Home Exercise vs. Physical Therapy for People with Knee Osteoarthritis- What Does the Literature Say?
- Posted on: Mar 5 2018
Osteoarthritis (OA) is the most common joint disability in the United States, affecting over 7 million people per year. You may know someone who has OA or you may have it yourself. Maybe you are coming to physical therapy already to be treated for it (Awesome!) or maybe you have questions regarding what you can do at home to help your condition. I want to discuss a study that looked at a supervised clinical exercise program with hands-on treatment vs. a home exercise program (HEP) in people with Knee OA. I won’t delve too much into the specifics of the study but rather provide the most important aspects and how it can relate to your specific case.
Title of the Study: Physical Therapy Treatment Effectiveness for Osteoarthritis of the Knee: A Randomized Comparison of Supervised Clinical Exercise and Manual Therapy Procedures Versus a Home Exercise Program
Participants/Subjects: 134 participants were divided randomly into 2 groups. The first group consisted of 66 participants who were placed into the supervised exercise group while the other 68 patients were put into the home exercise program group.
Methods/What They did: Participants in the supervised exercise group received supervised exercise, individualized manual therapy techniques, and a home exercise program over a 4-week time period. Participants in the home exercise group received the same home exercise program initially which were reinforced at a clinical visit 2 weeks after starting the study. Researchers choose to measure outcomes such as the distance walked in 6 minutes and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), a set of standardized questionnaires used by health professionals to evaluate the condition of patients with osteoarthritis of the knee, including pain, stiffness, and physical functioning of the joints.
Here are some of the common exercises that were performed by both of the groups (these exercises are commonly done here at Advanced PMR)
- Quad Sets
- Terminal Knee Extension
- Mini Squats
- Step Ups
- Hamstring/Quadriceps/Calf Stretches
Here are some of the manual techniques that were performed for the supervised exercise group (again, techniques that are able to be professionally performed by your therapist at Advanced PMR)
- Patellar/Knee cap Mobilizations
- Soft Tissue Mobilization/Massage
- Manual Stretching
- Knee Mobilizations to help promote flexion & extension
Results: Both groups showed clinically and statistically significant improvements in 6-minute walk distances and WOMAC scores at 4 weeks. Even better, improvements were still evident in both groups at 8 weeks during a re-measurement period. By 4 weeks, WOMAC scores had improved by 52% in the clinic treatment group and by 26% in the home exercise group. 6 Minute Walk Distance improved about 10% in both groups as well. After 1 year, both groups were substantially better and about equally improved over their original measurements. An interesting finding though was that, participants in the clinic treatment group were less likely to be taking medications for their arthritis and were more satisfied with the overall outcome of their rehabilitative treatment compared with subjects in the home exercise group.
Discussion/What Does This Mean to Me? Although both groups improved within the 1st month with exercise in the clinic or at home, participants in the clinic treatment group achieved about twice as much improvement in WOMAC scores than participants who performed similar unsupervised exercises at home. These results demonstrate that a home exercise program for patients with OA provides important benefit that can potentially help reduce their symptoms and avoid undergoing a knee replacement. By participating in a supervised exercise program and receiving important hands-on techniques, greater symptomatic relief can be had!
Here at Advanced PMR, each treatment program will be designed to your symptoms and goals when you come into therapy. A supervised exercise program along with hands-on manual treatment will be provided to you to get you back on your feet as soon as possible!
For more information on the study, click on this link: https://doi.org/10.1093/ptj/85.12.1301