International Journal of Advanced Research and Publications (2456-9992)

High Quality Publications & World Wide Indexing!

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
[Download Full Paper]

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.
[1] McAlindon, T. Bannuru, R. Sullivan, M. Arden, N. Berenbaum, F. Zeinstra, S. Underwood, M. “OARSI Guidelines for the nonsurgical management of knee osteoarthritis, Osteoarthritis and Cartilage”. Osteoarthritis and Cartilage Journal, XXII, pp. 363-388, 2014.

[2] Abbott, J. Robertson, M. Chapple, C. “Manual therapy, exercise therapy or both as additional to usual care for OA of the hip or knee”. Osteoarthritis and cartilage Journal, v21, pp.525-534, 2013.

[3] Ahmad, A. and Daud, M. “A comparative study between joint mobilization and conventional physiotherapy in knee osteoarthritis”. International Journal of Physiotherapy, Vol 3(2), pp. 159-162, 2016.

[4] Akinpelu, A. Alonge, T. Adekania, B. and Odole, A. “Prevalence and pattern of symptomatic knee osteoarthritis in Nigeria”. The Internal Journal of Allied Health Sciences and Practice, vol. 7, No. 3, pp. 1-7, available at http://ijahsp.nova.edu, 2009.

[5] Ali, S. Ahmed, I. and Khan, M. “Comparing the effects of manual therapy versus electrophysical agents in the management of knee osteoarthritis”. Pakistan journal of pharmaceutical sciences, Vol. 27, No. 4, pp.1103-1106, 2014.

[6] llen, K. and Golightly, Y. “Epidemiology of osteoarthritis: state of the evidence”. Journal of Curr Opin Rheumatol, Vol. 27, pp. 276–283, 2015.

[7] Alrushud, A. El-Sobkey, S. Hafez, A. Al-Ahaideb, A. “Impact of knee osteoarthritis on the quality of life among Saudi elders: A comparative study”. Saudi Journal of Sports Medicine, Vol. 13, Issue. 1, pp.10-16, 2013.

[8] Anwer, S. Ahmad, A. Zafar, H. and Brismee, J. “Effects of orthopaedic manual therapy in knee osteoarthritis: A systematic review and meta-analysis”. Physiotherapy Journal Vol.104, pp. 264-276, 2018.

[9] Arshad, N. Ijaz Gondal, M. Qamar, M. Basharat, A. “Manual therapy can be a potential therapy in knee osteoarthritis”. Saudi Journal of Sports Medicine, Vol. 18 pp. 18‑2, 2018.

[10] Ateef, M. Kulandaivelan, S. Tahseen, S. “Test– retest reliability and correlates of 6-minute walk test in patients with primary osteoarthritis of knees”. Indian Journal of Rheumatology, Vol.11 pp.192-196, 2016.

[11] Barber, R. Fullman, N. Sorensen, R. Bollyky, T. “Healthcare access and quality index based on mortality from amenable to personal health care in 195 countries and territories, 1990-2015: A novel analysis from the global burden of disease study 2015”. The Lancet, Vol. 390, pp 231-266, 2017.

[12] Bernhardsson, S. Kredo, T. Machingaidze, S. Young, T. “Advancing evidence-based practice in physical therapy settings: multinational perspectives on implementation strategies and interventions”. Journal of Physical Therapy, Vol. 97, pp. 51-60, 2017.

[13] Bija, M. Luma, H. Temfack, E. Gueleko, E. Kemta, F. and Ngandeu, M. “Patterns of knee osteoarthritis in a hospital setting in sub-Saharan Africa”. Journal of Clinical Rheumatology, Vol.14, pp. 2702-3, 2014.

[14] Bohannon, R. Bubela, D. Magasi, S. McCreath, H. “Comparison of walking performance over the first 2 minutes and the full 6 minutes of the six- minute Walk Test”. Journal of BMC Research Notes, Vol. 7, pp. 269, 2014.

[15] Chen, B. Zhan, H. Marszalek, J. “Manual therapy for knee osteoarthritis: A systematic review and meta-analysis”. Osteoarthritis and cartilage journal, Vol. 26, pp. 60-474, 2018.

