Wednesday 24 July 2013
Osteoarthritis improved by extra physiotherapy programmes
Manual physiotherapy or regular exercise programmes make a significant difference for people with painful osteoarthritis
in the knee and hip joints, and are cost-effective, new research from the University of Otago shows.
The randomised clinical trial involved 207 Dunedin patients over one year and used three protocols of treatment provided
by physiotherapists in addition to usual care by their GP.
One group was given seven manual physiotherapy sessions, in addition to usual care, for 40-50 minutes over nine weeks,
followed by two boosters after a further seven weeks. The second group involved a programme of exercise both in the
clinic and at home, while the third group was treated with a combination of manual and exercise therapy. A control group
received only usual care from their GP or other health providers.
Lead researcher Associate Professor Haxby Abbott of the Centre for Musculoskeletal Outcomes Research says that the
results show that individually supervised exercise therapy or manual therapy provided by a physiotherapist, in addition
to usual care, improve pain and physical function for at least one year.
“However, given a time constraint of a 40-50 minute clinic visit, there is no additional benefit gained from providing
both manual and exercise therapy on top of usual care for osteoarthritis,” Associate Professor Abbott says.
A further study, published this week in the international 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 just applying usual care management to osteoarthritis.
“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,” he says.
“On our main measure, we found that additional manual therapy provided the best symptom relief of the three treatments
we studied. On the other hand, the exercise programme 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.”
The researchers conclude at present there is quite low use of non-surgical and non-drug therapies for osteoarthritis in
primary care, and these studies point to a way of preventing or delaying pain and disability at significant cost
effectiveness for society and the health system.
“These results suggest that GPs should refer patients with hip or knee arthritis for individually supervised exercise or
manual therapy provided by a physiotherapist, in addition to continuing to provide usual care.”
The researchers say the Management of Osteoarthritis trial demonstrates for the first time the value of individually
prescribed and supervised programmes involving manual care or exercise in relieving symptoms of hip or knee
osteoarthritis.
The exercise programme involved stationary cycling, muscle strengthening, stretching and balance and agility exercises
both in the clinic and at home.
Both the Management of Osteoarthritis trial and the economic evaluation have been published in the international journal
Osteoarthritis and Cartilage.
The studies were funded by the Health Research Council of New Zealand and the Lottery Grants Board.
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