German Clinical Trial Register DRKS00009251 . Registered 10 September 2015 Background The reasoning behind evaluating medical interventions is that a hierarchy of methods exists which successively produce improved and therefore more rigorous evidence based medicine upon which to make clinical decisions . At the foundation of this hierarchy are case studies , retrospective and prospect i ve case series , followed by cohort studies with historical and concomitant non-r and omized controls . Open-label r and omized controlled studies ( RCTs ) , and finally blinded , placebo-controlled RCTs , which offer most internal validity are considered the most reliable evidence . Rigorous RCTs remove bias . Evidence from RCTs forms the basis of meta-analyses and systematic review s. This hierarchy , founded on a pharmacological model of therapy , is generalized to other interventions which may be complex and non-pharmacological ( healing , acupuncture and surgery ) . Discussion The hierarchical model is valid for limited questions of efficacy , for instance for regulatory purpose s and newly devised products and pharmacological preparations . It is inadequate for the evaluation of complex interventions such as physiotherapy , surgery and complementary and alternative medicine ( CAM ) . This has to do with the essential tension between internal validity ( rigor and the removal of bias ) and external validity ( generalizability ) . Summary Instead of an Evidence Hierarchy , we propose a Circular Model . This would imply a multiplicity of methods , using different design s , counterbalancing their individual strengths and weaknesses to arrive at pragmatic but equally rigorous evidence which would provide significant assistance in clinical and health systems innovation . Such evidence would better inform national health care technology assessment agencies and promote evidence based health reform BACKGROUND Multiple sclerosis ( MS ) is a major cause of chronic , neurological disability , with a significant long-term disability burden , often requiring comprehensive rehabilitation . OBJECTIVES To systematic ally evaluate evidence from published Cochrane Review s of clinical trials to summarise the evidence regarding the effectiveness and safety of rehabilitation interventions for people with MS ( pwMS ) , to improve patient outcomes , and to highlight current gaps in knowledge . METHODS We search ed the Cochrane Data base of Systematic Review s up to December 2017 , to identify Cochrane Review s that assessed the effectiveness of organised rehabilitation interventions for pwMS . Two review ers independently assessed the quality of included review s , using the Revised Assessment of Multiple Systematic Review s ( R-AMSTAR ) tool , and the quality of the evidence for reported outcomes , using the GRADE framework . MAIN RESULTS Overall , we included 15 review s published in the Cochrane Library , comprising 164 r and omised controlled trials ( RCTs ) and four controlled clinical trials , with a total of 10,396 participants . The included review s evaluated a wide range of rehabilitation interventions , including : physical activity and exercise therapy , hyperbaric oxygen therapy ( HBOT ) , whole-body vibration , occupational therapy , cognitive and psychological interventions , nutritional and dietary supplements , vocational rehabilitation , information provision , telerehabilitation , and interventions for the management of spasticity . We assessed all review s to be of high to moderate method ological quality , based on R-AMSTAR criteria .Moderate- quality evidence suggested that physical therapeutic modalities ( exercise and physical activities ) improved functional outcomes ( mobility , muscular strength ) , reduced impairment ( fatigue ) , and improved participation ( quality of life ) . Moderate- quality evidence suggested that inpatient or outpatient multidisciplinary rehabilitation programmes led to longer-term gains at the levels of activity and participation , and interventions that provided information improved patient knowledge . Low-qualitty evidence suggested that neuropsychological interventions , symptom-management programmes ( spasticity ) , whole body vibration , and telerehabilitation improved some patient outcomes . Evidence for other rehabilitation modalities was inconclusive , due to lack of robust studies . AUTHORS ' CONCLUSIONS The evidence suggests that regular specialist evaluation and follow-up to assess the needs of patients with all types of MS for appropriate rehabilitation interventions may be of benefit , although the certainty of evidence varies across the different types of interventions evaluated by the review s. Structured , multidisciplinary rehabilitation programmes and physical therapy ( exercise or physical activities ) can improve functional outcomes ( mobility , muscle strength , aerobic capacity ) , and quality of life . Overall , the evidence for many rehabilitation interventions should be interpreted cautiously , as the majority of included review s did not include data from current studies . More studies , with