Manual physical therapy and perturbation exercises in knee osteoarthritis.


Journal Article

OBJECTIVES: Knee osteoarthritis (OA) causes disability among the elderly and is often associated with impaired balance and proprioception. Perturbation exercises may help improve these impairments. Although manual physical therapy is generally a well-tolerated treatment for knee OA, perturbation exercises have not been evaluated when used with a manual physical therapy approach. The purpose of this study was to observe tolerance to perturbation exercises and the effect of a manual physical therapy approach with perturbation exercises on patients with knee OA. METHODS: This was a prospective observational cohort study of 15 patients with knee OA. The Western Ontario and McMaster Universities Arthritis Index (WOMAC), global rating of change (GROC), and 72-hour post-treatment tolerance were primary outcome measures. Patients received perturbation balance exercises along with a manual physical therapy approach, twice weekly for 4 weeks. Follow-up evaluation was done at 1, 3, and 6 months after beginning the program. RESULTS: Mean total WOMAC score significantly improved (Pā€Š=ā€Š0.001) after the 4-week program (total WOMAC: initial, 105; 4 weeks, 56; 3 months, 54; 6 months, 57). Mean improvements were similar to previously published trials of manual physical therapy without perturbation exercises. The GROC score showed a minimal clinically important difference (MCID)≥+3 in 13 patients (87%) at 4 weeks, 12 patients (80%) at 3 months, and 9 patients (60%) at 6 months. No patients reported exacerbation of symptoms within 72 hours following each treatment session. DISCUSSION: A manual physical therapy approach that also included perturbation exercises was well tolerated and resulted in improved outcome scores in patients with knee OA.

Full Text

Duke Authors

Cited Authors

  • Rhon, D; Deyle, G; Gill, N; Rendeiro, D

Published Date

  • November 2013

Published In

Volume / Issue

  • 21 / 4

Start / End Page

  • 220 - 228

PubMed ID

  • 24421635

Pubmed Central ID

  • 24421635

International Standard Serial Number (ISSN)

  • 1066-9817

Digital Object Identifier (DOI)

  • 10.1179/2042618613Y.0000000039


  • eng

Conference Location

  • England