Abstract
Objectives:Knee osteoarthritis (OA) causes disability among the elderly and is often associated with impaired balance and proprioception. Perturbation exercises may help improve these impairments. Although manual physical therapy is generally a well-tolerated treatment for knee OA, perturbation exercises have not been evaluated when used with a manual physical therapy approach. The purpose of this study was to observe tolerance to perturbation exercises and the effect of a manual physical therapy approach with perturbation exercises on patients with knee OA.Methods:This was a prospective observational cohort study of 15 patients with knee OA. The Western Ontario and McMaster Universities Arthritis Index (WOMAC), global rating of change (GROC), and 72-hour post-treatment tolerance were primary outcome measures. Patients received perturbation balance exercises along with a manual physical therapy approach, twice weekly for 4 weeks. Follow-up evaluation was done at 1, 3, and 6 months after beginning the program.Results:Mean total WOMAC score significantly improved (P = 0·001) after the 4-week program (total WOMAC: initial, 105; 4 weeks, 56; 3 months, 54; 6 months, 57). Mean improvements were similar to previously published trials of manual physical therapy without perturbation exercises. The GROC score showed a minimal clinically important difference (MCID)≥+3 in 13 patients (87%) at 4 weeks, 12 patients (80%) at 3 months, and 9 patients (60%) at 6 months. No patients reported exacerbation of symptoms within 72 hours following each treatment session.Discussion:A manual physical therapy approach that also included perturbation exercises was well tolerated and resulted in improved outcome scores in patients with knee OA.
Highlights
Mean total WOMAC score improved significantly, with 46% improvement from initial to 6 months (Table 3)
The total WOMAC score was significantly improved at the end of the 4-week treatment (P50.001), and this improvement remained for 6 months (P50.009)
In the present series of patients with knee OA, a manual physical therapy approach incorporating perturbation exercises resulted in significant improvement in all outcome scores and functional tests
Summary
Exercise interventions are important in the evidencebased treatment of knee osteoarthritis (OA).[1,2,3,4,5,6,7,8,9] The goals of exercise for knee OA are typically to improve movement, function, and cardiovascular fitness, while reducing pain and body mass index.[4,5] Impairments of balance, joint proprioception, and kinesthesia are related to knee OA and may persist even after knee replacement surgery.[10,11] These impairments may result in falls and increased cost of management.[12] Joint laxity and proprioceptive inaccuracy are predictors of poor functional outcomes.[13] the measurement of proprioceptive deficits has been poorly defined in the literature.[14]
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