Orthopedic manual therapy provides several benefits
for knee osteoarthritis patients

Despite some supportive studies, evidence inconclusive on intervention's overall effects
Orthopedic manual therapy (OMT) is defined as any hands-on therapy in which a physical therapist moves joints in a variety of specific directions. OMT is commonly used to manage knee osteoarthritis (OA), and several studies have shown it to be beneficial, but the evidence on its overall effectiveness is inconclusive. The literature is also mixed as to whether OMT plus exercise therapy leads to any additional benefits for patients. For these reasons, a systematic review and meta-analysis were conducted to evaluate the effects of OMT on knee OA.

Eleven studies included in meta-analysis
Four databases were searched for randomized-controlled trials (RCTs) investigating the effectiveness of OMT either alone or combined with exercise therapy for treating patients with knee OA. This search led to 11 RCTs being included in the meta-analysis, which involved 494 participants. Outcome measures of interest included pain, functional disability, range of motion (ROM), and physical performance, which were measured using a visual analog scale and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scale. Two independent reviewers also assessed quality and risk of bias of the included trials.

OMT found to reduce pain and improve function, and exercise therapy adds to benefits
Results indicated that OMT interventions with exercise therapy provided greater short-term benefits in reducing pain, improving function, and stair ascending/descending in knee OA patients compared to exercise therapy alone. Furthermore, low-to-moderate quality evidence was found suggesting that supplementing OMT with exercise therapy could also lead to benefits in these same parameters. The effect size of the pain reduction from OMT compared to exercise alone or controls was found to be moderate, which is similar to previous research, while a large effect size was identified for improved function. All studies were rated with high-quality scores and heterogeneity was very low for most outcomes. These findings suggest that OMT combined with exercise therapy is more effective than exercise alone for knee OA patients, as it led to short-term benefits in pain, function, and physical performance. Additional research is needed to further investigate the long-term effects of these interventions, but since OMT and exercise can continue to be considered preferred treatment options for knee OA, clinicians should refer presenting patients to physical therapy to receive them.

­-Summarized by Greg Gargiulo

-As reported in the September '18 issue of Physiotherapy