appropriate design , which report the type and intensity of modalities and their cost-effectiveness are needed to address the current gaps in knowledge INTRODUCTION Physiotherapy is one of the most important components of therapy for osteoarthritis of the knee . The objective of this prospect i ve case series was to assess the efficiency of a guidance manual for patients with osteoarthritis of the knee in relation to pain , range of movement , muscle strength and function , active goniometry , manual strength test and function . METHODS Thirty-eight adults with osteoarthritis of the knee ( > or= 45 years old ) who were referred to the physiotherapy service at the university hospital ( Santa Casa de Misericórdia de São Paulo ) were studied . Patients received guidance for the practice of specific physical exercises and a manual with instructions on how to perform the exercises at home . They were evaluated for pain , range of movement , muscle strength and function . These evaluations were performed before they received the manual and three months later . Patients were seen monthly regarding improvements in their exercising abilities . RESULTS The program was effective for improving muscle strength , controlling pain , maintaining range of movement of the knee joint , and reducing functional incapacity . DISCUSSION A review of the literature showed that there are numerous clinical benefits to the regular practice of physical therapy exercises by patients with osteoarthritis of the knee(s ) in a program with appropriate guidance . This study shows that this guidance can be attained at home with the use of a proper manual . CONCLUSIONS Even when performed at home without constant supervision , the use of the printed manual for orientation makes the exercises for osteoarthritis of the knee beneficial BACKGROUND Chronic knee pain is a major cause of disability in the elderly . Management guidelines recommend exercise and self-management interventions as effective treatments . The authors previously described a rehabilitation programme integrating exercise and self-management [ Enabling Self-management and Coping with Arthritic knee Pain through Exercise ( ESCAPE-knee pain ) ] that produced short-term improvements in pain and physical function , but sustaining these improvements is difficult . Moreover , the programme is untried in clinical environments , where it would ultimately be delivered . OBJECTIVES To establish the feasibility of ESCAPE-knee pain and compare its clinical effectiveness and costs with outpatient physiotherapy . DESIGN Pragmatic , r and omised controlled trial . SETTING Outpatient physiotherapy department and community centre . PARTICIPANTS Sixty-four people with chronic knee pain . INTERVENTIONS Outpatient physiotherapy compared with ESCAPE-knee pain . OUTCOMES The primary outcome was physical function assessed using the Western Ontario and McMaster Universities Osteoarthritis Index . Secondary outcomes included pain , objective functional performance , anxiety , depression , exercise-related health beliefs and healthcare utilisation . All outcomes were assessed at baseline and 12 months after completing the interventions ( primary endpoint ) . ANCOVA investigated between-group differences . RESULTS Both groups demonstrated similar improvements in clinical outcomes . Outpatient physiotherapy cost pound 130 per person and the healthcare utilisation costs of participants over 1 year were pound 583 . The ESCAPE-knee pain  programme cost pound 64 per person and the healthcare utilisation costs of participants over 1 year were pound 320 . CONCLUSIONS ESCAPE-knee pain can be delivered as a community-based integrated rehabilitation programme for people with chronic knee pain . Both ESCAPE-knee pain and outpatient physiotherapy produced sustained physical and psychosocial benefits , but ESCAPE-knee pain cost less and was more cost-effective Knee osteoarthritis is a major age-related public health problem and a leading cause of long-term pain and disability ( 1 , 2 ) . No effective medical treatments for the disease currently exist . Nonsteroidal anti-inflammatory drugs ( NSAIDs ) and acetaminophen are commonly used to treat osteoarthritis but often fail to relieve symptoms and may cause serious adverse effects ( 3 ) . Physical therapy , a globally recommended element of the st and ard care regimen for knee osteoarthritis , produces moderate benefits for pain and physical functioning , but data on psychological well-being and durability effects are limited ( 4 , 5 ) . Identifying new and effective treatments for patients with knee osteoarthritis is an urgent clinical and public health priority . Tai Chi is a multicomponent traditional Chinese mindbody practice that combines meditation with slow , gentle , graceful movements ; deep diaphragmatic breathing ; and relaxation ( 6 ) . Previous studies have indicated that Tai Chi can reduce pain and improve physical and psychological health among patients with chronic rheumatic disorders , such as rheumatoid arthritis and fibromyalgia ( 713 ) . In our previous r and omized trial , participants