Manual Therapy Versus Exercise on Knee Osteoarthritis

Study Overview
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Brief Summary
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Earlier research has shown that exercising while receiving manual therapy improves function and reduces pain in people with knee osteoarthritis. However, very little is known about the mechanisms by which manual therapy and exercise reduce pain and improve function. This study will ask subjects with knee osteoarthritis to receive one of the following interventions: (1) no treatment, (2) exercise only, or (3) manual therapy only. Measures will be taken of the patient's knee range of motion, knee swelling and pain before and after receiving the intervention. These measures will be analyzed to determine what effect exercise and manual therapy applied to the knee have on improving knee range of motion and reducing knee pain and swelling. Swelling will be measured using an ultrasound device which is used to take pictures inside the knee. This type of ultrasound measurement is painless and harmless.

Official Title
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Effects of Manual Therapy Versus Therapeutic Exercise on Knee Osteoarthritis: A Randomized Control Trial

Conditions
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Knee Osteoarthritis

Intervention / Treatment
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* Procedure: Manual Therapy
* Behavioral: Therapeutic Exercise
* Behavioral: Video Observation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Diagnosis of knee osteoarthritis. Exclusion Criteria: Inability to ambulate at least 100 feet, ride a stationary bicycle for at least 10 minutes, or lie in the prone position for at least 10 minutes, Intra-articular knee injection within one month of study inception, A history of exercise induced or uncontrolled angina within three months of the study entry, Severe dyspnea at rest, Previous bilateral total knee arthroplasty, Pregnancy, OR The absence of knee pain at the time of recruitment for the study.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 89 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Manual Therapy<br>Subjects will receive oscillatory (grade 1 & 2) manual knee mobilization for 15 minutes at various knee range of motion positions. | Procedure: Manual Therapy<br>* Grade 1 and 2 oscillatory manual mobilization of the tibiofemoral joint at various ranges of motion.<br>|
| Experimental: Therapeutic Exercise<br>Subjects will perform 15 minutes of combined resistance exercise and aerobic exercise. | Behavioral: Therapeutic Exercise<br>* Subjects will perform 5 minutes of lower extremity cycle ergometer with minimal resistance followed by 10 minutes of resistance exercise to the quadriceps at 3 tibiofemoral positions (0 degrees, 30 degrees and 60 degrees of knee flexion).<br>|
| Placebo Comparator: Control<br>Subjects will watch a 15 minute instructional video on a health topic. | Behavioral: Video Observation<br>* Subjects will watch a 15 minute video on a health topic unrelated to knee osteoarthritis.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Suprapatellar effusion measured via diagnostic ultrasound |  | Outcome measure will be measured 1 minute prior to intervention and 1 minute after intervention. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Pain Visual Analog Scale |  | Outcome measure will be measured 3 minutes prior to intervention and 3 minutes after intervention. | 
| Goniometric knee arc range of motion |  | Outcome measure will be measured 5 minutes prior to intervention and 5 minutes after intervention. | 
| Western Ontario and McMaster Universities Index of osteoarthritis of the knee |  | Outcome measure will be measured 12 minutes prior to intervention and 7 minutes after intervention. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Knee Osteoarthritis, Manual Therapy, Therapeutic Exercise, Ultrasound, Effusion