Kaya Mutlu Ebru, Ercin Ersin, Razak Ozdıncler Arzu, Ones Nadir
a Faculty of Health Sciences, Division of Physiotherapy and Rehabilitation , Istanbul University , Bakırkoy , Istanbul.
b Department of Orthopedics and Traumatology , Bakirkoy Dr. Sadi Konuk Training and Research Hospital , Bakırkoy , Istanbul.
Physiother Theory Pract. 2018 Aug;34(8):600-612. doi: 10.1080/09593985.2018.1423591. Epub 2018 Jan 8.
A broad spectrum of physical therapy exercise programs provides symptom relief and functional benefit for patients with knee OA. Manual physical therapy, including tailored exercise programs provide relatively higher level benefit that persists to one year. It is currently unknown if there are important differences in the effects of different manual physical therapy techniques for patients with knee OA and there are virtually no studies comparing manual physical therapy and electrotherapy modalities. The aim of the study was to compare long-term results between three treatment groups (mobilization with movements [MWMs], passive joint mobilization [PJM], and electrotherapy) to determine which treatment is most effective in patients with knee OA. A single-blind randomized clinical trial with parallel design was conducted in patients with knee OA. Seventy-two consecutive patients (mean age 56.11 ± 6.80 years) with bilateral knee OA were randomly assigned to one of three treatment groups: MWMs, PJM, and electrotherapy. All groups performed an exercise program and received 12 sessions. The primary outcome measures of the functional assessment were the Western Ontario and McMaster Universities Osteoarthritis index (WOMAC) and Aggregated Locomotor Function (ALF) test scores. The secondary outcome measures were pain level, measured using a pressure algometer and a visual analogue scale (VAS), range of motion (ROM), measured using a digital goniometer, and muscle strength, evaluated with a handheld dynamometer. Patients were assessed before treatment, after treatment and after 1 year of follow-up. Patients receiving the manual physical therapy interventions consisting of either MWM or PJM demonstrated a greater decrease in VAS scores at rest, during functional activities, and during the night compared to those in the electrotherapy group from baseline to after the treatment (p < 0.05). This improvement continued at the 1-year follow-up (p < 0.05). The MWMs and PJM groups also showed significantly improved WOMAC and ALF scores, knee ROM and quadriceps muscle strength compared to those in the electrotherapy group from baseline to 1-year follow-up (p < 0.05). In the treatment of patients with knee OA, manual physical therapy consisting of either MWM or PJM provided superior benefit over electrotherapy in terms of pain level, knee ROM, quadriceps muscle strength, and functional level.
多种物理治疗锻炼方案可为膝骨关节炎患者缓解症状并带来功能改善。手法物理治疗，包括量身定制的锻炼方案，能提供相对更高水平的益处，且这种益处可持续一年。目前尚不清楚不同的手法物理治疗技术对膝骨关节炎患者的疗效是否存在重要差异，而且几乎没有研究对手法物理治疗和电疗方式进行比较。本研究的目的是比较三个治疗组（运动手法松动术[MWMs]、被动关节松动术[PJM]和电疗）的长期效果，以确定哪种治疗方法对膝骨关节炎患者最有效。对膝骨关节炎患者进行了一项平行设计的单盲随机临床试验。72例双侧膝骨关节炎连续患者（平均年龄56.11±6.80岁）被随机分配到三个治疗组之一：运动手法松动术组、被动关节松动术组和电疗组。所有组都进行了锻炼方案并接受了12次治疗。功能评估的主要指标是西安大略和麦克马斯特大学骨关节炎指数（WOMAC）和综合运动功能（ALF）测试分数。次要指标包括使用压力痛觉计和视觉模拟量表（VAS）测量的疼痛水平、使用数字测角仪测量的关节活动范围（ROM）以及使用手持测力计评估的肌肉力量。在治疗前、治疗后和随访1年后对患者进行评估。与电疗组相比，接受运动手法松动术或被动关节松动术等手法物理治疗干预的患者，从基线到治疗后，静息时、功能活动期间和夜间的VAS评分下降幅度更大（p<0.05）。这种改善在1年随访时仍持续（p<0.05）。从基线到1年随访，运动手法松动术组和被动关节松动术组在WOMAC和ALF评分、膝关节ROM和股四头肌力量方面也比电疗组有显著改善（p<0.05）。在膝骨关节炎患者的治疗中，运动手法松动术或被动关节松动术组成的手法物理治疗在疼痛水平、膝关节ROM、股四头肌力量和功能水平方面比电疗提供了更显著的益处。