with knee osteoarthritis who completed 12 weeks of  Tai Chi showed greater improvements in pain , physical function , depression , and health status compared with an attention control group ( 12 ) . A 2013 up date d meta- analysis of 7 studies that included 348 participants with osteoarthritis showed significant reductions in pain and improvements in physical function after 8 to 24 weeks of Tai Chi training compared with a waiting list , attention control , or usual physical activity ( 14 ) . Those prior trials suggested that Tai Chi could provide a practical exercise regimen with an integrative mindbody approach to manage knee osteoarthritis . The physical component provides exercise benefits that are consistent with recommendations for knee osteoarthritis ( physical function , balance , and muscle strength ) ( 15 ) , and the mind component promotes psychological well-being , life satisfaction , and improved perceptions of health ( 9 , 16 ) . To date , however , no r and omized trials have directly compared Tai Chi and st and ard care treatments . The primary goal of this study was to compare the effectiveness of  Tai Chi  versus a physical therapy regimen among a large sample of patients with symptomatic and radiographic knee osteoarthritis who were seen in the clinical setting and followed for 12 months . Supplement . Study Protocol Methods Design Overview This 52-week , single-blind , r and omized , comparative effectiveness trial recruited participants with symptomatic and radiographic knee osteoarthritis . Patients were r and omly assigned to either Tai Chi ( 2 times per week for 12 weeks ) or physical therapy in a clinical setting ( 2 times per week for 6 weeks , followed by 6 weeks of rigorously monitored home exercise ) . Details of the trial design and conduct have been published ( 17 ) and registered at Clinical Trials.gov ( NCT01258985 ) . The study was approved by the Tufts Health Sciences Institutional Review Board and overseen by an independent data and safety monitoring board . Setting and Participants The trial was conducted at Tufts Medical Center in Boston , Massachusetts , between October 2010 and September 2014 . Participants were recruited through multimodal strategies , including print advertisements , online media , a booth at a senior exposition , and a clinical patient data base . We obtained informed consent before baseline assessment s for eligibility . We enrolled persons aged 40 years or older who met American College of Rheumatology criteria for symptomatic knee osteoarthritis and had radiographic evidence of tibiofemoral or patellofemoral osteoarthritis ( defined as the presence of a definite osteophyte in the tibiofemoral compartment and /or the patellofemoral compartment , as assessed on st and ing anteriorposterior and lateral or sunrise views ) ( 18 ) . All participants were required to have a score of 40 or greater on at least 1 of the 5 questions in the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) pain subscale ( range of 0 to 100 , with higher scores indicating greater pain ) at baseline . A study rheumatologist ( W.H. ) confirmed eligibility of applicants . We excluded persons who had participated in Tai Chi or physical therapy in the past year ; those with current serious medical conditions , such as dementia , symptomatic heart or vascular disease , or recent stroke , that would limit full participation ; those with intra-articular steroid or intra-articular hyaluronic acid injections in the past 3 or 6 months or reconstructive surgery before baseline screening on the most severely affected knee ; and those with a score less than 24 on the Mini-Mental State Examination ( 19 ) . Participants who satisfied eligibility criteria were offered enrollment . R and omization Participants were r and omly assigned in a 1:1 ratio to Tai Chi or physical therapy after the baseline evaluation . R and omization was done in 9 consecutive cycles , comprising about 20 participants each . Within each block of patients r and omly assigned in each cycle , those assigned to Tai Chi were further r and omly assigned to 1 of 3 instructors so that each instructor treated 1 group every 3 blocks . This design allowed for assessment of instructor-level effects . Pseudor and om numbers were generated in advance by the statistician ( C.S. ) using the R statistical package ( 20 ) . Assignments were concealed in sealed , opaque envelopes with date and signature labels . The study coordinator opened the consecutive envelopes individually after obtaining consent and confirming eligibility . Research study nurses , physical function assessors , and sponsor personnel were blinded to the treatment assignments during enrollment . The blinded assessors did not have access to the data until data collection was complete . Interventions Tai Chi and physical therapy ran concurrently to minimize seasonal influences on disease activity . We encouraged participants to maintain routine activities but refrain from new exercises outside the study . Both groups received educational information about the importance of physical activity