evaluate physical therapy interventions for adults with knee osteoarthritis
(OA), investigators from the University of
Minnesota School of Public Health, University of Minnesota Medical School, and
Minnesota Evidence-based Practice Center searched MEDLINE, the Cochrane
Library, the Physiotherapy Evidence Database, Scirus, Allied and Complementary
Medicine, and the Health and Psychosocial Instruments bibliography database
from 1970 to February 2012.
A total of 193 randomized, controlled trials (RCTs)
published in English were included in the review. Means of outcomes, physical
therapy interventions, and risk of bias were extracted to pool standardized
mean differences. Disagreements between reviewers abstracting and checking data
were resolved through discussion.
Meta-analyses of 84 RCTs provided evidence for 13 physical
therapy interventions on pain (58 RCTs), physical function (36 RCTs), and
disability (29 RCTs). Meta-analyses provided low-strength evidence that aerobic
(11 RCTs) and aquatic (3 RCTs) exercise improved disability and that aerobic
exercise (19 RCTs), strengthening exercise (17 RCTs), and ultrasonography (6
RCTs) reduced pain and improved function. Several individual RCTs demonstrated
clinically important improvements in pain and disability with aerobic exercise.
Other physical therapy interventions demonstrated no sustained benefit.
Individual RCTs showed similar benefits with aerobic, aquatic, and
strengthening exercise. Adverse events were uncommon and did not deter
participants from continuing treatment.
Free full text of the article is available in Annals of Internal Medicine. A report on the review also is available
from the Agency for Healthcare Research and Quality.
member Becky Jo Olson-Kellogg, PT, DPT,
GCS, coauthored the article.