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Am Fam Physician. 2000;61(12):3727-3728

Approximately one third of persons 63 to 94 years of age have osteoarthritis of the knee, a degenerative condition that typically limits ambulation and the ability to climb stairs and stand comfortably. Acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used therapies for osteoarthritis. Other treatments include physical therapy, exercise, cortisone injections and joint replacement surgery. Even though exercise plays an important role in osteoarthritis management, no one regimen has clearly been shown to reduce pain or improve function. Active and passive range-of-motion exercises traditionally have been an important component of physical therapy programs for osteoarthritis to improve joint mobility and function. Deyle and associates compared the effectiveness of a fixed therapeutic regimen for the knee, hip, ankle and lumbar spine with placebo in patients with osteoarthritis of the knee.

Eighty-three patients with confirmed osteoarthritis of the knee were randomized to receive treatment or placebo. The end points of the study were improved function, decreased pain and stiffness, and increased walking distance in six minutes. The treatment group received a combination of manual physical therapy and supervised exercise, while the placebo group received ultrasound therapy at a subtherapeutic intensity. For a detailed review of the patient exercise program used in the study, see the accompanying table. Both groups were treated twice weekly for four weeks, for a total of eight sessions. Patients in the treatment group also performed the same exercises at home. Neither group was aware of the treatment being given to the other group. Knee radiographs were obtained at baseline so that severity ratings could be assigned for each patient. Both groups returned one year after treatment for additional testing and to identify the patients who required knee surgery.

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Of the 69 patients who completed all treatment and testing, 33 were in the treatment group and 36 were in the placebo group. Patients in the treatment group had improved symptom scores and significantly increased average distances walked in six minutes compared with those in the placebo group. These improvements were maintained after one year. After one year, patients in the placebo group had significantly more knee surgeries than those in the treatment group.

The authors conclude that patients with osteoarthritis who are treated with a regimen that combines manual physical therapy with supervised exercise have improved function and less reported pain and stiffness than patients who are not treated with a physical therapy program. This type of treatment may decrease the need for knee surgery.

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