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 .
Effect of low-intensity pulsed ultrasound on the cartilage repair in people with mild to moderate knee osteoarthritis: a double-blinded, randomized, placebo-controlled pilot study.
OBJECTIVE To determine the feasibility of conducting a r and omized controlled trial assessing the effect of low-intensity pulsed ultrasound ( US ) therapy on cartilage repair in patients with mild to moderate knee osteoarthritis ( OA ) . DESIGN Pilot , double-blinded , r and omized placebo-controlled trial with 2-months follow-up . SETTING Rehabilitation research facility . PARTICIPANTS Adults ( N=27 ; ≥45y ) with grade s 1 or 2 of medial joint space narrowing ( Osteoarthritis Research Society International atlas ) due to knee OA were r and omly allocated to receive active ( n=14 ) or sham ( n=13 ) US therapy .  Four participants withdrew for personal reasons . INTERVENTIONS Twenty-four sessions of active ( 20 % duty cycle , 1MHz , average temporal intensity : 0.2W/cm(2 ) , therapeutic dose : 112.5J/cm(2 ) ) or sham ( no sound-head crystal ) US therapy . MAIN OUTCOME MEASURES Success of recruitment and adherence rates were established by a priori criteria . Effect on cartilage repair was assessed by measuring cartilage volume and thickness and scoring cartilage injury , subchondral cyst formation , and bone marrow lesions on magnetic resonance images . RESULTS Patient recruitment and adherence rates were successful . No significant age-adjusted differences were seen between groups in the cartilage repair outcomes . Age-adjusted analyses , including only subjects who attended 20 sessions or more , showed an increase in medial tibia cartilage thickness in the active US therapy group ( 90μm ; 95 % confidence interval , 1 - 200 ; P=.05 ) . CONCLUSIONS Conducting a r and omized controlled trial to assess the effects of US therapy on the cartilage repair in people with mild to moderate knee OA is feasible . However , further pilot studies are needed to determine the optimal US dose and application parameters before design ing a full trial
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 .