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 .
Immediate effects of transcutaneous electrical nerve stimulation and focal knee joint cooling on quadriceps activation.
PURPOSE To determine whether transcutaneous electrical nerve stimulation ( TENS ) and focal knee joint cooling will affect the quadriceps central activation ratio ( CAR ) in patients with tibiofemoral osteoarthritis . METHODS Thirty-three participants with diagnosed tibiofemoral osteoarthritis were r and omly allocated to the 45-min TENS treatment ( six males and four females , 56 + /- 10.1 yr , 174.11 + /- 10.78 cm , 89.34 + /- 21.3 kg ) , the 20-min focal knee joint cooling treatment ( six males and five females , 58 + /- 8.4 yr , 176.41 + /- 8.29 cm , 83.18 + /- 17.97 kg ) , or the control group ( five males and seven females , 54 + /- 9.9 yr , 166.37 + /- 13.07 cm , 92.14 + /- 25.37 kg ) . Volitional quadriceps activation , maximal voluntary isometric contraction , and subjective pain measurements were conducted at baseline and at 20 , 30 , and 45 min . The 20-min focal knee joint cooling intervention consisted of two 1.5-L ice bags to the anterior and posterior aspects of the knee . The TENS group received 45 min of a sensory , biphasic square wave stimulation ( 150-mus phase duration and 150 pps ) from four 2 x 2-inch electrodes positioned around the patella . RESULTS : TENS result ed in a significantly higher percent change in CAR scores compared with control at 20 min ( 6.4 + /- 4.8 vs -3.5 + /- 8 , P = 0.006 ) , 30 min ( 9.7 + /- 10.16 vs -1 + /- 7.9 , P = 0.025 ) , and 45 min ( 11.25 + /- 6.96 vs 0.81 + /- 9.4 , P = 0.029 ) . Focal knee joint cooling result ed in significantly higher percent change scores compared with the control group at 20 min ( 5.75 + /- 7.25 vs -3.5 + /- 8 , P = 0.009 ) and trended to be higher at 45 min ( 9.06 + /- 9.63 vs 0.81 + /- 9.4 , P = 0.098 ) . No significant differences in percent change for CAR were found between the TENS and the focal knee joint cooling group . CONCLUSIONS Both TENS and focal knee joint cooling  increased the quadriceps CAR immediately after application in participants with tibiofemoral osteoarthritis
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 .