Physical Therapy Interventions For Knee Pain Secondary To Osteoarthritis

OBJECTIVES: To assess the association between intermediate and patient-centered outcomes and harms with physical therapy interventions in community-dwelling adults with chronic knee pain secondary to osteoarthritis and to examine validity and minimum clinically important differences of the tools for outcome measurement. DATA SOURCES: We searched major electronic bibliographic databases including MEDLINE, the Cochrane Library, the Physiotherapy Evidence Database, and Allied and Complementary Medicine and trial registries up to February 29, 2012. REVIEW METHODS: We performed a systematic review of randomized and nonrandomized studies published in English to synthesize rates or means of measured pain, function, and quality of life with physical therapy interventions. Observational studies provided evidence of the association between changes in knee joint functional tests and patient-centered outcomes and minimum clinically important differences in validated tools for outcome measures. We performed meta-analyses of standardized mean differences using random effects models to synthesize the evidence. RESULTS: Of 4,266 retrieved references, 154 eligible references examined the association between patient-centered and intermediate outcomes and 422 eligible references examined physical therapy interventions. Of these, 193 randomized controlled trials (RCTs) reported on knee pain, disability, quality of life, and functional outcomes after physical therapy interventions. Pooling criteria were met by 84 RCTs that provided evidence for 12 physical therapy interventions on pain (n = 58), physical function (n = 36), and disability (n = 29). Most studies reported physical therapy effects at followups of 3 months or less. Evidence on longer-term physical therapy effects was available for seven intervention-outcome pairs. Meta-analyses at the longest time of followup provided low-strength evidence that aerobic (n = 11) and aquatic exercise (n = 3) improved disability; aerobic exercise (n = 19), strengthening exercise (n = 17), and ultrasound (n = 6) reduced pain and improved function. Six of 11 individual RCTs demonstrated clinically important improvements in pain and disability with aerobic exercise. Pain relief was consistent in RCTs that reported physical therapist supervision of aerobic exercise. Diathermy, orthotics, and magnetic stimulation demonstrated no benefit. Limited direct comparative effectiveness evidence demonstrated similar benefits in disability measures with aerobic, aquatic, and strengthening exercise. Evidence from individual RCTs did not permit robust conclusions about which physical therapy interventions are most effective or whether differences in effect could be attributed to patient characteristics. Patients with high compliance to exercise tended to have better treatment responses. We found no association between the duration of examined interventions and better intermediate or patient-centered outcomes. Adverse events were uncommon and not severe enough to deter participants from continuing treatment. Gait, mobility restrictions, muscle strength, and range-of-motion measures were associated with disability measures in individual studies. Minimum clinically important differences in scales were determined for 26 tools but have not been used in RCTs to examine the clinical importance of improvements. The definition of the Patient Acceptable Symptom State that accounts for patient satisfaction was available for the Western Ontario McMaster Universities Osteoarthritis Index, the Visual Analog Scale for Pain, and the Patient Global Assessment Scale. CONCLUSIONS: Low-strength evidence suggested that core physical therapy interventions, including aerobic, aquatic, strengthening, and proprioception exercise, improved patient outcomes. Risk of bias in studies and heterogeneity in populations and physical therapy interventions downgraded the strength of evidence to low or moderate in most cases. Studies focused on a single modality of physical therapy rather than the combinations typically used in practice. Benefits with physical therapy interventions were not consistently evaluated according to the clinical importance of improvement in scales and tests. Adverse events were uncommon and not severe enough to deter participants from continuing treatment. Evidence about long-term adherence to and benefits of available physical therapy interventions is lacking.

This comprehensive reference on total knee arthroplasty describes all surgical techniques and prosthetic designs for primary and revision arthroplasty, discusses every aspect of patient selection, preoperative planning, and intraoperative and postoperative care.

