File
Hauke J.1,2, Neukirch B.1, Weyermann M.1, Alfuth M.1
1Niederrhein University of Applied Sciences, Faculty of Health Care, Krefeld, Germany, 2Deutsche Arzt AG, Essen, Germany
Background: Pain and decreased function lead to reduced quality of life in patients with knee osteoarthritis. Physiotherapy treatment programs aim to prevent patients from surgery (total knee arthroplasty) by reducing pain and disability.
Purpose: To demonstrate the outcomes of an outpatient physiotherapy treatment program in patients with knee osteoarthritis.
Methods: One hundred and twenty-seven patients (n=127) with knee osteoarthritis met the inclusion criteria for this retrospective analysis of prospectively collected data and volunteered to participate. Main inclusion criteria were diagnosis of knee osteoarthritis and indication of total knee arthroplasty. Fifty-nine patients (n=59) completed all assessments after 5 months of intervention with a further telephone recall after 4 weeks and were finally analyzed. The study was conducted within the outpatient physiotherapy services of a physiotherapy center. The attending physician allocated the insured patient to the pre-assessment including anamnesis, physical examination, radiological examination and standardized questionnaires. If the patient met inclusion criteria, a standardized treatment program including manual therapy and exercise therapy with complementary behavioral education with respect to the individual needs was performed. Manual therapy was primarily applied in individual treatment sessions (30 min.) during the early phase of the treatment program where problems were most likely severe. Exercise therapy was added progressively with a duration of 60 min. per session, including balance and strengthening exercises with or without common devices. This aimed to improve sensorimotor control, muscle strength and gait ability. Treatment sessions took place two days per week. Pain [Numeric Rating Scale, 0-10], flexibility [°] for extension, flexion, internal and external rotation of the knee joint as well as functional status [Lequesne Index, 0-24] were the outcomes that were measured before and after 5 months of treatment. Prevention from surgery (%) was evaluated using the telephone recall. The Wilcoxon signed-rank test (p 0.05) was used to test significance of differences between pre and post measurements using SPSS 21.0. Effect sizes (Cohen´s d) between pre and post measurements were calculated.
Results: Before treatment pain was rated at a median of 7.0. After 5 months a significant reduction of pain to a median of 5.0 was found (p 0.001; d=ǀ0.882ǀ). Knee flexibility restrictions were significantly improved from a median of -5.0 to 0.0 for extension (p 0.001; d=0.553), a median of 110.0 to 125.0 for flexion
(p 0.001; d=1.014), a median of 10.0 to 15.0 for internal rotation (p 0.001; d=0.635) as well as from a median of 20.0 to 25.0 for external rotation (p 0.001; d=0.669). The total score of the Lequesne Index significantly improved from a median of 11.5 to 7.5 (p 0.001; d=ǀ0.855ǀ). 84.75% of the patients were prevented from surgery. 15.25% of the patients decided on surgery.
Conclusion(s): Patients with knee osteoarthritis who were treated with the treatment program demonstrated a clinically relevant decrease of pain and an improved functional status. Results should be considered with caution, because less than 50% of patients finished all assessments and could be finally analyzed.
Implications: The treatment program may help to prevent patients with knee osteoarthritis from surgery and to enhance their quality of life.
Funding acknowledgements: None.
Topic: Orthopaedics
Ethics approval: All patients included in the study gave written consent. Ethical approval was not required because the study evaluated common practice.
All authors, affiliations and abstracts have been published as submitted.