and home practice . We tracked reasons for missed sessions and asked participants to complete daily logs indicating duration of practice . Participants were encouraged to integrate at least 30 minutes of Tai Chi or physical therapy into their daily routine throughout follow-up . Attendance was monitored during each in-person session by using attendance forms and sign-in sheets . Study staff made monthly calls to monitor adherence throughout the 1-year follow-up . Tai Chi The 60-minute Tai Chi sessions occurred twice per week for 12 weeks . We recruited 3 experienced Tai Chi instructors from the greater Boston area . We developed a st and ardized classical Yang style Tai Chi protocol for knee osteoarthritis that was based on the literature ( 13 ) . Before study initiation , the principal investigator ( C.W. ) and the Tai Chi master ( R.R. , who was also 1 of the 3 instructors ) review ed the concepts of knee osteoarthritis and trained the other instructors ( 17 , 21 ) . In the first session , participants received printed material s on  Tai Chi principles , practice techniques , and safety pre caution s. The instructor explained mindbody exercise theory and procedures . Subsequent sessions started with a warm-up and a review of Tai Chi principles and movement , breathing techniques , and relaxation methods . Participants were instructed to practice Tai Chi at home for at least 20 minutes per day . The principal investigator monitored all sessions by regularly review ing video recordings and providing feedback throughout the study . After completing the 12-week intervention ( 24 sessions ) , participants were instructed to continue Tai Chi practice for 52 weeks with the aid of provided homework material s. Physical Therapy The physical therapy protocol followed U.S. guidelines for knee osteoarthritis treatment ( 15 ) and consisted of two 30-minute outpatient sessions per week for 6 weeks . Before enrollment , the supervising physical therapist ( M.I. ) trained the 3 physical therapists . She observed evaluations and interventions during each treatment cycle to ensure consistency in documentation and provided feedback for program progression ( 17 ) . Depending on the diagnostic findings in the initial musculoskeletal examination , the therapist targeted physical therapy regimens to address specific treatment goals developed collaboratively with the participant . At each session , the physical therapist examined the participant for adverse signs and symptoms before proceeding with manual therapy or exercise . Patients were encouraged to also perform exercises at home . After 6 weeks , participants were instructed to continue exercises in 30-minute sessions 4 times per week for 6 weeks . These were monitored weekly by telephone by using st and ardized forms to ascertain frequency , exercises completed , adverse events , and adherence . Outcomes and Follow-up Knee osteoarthritis outcomes , which were measured at baseline and 12 , 24 , and 52 weeks , were drawn from the core set recommended by the Osteoarthritis Research Society International ( OARSI ) and focused on pain , physical function , and patients ' overall assessment of their disease severity ( 22 ) . Primary Outcome The primary outcome was the change in WOMAC pain subscale score between baseline and 12 weeks . The WOMAC is a vali date d , self-administered visual analogue scale design ed specifically to evaluate osteoarthritis symptoms ( 23 ) . Secondary Outcomes Secondary outcomes were measured at baseline and 12 , 24 , and 52 weeks and included WOMAC physical function and stiffness scores , Patient Global Assessment score , Beck Depression Inventory-II score ( 24 ) , scores on the physical and mental components of the 36-item Short Form Health Survey ( SF-36 ) ( 25 ) , Arthritis Self-Efficacy Scale score ( 26 ) , and results of the 6-minute walk test ( 27 ) and the Background Because of health care funding and policy changes , there is a need to examine the effects of an evolution toward patient-directed ( ie , home-based ) rehabilitation programs on clinical outcomes of patients undergoing anterior cruciate ligament reconstruction . Hypothesis There will be no difference in the effectiveness of a home-based rehabilitation program and a st and ard physical therapy-supervised rehabilitation program in patients 3 months after nonacute anterior cruciate ligament reconstruction with bone-patellar tendon-bone grafts . Study Design R and omized controlled clinical trial ; Level of evidence , 1 . Methods There were 145 patients ( 16 - 59 years ) who attended a presurgery education class . Home-based patients attended 4 physical therapy sessions , and physical therapy-supervised patients attended 17 physical therapy sessions over the first 12 weeks after surgery . All patients followed the same st and ardized rehabilitation program . Study outcome measures included active-assisted knee flexion and passive knee extension range of motion , knee range of motion during walking , KT computerized arthrometer results , and isokinetic quadriceps and hamstrings strength . Patient outcomes were dichotomized