Manual therapy or exercise therapy programs provided by a physical therapist is a cost-effective way to relieve pain in people with osteoarthritis (OA) in the knee and hip joints, new research from New Zealand’s University of Otago shows.
The randomized clinical trial involved 206 patients with hip or knee OA over 1 year and used 3 protocols of treatment provided by physical therapists in addition to usual care by their family practice physician.
One group was given 7 manual physical therapy sessions in addition to usual care, for 40-50 minutes over 9 weeks, followed by 2 boosters after a further 7 weeks. The second group involved a program of exercise both in the clinic and at home, involving stationary cycling, muscle strengthening, stretching and balance, and agility exercises. The third group was treated with a combination of manual and exercise therapy. A control group received only usual medical care from their family practice doctor or other health care providers.
Researchers say the results showed that individually supervised exercise therapy or manual therapy provided by a physical therapist, in addition to usual care, improved pain and physical function for at least 1 year. Given the time limits of the therapy sessions, the researchers added that there doesn’t appear to be additional benefit gained from providing both manual and exercise therapy on top of usual care for OA.
A further study, also published in the journal Osteoarthritis and Cartilage, looked at the economics of the additional treatment in this trial. It found that both additional exercise therapy and manual therapy are more cost effective for the health system and for individuals than applying only the usual OA care management.
"Exercise therapy provided the best cost-effectiveness from a health system perspective, while manual therapy was best, and was actually cost-saving, from a societal perspective," said lead author Haxby Abbott.
"On our main measure, we found that additional manual therapy provided the best symptom relief of the 3 treatments we studied. On the other hand, the exercise program also produced very good results on physical tests and on quality of life gains. So each has its strengths; there is no clear best choice for everyone. What’s clear is that either is better than usual care only."
"These results suggest that family practice doctors should refer patients with hip or knee arthritis for individually supervised exercise or manual therapy provided by a physical therapist, in addition to continuing to provide usual medical care."
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