The relative effectiveness of three full kinetic chain treatment protocols for osteoarthritis of the knee : manual therapy, rehabilitation and a combination thereof

Abstract

Background : Many treatment options provide symptomatic improvement of joint function for osteoarthritis (OA) of the knee. Research suggests full kinetic chain (FKC) manual and manipulative therapy (MMT) and rehabilitation yields greater benefits than home rehabilitation alone. However this treatment combination has never been compared against FKC MMT alone. Objectives : Objectives: To determine the effectiveness of three FKC treatment protocols in the management of knee OA. Method : A single-blinded, randomised comparative trial of sixty-six patients with knee OA, equally allocated to three treatment groups: manipulation only, rehabilitation only or manipulation plus rehabilitation (a.k.a. combination group). Manipulation groups received bi-weekly FKC treatment, while a daily at-home stretching and exercise programme was prescribed to the groups receiving rehabilitation. Treatment lasted three weeks, with outcomes measure taken at baseline, pre-visit 4 and 1-week follow up. Primary outcome measures included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and McMaster Overall Therapeutic Effectiveness (OTE) Tool. Results : There was a drop-out rate of 7.6% (n=5), with intent to treat analysis providing the missing data. All three treatment groups showed clinically and statistically significant changes in overall WOMAC scores from baseline to 1-week follow up. The combination group showed the largest improvement (50.5%), followed by manipulation (44.4%) and rehabilitation (33.6%). However, this difference between group improvement was not statistically significant (p= 0.156). Conclusion : All three intervention protocols showed statistically significant improvement in most outcome measures at 1-week follow-up. However, there was no statistically significant difference between groups and therefore it is concluded that the interventions appear to be equally effective in the short-term management of knee OA.