as either clinical ly acceptable or unacceptable . Rehabilitation programs were compared by the proportion of acceptable patients in each group . Results The home-based group had a significantly higher percentage of patients with acceptable flexion and extension range of motion compared to the st and ard physical therapy group ( flexion , 67 % vs 47 % ; extension , 97 % vs 83 % ) . There were no significant differences between the groups in range of motion during walking , ligament laxity , and strength . Conclusion A structured , minimally supervised rehabilitation program was more effective in achieving acceptable knee range of motion in the first 3 months after anterior cruciate ligament reconstruction than a st and ard physical therapy-based program . Clinical Relevance Recreational athletes undergoing nonacute anterior cruciate ligament reconstruction can successfully reach acceptable rehabilitation goals in the first 3 months after surgery with a limited number of purpose ful physical therapy education sessions , allowing recreational athletes more flexibility when integrating the necessary postoperative rehabilitation into their daily activities Introduction Arthroscopic partial meniscectomy ( APM ) to treat degenerative meniscus injury is the most common orthopaedic procedure . However , valid evidence of the efficacy of APM is lacking . Controlling for the placebo effect of any medical intervention is important , but seems particularly pertinent for the assessment of APM , as the symptoms commonly attributed to a degenerative meniscal injury ( medial joint line symptoms and perceived disability ) are subjective and display considerable fluctuation , and accordingly difficult to gauge objective ly . Methods and analysis A multicentre , parallel r and omised , placebo surgery controlled trial is being carried out to assess the efficacy of APM for patients from 35 to 65 years of age with a degenerative meniscus injury . Patients with degenerative medial meniscus tear and medial joint line symptoms , without clinical or radiographic osteoarthritis of the index knee , were enrolled and then r and omly assigned ( 1 : 1 ) to either APM or diagnostic arthroscopy ( placebo surgery ) . Patients are followed up for 12 months . According to the prior power calculation , 140 patients were r and omised . The two r and omised patient groups will be compared at 12 months with intention-to-treat analysis . To safeguard against bias , patients , healthcare providers , data collectors , data analysts , outcome adjudicators and the research ers interpreting the findings will be blind to the patients ’ interventions ( APM/placebo ) . Primary outcomes are Lysholm knee score ( a generic knee instrument ) , knee pain ( using a numerical rating scale ) , and WOMET score ( a disease-specific , health-related quality of life index ) . The secondary outcome is 15D ( a generic quality of life instrument ) . Further , in one of the five centres recruiting patients for the r and omised controlled trial ( RCT ) , all patients scheduled for knee arthroscopy due to a degenerative meniscus injury are prospect ively followed up using the same protocol as in the RCT to provide an external validation cohort . In this article , we present and discuss our study design , focusing particularly on the internal and external validity of our trial and the ethics of carrying out a placebo surgery controlled trial . Ethics and dissemination The protocol has been approved by the institutional review board of the Pirkanmaa Hospital District and the trial has been duly registered at Clinical Trials.gov . The findings of this study will be disseminated widely through peer- review ed publications and conference presentations . Trial registration Clinical Trials.gov , number NCT00549172 One hundred sixty patients ( mean age , 68 ± 8 years ) having primary total knee arthroplasty were assigned r and omly to two rehabilitation programs : ( 1 ) clinic-based rehabilitation provided by outpatient physical therapists ; or ( 2 ) home-based rehabilitation monitored by periodic telephone calls from a physical therapist . Both rehabilitation programs emphasized a common home exercise program . Before surgery , and at 12 and 52 weeks after surgery , no statistically significant differences were observed between the clinic- and the home-based groups on any of the following measures : ( 1 ) total score on the Knee Society clinical rating scale ; ( 2 ) total score on the Western Ontario and McMaster Universities Osteoarthritis Index ; ( 3 ) total score on the Medical Outcomes Study Short Form ; ( 4 ) pain scale of the Knee Society clinical rating scale ; ( 5 ) pain scale of the Western Ontario and McMaster Universities Osteoarthritis Index ; ( 6 ) functional scale of the Western Ontario and McMaster Universities Osteoarthritis Index ; ( 7 ) distance walked in 6 minutes ; ( 8) number of stairs ascended and descended in 30 seconds ; and ( 9 ) knee flexion range of motion , on either the per protocol or the intent-to-treat or the analyses . After primary total knee arthroplasty , patients who