An authoritative investigation of the sources andtreatment of osteoarthritic joint pain Millions of people throughout the world suffer from osteoarthritis (OA)—a medical condition causing its sufferers excruciating pain that is often disabling. This is the first book to offer clinicians an in-depth understanding of the biological sources of osteoarthritic pain and how they can be treated. Here, a team of leading international authorities has contributed state-of-the-art information on: The Neuroscience of Articular Pain—spinal and peripheral mechanisms of joint pain; experimental models for the study of osteoarthritic pain; inflammatory mediators and nociception in arthritis; phantoms in rheumatology; and more Osteoarthritis and Pain—joint mechanisms and neuromuscular aspects of OA; bone pain and pressure in OA joints; structural correlates of OA pain; and more Treatment of Osteoarthritic Pain—general approaches to treatment; treatments targeting pain receptors; treatments targeting biomechanical abnormalities; and treatments targeting inflammation Whether you're a medical professional, researcher, student, or a generalist or specialist focusing on pain or arthritis, this is your one-stop reference for understanding and treating joint pain in osteoarthritis.

Hip and Knee Pain Disorders has been written to provide a state-of-the-art, evidence-informed and clinically-informed overview of the examination and conservative management of hip/knee pain conditions. Under the current predominantly evidence-based practice paradigm, clinician expertise, patient preference, and best available research determine examination, and prognostic and clinical management decisions. However, this paradigm has been understood by many to place greater value and emphasis on the research component, thereby devaluing the other two. Evidence-informed practice is a term that has been suggested to honor the original intent of evidence-based practice, while also acknowledging the value of clinician experience and expertise. In essence, evidence-informed practice combines clinical reasoning, based on current best evidence, with authority-based knowledge and a pathophysiological rationale derived from extrapolation of basic science knowledge. Unlike other published textbooks that overemphasize the research component in decision-making, this book aims to address the clinical reality of having to make decisions on the management of a patient with hip/knee pain, in the absence of a comprehensive scientific rationale, using other sources of knowledge. It offers an evidence-informed textbook that values equally research evidence, clinician expertise and patient preference. The book is edited by three recognised world leaders in clinical research into manual therapy and chronic pain. Their research activities are concentrated on the evidence-based management of musculoskeletal pain conditions using conservative interventions. For this book they have combined their knowledge and clinical expertise with that of 38 additional contributors, all specialists in the field The contributors include a mix of clinicians and clinician-researchers. Hip and Knee Pain Disorders is unique in bringing together manual therapies and exercise programs in a multimodal approach to the management of these pain conditions from both a clinical, but also evidence-based, perspective. It acknowledges the expanding direct access role of the physical therapy profession. The book provides an important reference source for clinicians of all professions interested in conservative management of the hip and knee regions. It will also be useful as a textbook for students at both entry and post-graduate level.

Early osteoarthritis is novel topic for orthopedic surgeons and its process begins immediately after joint injury. The mechanical restoration of the joint surface or ligamentous stability is not sufficient to restore the homeostatic environment in the joint, and this leads to osteoarthritis, despite mechanical stability and alignment. This book sheds light on the various mechanisms and systems involved in the gradual decline of the injured joint toward manifest osteoarthritis. Published in collaboration with ISAKOS, this volume appeals to all stakeholders in surgical orthopaedics and sports medicine.

A trustworthy clinical companion, the textbook offers best practice and management strategies for these common joint diseases. Formerly published as Osteoarthritis, the extensively revised third edition of the Oxford Textbook of Osteoarthritis and Crystal Arthropathy provides up-to-date and evidence-based guidance on how to assess, diagnose, and manage patients. A prestigious and international author team ensure information is expert and relevant-this is a practical tool for clinicians managing people with osteoarthritis, gout, and other crystal-associated arthritis. Confidently consider and chose the right blend of treatment for your patient, whether physical, pharmacological, surgical, or supportive. The Oxford Textbook of Osteoarthritis and Crystal Arthropathy provides full coverage of joint failure, and includes detailed sections on epidemiology, risk factors, clinical assessment, and investigations. This edition also now includes new sections on gout and other crystal arthropathies. Clinically relevant and easily understandable overviews of basic science, including pathology and pain physiology, along with critical appraisal of current guidelines, make this a highly valuable resource. Significant coverage is also given to patient education and the involvement of the patient in management planning. Also highly illustrated, the textbook is a strong reference tool with summary boxes and key points at the end of chapters making it easy to find information quickly and help you deliver the optimum patient outcome. The textbook equips rheumatologists and musculoskeletal health professionals with the knowledge to provide best possible patient care.