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.

A FULL-COLOR, CASE-BASED PHYSICAL THERAPY ATLAS FOR CLINICIANS AND STUDENTS The Color Atlas of Physical Therapy delivers a high-quality visual presentation of the disorders a physical therapist would most likely encounter in daily practice. Enhanced by more than 1,000 full-color illustrations and concise, evidence-based treatment recommendations, the book features a consistent design that makes information retrieval at the point of care fast and easy. MOST CHAPTERS INCLUDE VITAL INFORAMTION SUCH AS: Condition/Disorder Synonyms ICD -9 and 10-CM Codes Preferred Practice Patterns Patient Presentation Key Features: Description Essentials of Diagnosis General Considerations Demographics Clinical Findings: Signs and Symptoms Functional Implications Possible Contributing Causes Differential Diagnosis Functional Goals Means of Confirmation: Laboratory Imaging Findings and Interpretation Treatment: Medications Medical Procedures Referrals Impairments Tests and Measures Intervention Prognosis References Patient Resources

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.

Written by a team of international experts in the field, this text presents a comprehensive approach to the rehabilitation of arthritic conditions. Psychosocial and life span developmental processes, epidemiology, pathology, medical management, and pharmacology are discussed from a physical therapy perspective. The principles of orthotics and splinting are also covered.