completed a home exercise program ( home-based rehabilitation ) performed similarly to patients who completed regular outpatient clinic sessions in addition to the home exercises ( clinic-based rehabilitation ) . Additional studies need to determine which patients are likely to benefit most from clinic-based rehabilitation programs Background Chronic low back pain ( CLBP ) is a persistent disabling condition with rising significant healthcare , social and economic costs . Current research supports the use of exercise-based treatment approaches that encourage people with CLBP to assume a physically active role in their recovery . While international clinical guidelines and systematic review s for CLBP support supervised group exercise as an attractive first-line option for treating large numbers of CLBP patients at low cost , barriers to their delivery include space and time restrictions in healthcare setting s and poor patient attendance . The European Clinical Guidelines have identified the need for research in the use of brief/minimal contact self-activation interventions that encourage participation in physical activity for CLBP . Walking may be an ideally suited form of individualized exercise prescription as it is easy to do , requires no special skills or facilities , and is achievable by virtually all ages with little risk of injury , but its effectiveness for LBP is unproven . Methods and design This study will be an assessor-blinded r and omized controlled trial that will investigate the difference in clinical effectiveness and costs of an individualized walking programme and a supervised general exercise programme compared to usual physiotherapy , which will act as the control group , in people with chronic low back pain . A sample of 246 patients will be recruited in Dublin , Irel and through acute general hospital outpatient physiotherapy departments that provide treatment for people with CLBP . Patients will be r and omly allocated to one of the three groups in a concealed manner . The main outcomes will be functional disability , pain , quality of life , fear avoidance , back beliefs , physical activity , satisfaction and costs , which will be evaluated at baseline , and 3 , 6 and 12 months [ follow-up by pre-paid postage ] . Qualitative telephone interviews and focus groups will be embedded in the research design to obtain feedback about participants ' experiences of the interventions and trial participation , and to inform interpretation of the quantitative data . Planned analysis will be by intention to treat ( quantitative data ) and thematic analysis ( qualitative data ) Discussion The trial will evaluate the effectiveness of a walking programme and a supervised general exercise programme compared to usual physiotherapy in people with CLBP.Trial registration Current controlled trial IS RCT Background Osteoarthritis of the knee involving predominantly the medial tibiofemoral compartment is common in older people , giving rise to pain and loss of function . Many people experience progressive worsening of the disease over time , particularly those with varus malalignment and increased medial knee joint load . Therefore , interventions that can reduce excessive medial knee loading may be beneficial in reducing the risk of structural progression . Traditional quadriceps strengthening can improve pain and function in people with knee osteoarthritis but does not appear to reduce medial knee load . A neuromuscular exercise program , emphasising optimal alignment of the trunk and lower limb joints relative to one another , as well as quality of movement performance , while dynamically and functionally strengthening the lower limb muscles , may be able to reduce medial knee load . Such a program may also be superior to traditional quadriceps strengthening with respect to improved pain and physical function because of the functional and dynamic nature . This r and omised controlled trial will investigate the effect of a neuromuscular exercise program on medial knee joint loading , pain and function in individuals with medial knee joint osteoarthritis . We hypothesise that the neuromuscular program will reduce medial knee load as well as pain and functional limitations to a greater extent than a traditional quadriceps strengthening program . Methods / Design 100 people with medial knee pain , radiographic medial compartment osteoarthritis and varus malalignment will be recruited and r and omly allocated to one of two 12-week exercise programs : quadriceps strengthening or neuromuscular exercise . Each program will involve 14 supervised exercise sessions with a physiotherapist plus four unsupervised sessions per week at home . The primary outcomes are medial knee load during walking ( the peak external knee adduction moment from 3D gait analysis ) , pain , and self-reported physical function measured at baseline and immediately following the program . Secondary outcomes include the external knee adduction moment angular impulse , electromyographic muscle activation patterns , knee and hip muscle strength , balance , functional ability , and quality -of-life . Discussion The findings will help determine whether neuromuscular exercise is superior to traditional quadriceps strengthening regarding effects on knee load , pain and physical function in people with medial knee osteoarthritis and varus malalignment . Trial Registration Australian New Zeal and Clinical Trials Registry reference : Background Cancer chemotherapy is frequently associated with a decline in general physical condition , exercise tolerance , and muscle strength and with an increase in fatigue . While accumulating evidence suggests that physical activity and exercise interventions during chemotherapy treatment may contribute to maintaining cardiorespiratory fitness and strength , the results of studies conducted to date have not been consistent . Additional research is needed to determine the optimal intensity of exercise training programs in general and in particular the relative effectiveness of supervised , outpatient ( hospital- or physical therapy practice -based ) versus home-based programs . Methods This multicenter , prospect i ve , r and omized trial will evaluate the effectiveness of a low to moderate intensity , home-based , self-management physical activity program , and a high intensity , structured , supervised exercise program , in maintaining or enhancing physical fitness ( cardiorespiratory fitness and muscle strength ) , in minimizing fatigue and in enhancing the health-related quality of life ( HRQoL ) .  Patients receiving adjuvant chemotherapy for breast or colon cancer ( n = 360 ) are being recruited from twelve hospitals in the Netherl and s , and r and omly allocated to one of the two treatment groups or to a  ' usual care ' control group .  Performance-based and self-reported outcomes are assessed at baseline , at the end of chemotherapy and at six month follow-up . Discussion This large , multicenter , r and omized clinical trial will provide additional empirical evidence regarding the effectiveness of physical exercise during adjuvant chemotherapy in enhancing physical fitness , minimizing fatigue , and maintaining or enhancing patients ' quality of life . If demonstrated to be effective , exercise intervention programs will be a welcome addition to the st and ard program of care offered to patients with cancer receiving chemotherapy . Trial registration This study is registered at the Netherl and s Trial Register ( NTR 2159 Background and Purpose Aquatic physical therapy is frequently used in the management of patients with hip and knee osteoarthritis ( OA ) , yet there is little research establishing its efficacy for this population . The purpose of this study was to evaluate the effects of aquatic physical therapy on hip or knee OA . Subjects A total of 71 volunteers with symptomatic hip OA or knee OA participated in this study . Methods The study was design ed as a r and omized controlled trial in which participants r and omly received 6 weeks of aquatic physical therapy or no aquatic physical therapy . Outcome measures included pain , physical function , physical activity levels , quality of life , and muscle strength . Results The intervention result ed in less pain and joint stiffness and greater physical function , quality of life , and hip muscle strength . Totals of 72 % and 75 % of participants reported improvements in pain and function , respectively , compared with only 17 % ( each ) of control participants . Benefits were maintained 6 weeks after the completion of physical therapy , with 84 % of participants continuing independently . Discussion and Conclusion Compared with no intervention , a 6-week program of aquatic physical therapy result ed in significantly less pain and improved physical function , strength , and quality of life . It is unclear whether the benefits were attributable to intervention effects or a placebo response Background Knee osteoarthritis ( OA ) causes pain and long-term disability with annual healthcare costs exceeding $ 185 billion in the United States . Few medical remedies effectively influence the course of the disease . Finding effective treatments to maintain function and quality of life in patients with knee OA is one of the national priorities identified by the Institute of Medicine . We are currently conducting the first comparative effectiveness and cost-effectiveness r and omized trial of Tai Chi versus a physical-therapy regimen in a sample of patients with symptomatic and radiographically confirmed knee OA . This article describes the design and conduct of this trial . Methods / Design A single-center , 52-week , comparative effectiveness r and omized controlled trial of Tai Chi versus a st and ardized physical-therapy regimen is being conducted at an urban tertiary medical center in Boston , Massachusetts . The study population consists of adults ≥ 40 years of age with symptomatic and radiographic knee OA ( American College of Rheumatology criteria ) . Participants are r and omly allocated to either 12 weeks of Tai Chi ( 2x/week ) or Physical Therapy ( 2x/week for 6 weeks , followed by 6 weeks of rigorously monitored home