Centre for Musculoskeletal Outcomes Research, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
Osteoarthritis Cartilage. 2013 Apr;21(4):525-34. doi: 10.1016/j.joca.2012.12.014. Epub 2013 Jan 8.
To evaluate the clinical effectiveness of manual physiotherapy and/or exercise physiotherapy in addition to usual care for patients with osteoarthritis (OA) of the hip or knee.
In this 2 × 2 factorial randomized controlled trial, 206 adults (mean age 66 years) who met the American College of Rheumatology criteria for hip or knee OA were randomly allocated to receive manual physiotherapy (n = 54), multi-modal exercise physiotherapy (n = 51), combined exercise and manual physiotherapy (n = 50), or no trial physiotherapy (n = 51). The primary outcome was change in the Western Ontario and McMaster osteoarthritis index (WOMAC) after 1 year. Secondary outcomes included physical performance tests. Outcome assessors were blinded to group allocation.
Of 206 participants recruited, 193 (93.2%) were retained at follow-up. Mean (SD) baseline WOMAC score was 100.8 (53.8) on a scale of 0-240. Intention to treat analysis showed adjusted reductions in WOMAC scores at 1 year compared with the usual care group of 28.5 (95% confidence interval (CI) 9.2-47.8) for usual care plus manual therapy, 16.4 (-3.2 to 35.9) for usual care plus exercise therapy, and 14.5 (-5.2 to 34.1) for usual care plus combined exercise therapy and manual therapy. There was an antagonistic interaction between exercise therapy and manual therapy (P = 0.027). Physical performance test outcomes favoured the exercise therapy group.
Manual physiotherapy provided benefits over usual care, that were sustained to 1 year. Exercise physiotherapy also provided physical performance benefits over usual care. There was no added benefit from a combination of the two therapies.
Australian New Zealand Clinical Trials Registry ACTRN12608000130369.
评估在常规护理的基础上增加手法物理治疗和/或运动物理治疗对髋或膝关节骨关节炎（OA）患者的临床疗效。
在这项 2×2 析因随机对照试验中，206 名符合美国风湿病学会髋或膝关节 OA 标准的成年人（平均年龄 66 岁）被随机分配接受手法物理治疗（n=54）、多模式运动物理治疗（n=51）、联合运动和手法物理治疗（n=50）或不接受试验性物理治疗（n=51）。主要结局是 1 年后的西部安大略省和麦克马斯特大学骨关节炎指数（WOMAC）变化。次要结局包括身体表现测试。结果评估者对分组分配不知情。
在招募的 206 名参与者中，193 名（93.2%）在随访时保留。WOMAC 基线平均（SD）评分为 100.8（53.8），评分范围为 0-240。意向治疗分析显示，与常规护理组相比，1 年后 WOMAC 评分的调整降幅为常规护理加手法治疗组 28.5（95%置信区间（CI）9.2-47.8）、常规护理加运动治疗组 16.4（-3.2-35.9）和常规护理加联合运动治疗和手法治疗组 14.5（-5.2-34.1）。运动治疗和手法治疗之间存在拮抗相互作用（P=0.027）。身体表现测试结果有利于运动治疗组。
手法物理治疗比常规护理提供了益处，并持续到 1 年。运动物理治疗也为常规护理提供了身体表现的益处。两种疗法联合应用没有额外的益处。
澳大利亚和新西兰临床试验注册 ACTRN12608000130369。
