A randomized controlled trial of osteopathic manipulative treatment following knee or hip arthroplasty.

CONTEXT

Preliminary study results suggest that osteopathic manipulative treatment (OMT) may reduce pain, improve ambulation, and increase rehabilitation efficiency in patients undergoing knee or hip arthroplasty.

OBJECTIVE

To determine the efficacy of OMT in patients who recently underwent surgery for knee or hip osteoarthritis or for a hip fracture.

DESIGN

Randomized controlled trial involving hospital and postdischarge phases.

SETTING

Hospital-based acute rehabilitation unit.

PATIENTS

A total of 42 women and 18 men who were hospitalized between October 1998 and August 1999.

INTERVENTION

Patients were randomly assigned to groups that received either OMT or sham treatment in addition to standard care. Manipulation was individualized and performed according to study guidelines regarding frequency, duration, and technique.

MAIN OUTCOME MEASURES

Changes in Functional Independence Measure (FIM) scores and in daily analgesic use during the rehabilitation unit stay; length of stay; rehabilitation efficiency--defined as the FIM total score change per rehabilitation unit day; and changes in Medical Outcomes Study Short Form-36 scores from rehabilitation unit admission to 4 weeks after discharge.

RESULTS

Of 19 primary outcome measures, the only significant difference between groups was decreased rehabilitation efficiency with OMT (2.0 vs 2.6 FIM total score points per day; P = .01). Stratified analyses demonstrated that poorer OMT outcomes were confined to patients with osteoarthritis who underwent total knee arthroplasty (length of stay, 15.0 vs 8.3 days; P = .004; rehabilitation efficiency, 2.1 vs 3.4 FIM total score points per day; P < .001).

CONCLUSION

The OMT protocol used does not appear to be efficacious in this hospital rehabilitation population.