Manual physical therapy provided benefits over usual care that were sustained to 1 year for patients with osteoarthritis of the hip or knee, say authors of an article published online in Osteoarthritis and Cartilage. Exercise physical therapy also provided physical performance benefits over usual care. There was no added benefit from a combination of the 2 therapies. 

In this 2x2 factorial randomized controlled trial conducted in New Zealand, 206 adults (mean age 66 years) who met the American College of Rheumatology criteria for hip or knee osteoarthritis were allocated to receive manual physical therapy (n=54), multimodal exercise physical therapy (n=51), combined exercise and manual physical therapy (n=50), or no trial physical therapy (n=51). The primary outcome was change in the Western Ontario and McMaster osteoarthritis index (WOMAC) after 1 year. Secondary outcomes included physical performance tests. Outcome assessors were blinded to group allocation.

Of 206 participants recruited, 193 (93.2%) were retained at follow-up. Mean (SD) baseline WOMAC score was 100.8 (53.8) on a scale of 0 to 240. Intention-to-treat analysis showed adjusted reductions in WOMAC scores at 1 year compared with the usual care group of 28.5 for usual care plus manual therapy, 16.4 for usual care plus exercise therapy, and 14.5 for usual care plus combined exercise therapy and manual therapy. There was an antagonistic interaction between exercise therapy and manual therapy. Physical performance test outcomes favored the exercise therapy group.