Deyle G D, Henderson N E, Matekel R L, Ryder M G, Garber M B, Allison S C
Brooke Army Medical Center and US Army-Baylor University, Fort Sam Houston, Texas 78234-6200, USA.
Ann Intern Med. 2000 Feb 1;132(3):173-81. doi: 10.7326/0003-4819-132-3-200002010-00002.
Few investigations include both subjective and objective measurements of the effectiveness of treatments for osteoarthritis of the knee. Beneficial interventions may decrease the disability associated with osteoarthritis and the need for more invasive treatments.
To evaluate the effectiveness of physical therapy for osteoarthritis of the knee, applied by experienced physical therapists with formal training in manual therapy.
Randomized, controlled clinical trial.
Outpatient physical therapy department of a large military medical center.
83 patients with osteoarthritis of the knee who were randomly assigned to receive treatment (n = 42; 15 men and 27 women [mean age, 60 +/- 11 years]) or placebo (n = 41; 19 men and 22 women [mean age, 62 +/- 10 years]).
The treatment group received manual therapy, applied to the knee as well as to the lumbar spine, hip, and ankle as required, and performed a standardized knee exercise program in the clinic and at home. The placebo group had subtherapeutic ultrasound to the knee at an intensity of 0.1 W/cm2 with a 10% pulsed mode. Both groups were treated at the clinic twice weekly for 4 weeks.
Distance walked in 6 minutes and sum of the function, pain, and stiffness subscores of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). A tester who was blinded to group assignment made group comparisons at the initial visit (before initiation of treatment), 4 weeks, 8 weeks, and 1 year.
Clinically and statistically significant improvements in 6-minute walk distance and WOMAC score at 4 weeks and 8 weeks were seen in the treatment group but not the placebo group. By 8 weeks, average 6-minute walk distances had improved by 13.1% and WOMAC scores had improved by 55.8% over baseline values in the treatment group (P < 0.05). After controlling for potential confounding variables, the average distance walked in 6 minutes at 8 weeks among patients in the treatment group was 170 m (95% CI, 71 to 270 m) more than that in the placebo group and the average WOMAC scores were 599 mm higher (95% CI, 197 to 1002 mm). At 1 year, patients in the treatment group had clinically and statistically significant gains over baseline WOMAC scores and walking distance; 20% of patients in the placebo group and 5% of patients in the treatment group had undergone knee arthroplasty.
A combination of manual physical therapy and supervised exercise yields functional benefits for patients with osteoarthritis of the knee and may delay or prevent the need for surgical intervention.
很少有研究同时包括对膝关节骨关节炎治疗效果的主观和客观测量。有益的干预措施可能会减少与骨关节炎相关的残疾以及对更具侵入性治疗的需求。
评估由接受过手法治疗正规培训的经验丰富的物理治疗师实施的物理治疗对膝关节骨关节炎的有效性。
随机对照临床试验。
一家大型军事医疗中心的门诊物理治疗科。
83例膝关节骨关节炎患者，随机分为治疗组（n = 42；15名男性和27名女性[平均年龄，60±11岁]）或安慰剂组（n = 41；19名男性和22名女性[平均年龄，62±10岁]）。
治疗组接受手法治疗，根据需要应用于膝关节以及腰椎、髋关节和踝关节，并在诊所和家中进行标准化的膝关节锻炼计划。安慰剂组接受强度为0.1W/cm²、脉冲模式为10%的膝关节亚治疗剂量超声治疗。两组均在诊所每周治疗两次，共4周。
6分钟步行距离以及西安大略和麦克马斯特大学骨关节炎指数（WOMAC）的功能、疼痛和僵硬子评分总和。一名对分组情况不知情的测试者在初次就诊（治疗开始前）、4周、8周和1年时进行组间比较。
治疗组在4周和8周时6分钟步行距离和WOMAC评分在临床和统计学上有显著改善，而安慰剂组没有。到8周时，治疗组的平均6分钟步行距离比基线值提高了13.1%，WOMAC评分提高了55.8%（P < 0.05）。在控制潜在混杂变量后，治疗组患者在8周时的平均6分钟步行距离比安慰剂组多170m（95%CI，71至270m），平均WOMAC评分高599mm（95%CI，197至1002mm）。1年时，治疗组患者的WOMAC评分和步行距离相对于基线有临床和统计学上的显著改善；安慰剂组20%的患者和治疗组5%的患者接受了膝关节置换术。
手法物理治疗和监督下的锻炼相结合对膝关节骨关节炎患者产生功能益处，并可能延迟或避免手术干预的需要。