[16] Chu Buh, F. Vukugah, A. Ghyslaine, B. Atemkeng, T. and Krishna, N. “Conventional Physiotherapy and Additional Krishna’s Kinetikinetic Manual Therapy (KKMT) For Knee Osteoarthritis Rehabilitation: A Comparative study” IJARP, Vol. 2, Issue. 1, pp.54-58, January 2018.

[17] Ciolac, E. Silva, J. Greve, J. “Effects of resistance training in older women with knee osteoarthritis and total knee arthroplasty”. Journal of Clinics, Vol. 70, pp. 7–13, 2015.

[18] Conley, S. Feder, S. Redeker, N. “The relationship between pain, fatigue, depression and functional performance in stable heart failure”. Journal of Heart and Lung, Vol. 44, pp. 107–112, 2015.

[19] Cross, M. Smith, E. Holy, D. Noite, S. “The global burden of hip and knee osteoarthritis: Estimates from the global of disease 2010 study”. Annals of the Rheumatic Diseases, Vol 73, pp. 1323-1330, 2014.

[20] Crossley, K. Stefanik, J. Selfe, J. “Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester. Part 1: Terminology, definitions, clinical examination, natural history, patellofemoral osteoarthritis and patient reported outcome measures. Journal of Sports Medicine, Vol. 50, pp. 839-843, 2016.

[21] Correia de Faria Santarém, G. de Cleva, R. Santo, M. “Correlation between Body Composition and Walking Capacity in Severe Obesity”. Journal of pone, Vol. 10, pp. 1-10, 2015.

[22] Fernandes, L. Hagen, K. Bijlsma, J. Andreassen, O. Christensen, P. “EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis”. Annals of the rheumatic diseases. Vol. 72, pp.1125–35, 2013.

[23] Fitzgerald, G. Fritz, J. Childs, J. “Exercises, manual therapy and use of booster sessions in physical therapy for knee OA”. Journal of Osteoarthritis and cartilage, Vol. 24, pp.1340-1349, 2016.

[24] Hame, S. and Alexander, R. “Knee osteoarthritis in women”. Journal of Curr Rev Musculoskeletal Medicine, Vol. 6, pp. 182–187, 2013.

[25] Hameed, R. Waqas, M. Akhtar, F. Joseph, R. Niazi, A. Mahmood, A. “Effect of Manual Therapy on Knee Osteoarthritis (OA) Pain, A Randomized Control Trial”. International Journal of Research Studies in Medical and Health Sciences, Vol. 2, Issue. 4, pp. 19-22, 2017.

[26] Ilori, T. Ladipo, M. Ogunbode, A. and Obimakinde, A. “Knee osteoarthritis and perceived social support amongst patients in a family medicine clinic”. Journal of South African Family Practice, Vol. 58, pp. 202-206, 2016.
[27] Kaur, R. Ghosh, A. and Singh, A. “Prevalence of knee osteoarthritis and its determinants in 30-60 years old women of Gurdaspur, Punjab”. International Journal of Medical Science and Public Health, Vol. 7, pp. 825-30, 2018.

[28] Kawano, M. Araújo, I. Castro, M. Matos, M. “Assessment of quality of life in patients with knee osteoarthritis”. Journal of Acta Ortop Bras, Vol. 23, pp, 307-10, 2015.

[29] Kellgren, J. and Lawrence, J. “Radiological assessment of osteoarthrosis”. Annals of Rheumatic Diseases, Vol. 16, pp. 494-502, 1997.

[30] Kiran, A. Ijaz, M. Qamar, M. and Basharat, A. “Comparison of Efficacy of Mulligan’s Mobilization with Movement with Maitland Mobilization along with Conventional Therapy in the Patients with Knee Osteoarthritis: A Randomized Clinical Trial”. Libyan Int Med Univ Journal, Vol. 3, pp. 26-30, available at http://www.journal.limu.edu.ly, April 2018.

[31] Lupenga, J. Namwila, N. Munalula-Nkandu, E. Chiluba, B. “Evaluating Evidence Based Practice of Physiotherapists and The Quality of Physiotherapy Services in Selected Health Facilities of Lusaka, Zambia”. Indonesian Journal of Disability Studies (IJDS), Vol. 6, pp. 133-142, 2019.

[32] Mahamed, A. Sivachidambaram, K. and Shaziya, T. “Test–retest reliability and correlates of 6-minute walk test in patients with primary osteoarthritis of knees”. Vol. 11 Issue. 4, pp. 192-196, 2016.

