Effect of Manual Therapies With Supervised Exercise Protocol on Pain and Functional Disability in Patients With Knee OA
Condition: Knee Osteoarthritis
MeSH terms: Osteoarthritis; Osteoarthritis, Knee
Study type: Interventional

Summary: 
      Osteoarthritis (OA) is referred to a group of conditions that involve mostly the larger
      weight-bearing joints such as the hip, knee, and ankle. It is the result of an intricate,
      multifaceted, progressive softening and break-down of articular cartilage along with capsular
      fibrosis and re-growth of new cartilages and bones called osteophytes at the margin of the
      articular surfaces to increase the surface area of them.

      The current study aimed to find out the efficacy of specified manual therapies in combination
      with a supervised exercise protocol on managing pain intensity and functional disability in
      patients with knee osteoarthritis.
    

Detailed description: 
      Out of 70-millions older adults in the America, the majority of females have been suffering
      from osteoarthritis (OA) that progressively lead to chronic pain, joint stiffness, reduced
      mobility, muscle atrophy, poor balance, and ultimately, physical disability. Other
      physiological changes such as reduction in quadriceps' muscle strength and range of motion
      (ROM) in sagittal plane, and shortening of soft tissues around the joints collectively yield
      the distinctive clinical features such as articular pain; worsening on weight -bearing
      activities, resting/morning joint stiffness, progressive decline in physical activities and
      increasing to deformities/disabilities.Researchers observed the effectiveness of a structured
      exercise programs including an aerobic exercise program, a resistance exercise program, and a
      health education program in improving functional outcomes (self-reported disability) and
      decreasing the knee pain among older adults with knee OA at short-term and long term.the
      manual therapy along with supervised exercise protocol revealed a significant reduction in
      joint stiffness and knee pain and improvement in functional status of the patients with knee
      OA for short-term and long-term (1-year follow-up) than the placebo therapy (sub-therapeutic
      dose of ultrasound).

      The study based on a randomized, pretest-posttest experimental group design, included a total
      of 32-participants with knee osteoarthritis randomly divided into groups A and B. Group A
      received a supervised exercise protocol, however group B received specified manual therapies
      in a combination of a supervised exercise protocol. Pain and functional disability measured
      with NPRS and WOMAC index respectively. Data collected on day-1st pre-intervention
      (baseline), day-14th posttest, and day-28th follow-up and analyzed using t-test and one-way
      ANOVA by keeping the level of significance at p<0.05.
    

Intervention name(s): Supervised exercise protocol; Specified Manual Therapies
Intervention type(s): Other; Other
Intervention description(s): Strengthening exercises:It included a sets/group of exercises such as a static quad set in knee extension, standing terminal knee extension, seated leg-press, partial squats weight-lessened with arm support as needed, and step-ups Stretching Exercises:A slow, sustained stretching was performed in different positions for different group of muscles with holding time 30-seconds, a gap of 1-minute between two repetitions, and repeated 3-times per session on alternate day for 2-weeks. The stretching performed for the calf muscle, hamstring muscle, and quadriceps femoris muscle in standing, supine, and prone positions respectively.; Myofascial Mobilization: Patellar glide performed in all available ROM and direction such as superior-inferior and lateral-medial translation/glides of patella over patellar fossa.
Myofascial manipulation technique: Manipulation of knee joint. An impulse type thrust was delivered, directed in the caudal direction to mobilize the joint in a near-full extension position.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Two-arm parallel groups randomized clinical trial
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Specified manual therapy; Strengthening exercise; Stretching exercise; Knee OA; NPRS; WOMAC