A Randomized Clinical Trial On Effectiveness Of Manual Therapy In Management Of Knee Osteoarthritis At Two Selected Teaching Hospitals In Zambia
Volume 4 - Issue 3, March 2020 Edition
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Sporah Chisha, Margaret M. Mweshi, Brian Chanda Chiluba
Conventional therapy, Knee Osteoarthritis, Manual therapy, Physiotherapy.
Osteoarthritis which is a degenerative joint disease affecting the articular cartilage, bone and soft tissues around the joint is a highly prevalent condition worldwide with an incidence of 20.4% at the University Teaching Hospital and Levy Mwanawasa Teaching Hospital in Zambia. It has no known effective intervention due to its poorly understood pathogenesis. Combined interventions of Manual Therapy and Conventional Physiotherapy are significant in restoring function, quality of life, reducing disability, drug consumption and surgery in individuals with knee OA. This study evaluated the emerging optimistic evidence on the effectiveness of manual therapy, established the possible factors associated with it and assessed its impact on physical function and quality of life in patients with knee osteoarthritis. This study was a single-blinded RCT involving 6 male and 24 female participants with bilateral knee osteoarthritis aged between 30-85 years at University Teaching Hospital and Levy Mwanawasa Teaching Hospital. Participants were randomized using un-labelled opaque envelops to a conventional group (n=15) and intervention group (n=15). The conventional group received a treatment protocol of hot packs, Transcutaneous Electrical Nerve Stimulation and exercise therapy, while those in the intervention group received the same protocol combined with manual therapy twice per week for 5 weeks giving 10 treatment sessions. Short Form 36 questionnaire (SF-36), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Six-minute walk test questionnaire (6-MWT) and Visual Analogue Scale (VAS) were tools used for data collection before and after treatment. Data was entered in SPSS imported into Microsoft Excel and analyzed using STATA software version 13. Paired t-test mean values of group effect for VAS, 6-MWT, WOMAC and SF-36 Questionnaire were compared at week 0 and week 5. There was an improvement in all mean values; VAS (2.4), 6-MWT (195.75), WOMAC (51) and SF-36 (307.9) to 1.5, 276.3, 30 and 542.2 respectively. The difference between conventional and interventional groups was statistically significant for the WOMAC and SF-36 Questionnaire (p = 0.0102 and p = 0.0085). Differences were not significant for 6-MWT (p = 0.1678) and VAS (p = 0.2893). Adding manual therapy to conventional physiotherapy is more effective in reducing knee pain, improving walking distance, physical function and quality of life in patients with knee osteoarthritis. The effects of manual therapy on knee osteoarthritis were sustained up to 2 weeks after treatment.
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