exercise ) . The primary outcome measure is pain ( Western Ontario and McMaster Universities WOMAC ) subscale at 12 weeks . Secondary outcomes include WOMAC stkiffness and function domain scores , lower extremity strength and power , functional balance , physical performance tests , psychological and psychosocial functioning , durability effects , health related quality of life , and healthcare utilization at 12 , 24 and 52 weeks . Discussion This study will be the first r and omized comparative-effectiveness and cost-effectiveness trial of Tai Chi versus Physical Therapy in a large symptomatic knee OA population with long-term follow up . We present here a robust and well- design ed r and omized comparative-effectiveness trial that also explores multiple outcomes to eluci date the potential mechanisms of mind-body effect for a major disabling disease with substantial health burdens and economic costs . Results of this study are expected to have important public health implication s for the large and growing population with knee OA.Trial registration Clinical Trials.gov identifier : Background Increasing numbers of patients are surviving critical illness , but survival may be associated with a constellation of physical and psychological sequelae that can cause ongoing disability and reduced health-related quality of life . Limited evidence currently exists to guide the optimum structure , timing , and content of rehabilitation programmes . There is a need to both develop and evaluate interventions to support and expedite recovery during the post-ICU discharge period . This paper describes the construct development for a complex rehabilitation intervention intended to promote physical recovery following critical illness . The intervention is currently being evaluated in a r and omised trial ( IS RCT N09412438 ; funder Chief Scientists Office , Scotl and ) . Methods The intervention was developed using the Medical Research Council ( MRC ) framework for developing complex healthcare interventions . We ensured representation from a wide variety of stakeholders including content experts from multiple specialties , method ologists , and patient representation . The intervention construct was initially based on literature review , local observational and audit work , qualitative studies with ICU survivors , and brainstorming activities . Iterative refinement was aided by the publication of a National Institute for Health and Care Excellence guideline ( No. 83 ) , publicly available patient stories ( Healthtalkonline ) , a stakeholder event in collaboration with the James Lind Alliance , and local piloting . Modelling and further work involved a feasibility trial and development of a novel generic rehabilitation assistant ( GRA ) role . Several rounds of external peer review during successive funding applications also contributed to development . Results The final construct for the complex intervention involved a dedicated GRA trained to pre-defined competencies across multiple rehabilitation domains ( physiotherapy , dietetics , occupational therapy , and speech/ language therapy ) , with specific training in post-critical illness issues . The intervention was from ICU discharge to 3 months post-discharge , including inpatient and post-hospital discharge elements . Clear strategies to provide information to patients /families were included . A detailed taxonomy was developed to define and describe the processes undertaken , and capture them during the trial . The detailed process measure description , together with a range of patient , health service , and economic outcomes were successfully mapped on to the modified CONSORT recommendations for reporting non-pharmacologic trial interventions . Conclusions The MRC complex intervention framework was an effective guide to developing a novel post-ICU rehabilitation intervention . Combining a clearly defined new healthcare role with a detailed taxonomy of process and activity enabled the intervention to be clearly described for the purpose of trial delivery and reporting . These data will be useful when interpreting the results of the r and omised trial , will increase internal and external trial validity , and help others implement the intervention if the intervention proves clinical ly and cost effective
In select young and healthy population with few co morbidities  supervised physical therapy  is no more beneficial than a  home exercise program  following relatively simple knee surgical procedures ( arthroscopic meniscetomy ) .
Physical therapy is common following a knee surgery .
With rising healthcare costs there is debate as to the appropriateness of outpatient physical therapy following such interventions .
Many of the existing controlled trials have concluded that there is no benefit to subjects that receive supervised physical therapy when compared to subjects that perform their exercises at home .
The purpose of this systematic review was to consider the existing evidence regarding benefit following  knee surgery  and evaluate the quality , internal and external validity of such evidence .