Several individual RCTs demonstrated clinical ly important improvements in pain and disability with aerobic exercise .
Other PT interventions demonstrated no sustained benefit .
Individual RCTs showed similar benefits with aerobic , aquatic , and strengthening exercise .
Adverse events were uncommon and did not deter participants from continuing treatment .
Low-strength evidence suggested that only a few PT interventions were effective .
BACKGROUND Osteoarthritis is a leading cause of disability .
Nonsurgical treatment is a key first step .
PURPOSE Systematic literature review of physical therapy ( PT ) interventions for community-dwelling adults with knee osteoarthritis .
Effects of noninvasive interactive neurostimulation on symptoms of osteoarthritis of the knee: a randomized, sham-controlled pilot study.
OBJECTIVE To explore the effects of noninvasive interactive neurostimulation used as an adjunct to usual care , on pain and other symptoms in adults with osteoarthritis of the knee . DESIGN R and omized , sham-controlled trial . SETTING A university in the southern United States . SUBJECTS Thirty-seven ( 37 ) adults with knee osteoarthritis ( based on American College of Rheumatology diagnostic criteria ) . INTERVENTIONS Seventeen ( 17 ) noninvasive interactive neurostimulation ( active or sham ) sessions over 8 weeks with a week 12 follow-up . OUTCOME MEASURES Eleven-point numeric rating scale for weekly pain ; Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) , patient global assessment , and Short-Form Health Survey ( SF-36 ) completed at baseline and weeks 4 , 8 , and 12 . RESULTS For the main outcome , pain , the differences between the groups over time did not reach statistical significance ( all p > 0.05 ) . However , a clinical ly important reduction in pain ( defined as a 2-point or 30 % reduction on an 11-point numeric rating scale ) was maintained at week 12 by the active noninvasive interactive neurostimulation group ( 2.17 points , 34.55 % reduction ) but not the sham group ( 1.63 , 26.04 % reduction ) . Pain improved over time in participants regardless of group membership ( numeric rating scale average pain , p = 0.002 ; numeric rating scale worst pain , p < 0.001 ; and WOMAC pain , p < 0.001 ) , as did WOMAC function , WOMAC stiffness , and WOMAC total score ( all p < 0.001 ) . Repeated measures ANOVA revealed a statistically significant difference between the groups over time for the SF-36 Vitality scale , F ( 3 , 105 ) = 3.54 , p = 0.017 . In addition , the active device group improved on the patient global assessment from baseline to week 8 compared to the sham device group , F ( 1 , 35 ) = 4.025 , p = 0.053 . CONCLUSIONS In this pilot study , clinical ly important reductions in knee pain were maintained at week 12 in the active , but not the sham , noninvasive interactive neurostimulation group . Further study of this noninvasive therapy is warranted
Several individual RCTs demonstrated clinical ly important improvements in pain and disability with aerobic exercise .
Other PT interventions demonstrated no sustained benefit .
Individual RCTs showed similar benefits with aerobic , aquatic , and strengthening exercise .
Adverse events were uncommon and did not deter participants from continuing treatment .
Low-strength evidence suggested that only a few PT interventions were effective .
BACKGROUND Osteoarthritis is a leading cause of disability .
Nonsurgical treatment is a key first step .
PURPOSE Systematic literature review of physical therapy ( PT ) interventions for community-dwelling adults with knee osteoarthritis .