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Effect of manual therapy and exercise on pain, stiffness and function in persons with knee osteoarthritis.


Knee osteoarthritis (OA) is a major cause of pain and difficulty with gait. The purpose of this study was to determine if a physical therapy treatment program would improve pain, stiffness and function and alter gait biomechanics in persons with knee OA. Fifteen males and 26 females with knee OA participated. Subjects completed a Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) and then were randomly assigned to either the treatment or control group. Groups were blocked by gender and initial WOMAC score (two levels). The treatment group received 8 treatments of manual therapy and exercise, the control group received no treatment until posttreatment testing was completed. Both groups underwent video-based motion analysis pre- and posttreatment. Five walking trials were collected at each of two speeds: the subject's self-selected speed and a control speed of 1.2 +/- 0.1 m/ s. Knee motion, forces, and moments were analyzed with the motion analysis system (Motion Analysis, Santa Rosa, CA). Changes in peak knee compression, knee compression impulse, stance phase knee flexion range, peak knee adduction moment, knee extension moments, and WOMAC scores were analyzed using MANCOVA in SAS, Version 8.1. Pain, stiffness, and physical function improved as measured by WOMAC scores, but no significant changes occurred in any of the biomechanics measures. Improvements were greatest in subjects whose pretreatment knee pain, stiffness, and disability were more severe. These results suggest that manual therapy and exercise was effective at improving pain and function in persons with knee OA without altering knee biomechanics. Perhaps other factors affect gait biomechanics more than pain itself in persons with knee OA.