[33] McAlindon, T. Bannuru, R. Sullivan, M. “Osteoarthritis Research Society International guidelines for the non-surgical management of knee OA”. Journal of Osteoarthritis and cartilage, Vol. 22, pp. 363-388, 2014.

[34] Middelkoop, V. Bennel, L. Callaghan, J. “International patellofemoral osteoarthritis consortium: Consensus statement on diagnosis, burden, outcome measures, prognosis, risk factors and treatment. Journal of Seminars in Arthritis, Vol. 47, pp. 666-675, 2018.

[35] Mobasheri, A. “The Future of Osteoarthritis Therapeutics: Targeted Pharmacological Therapy”. Journal of Curr Rheumatol Rep, Vol. 15, pp. 364, 2013.

[36] Mulla, Y. Munthali, J. Makasa, E. and Kayumba, K. “Joint replacement in Zambia: a review of Hip & Knee Replacement surgery done at the Zambian-Italian Orthopaedic Hospital”. Medical Journal of Zambia, Vol. 37, No. 3, pp. 153-159, 2010.

[37] Palazzo, C. Nguyen, C. Lefevre-Colau, M. Rannou, F. and Poiraudeau, S. “Risk factors and burden of osteoarthritis”. Annals of physical and rehabilitation medicine, Vol. 59, pp. 134-138, 2016.

[38] Polat, C. Doğan, A. Özcan, D. “The Effectiveness of Transcutaneous Electrical Nerve Stimulation in Knee Osteoarthritis with Neuropathic Pain Component: A Randomized Controlled Study”. Turk Journal of Osteoporos, Vol. 23, pp. 47-51, 2017.

[39] Postler, A. Ramos, A. Goronzy, J. Günther, K. Lange, T. Schmitt, J. “Prevalence and treatment of hip and knee osteoarthritis in people aged 60 years or older in Germany: an analysis based on health insurance claims data”. Journal of Clinical Interventions in Aging, Vol; 13 p: 2339–2349, 2018.

[40] Rhon, D. Deyle, G. Gill, N. and Rendeiro, D. “Manual physical therapy and perturbation exercises in knee osteoarthritis”. Journal of Manual and Manipulative Therapy vol. 21 no.4, 2013.

[41] Salamh, P. Cook, C. Reiman, M. and Sheets, C. “Treatment effectiveness and fidelity of manual therapy to the knee: A systematic review and meta-analysis”. Journal of musculoskeletal care, Vol. 15, pp. 238-248, 2017.

[42] Sit, R. Chan, K. Zou, D. Chan, C. Yip, B. Zhang, D. Chan, Y. “Clinic-Based Patellar Mobilization Therapy for Knee Osteoarthritis: A Randomized Clinical Trial”. Journal of Annals and Family Medicine, Vol. 16, pp. 521-529, 2014.

[43] Sowers, M. and Karvonen-Gutierrez, C. “The evolving role of obesity in knee osteoarthritis”. Journal of Curr Opin Rheumatol, Vol. 22, pp. 533–7, 2010.

[44] Turkiewicz, A. Petersson, F. Bjork, J. Hawker, G. and Daulberg, E. “Current and future impact of osteoarthritis on health care: A population- based study with projections to year 2032”. Journal of Osteoarthritis and cartilage, Vol. 22, pp. 1826-1832, 2014.

[45] Usenbo, A. Kramer, V. Young, T. and Musekiwa, A. “Prevalence of Arthritis in Africa: A Systematic Review and Meta-Analysis”. Journal of pone, Vol 10, pp. 1-19, 2015.

[46] Vos, T. Abajobir, A. Abate, K. Abbafati, C. Abbas, K. “Global, regional and national incidence, prevalence and years lived with disability for 328 diseases and injury for 195 countries 1990-2016: A systematic analysis for the global burden of disease study 2016”. The Lancet, Vol. 390, pp. 1211-1259, 2016.

[47] Yusuf, E. “Metabolic factors in osteoarthritis: obese people do not walk on their hands”. Journal of Arthritis Res Ther, Vol. 14, pp.123, 2012.

[48] Yusuf, E. “Pharmacologic and Non-Pharmacologic Treatment of Osteoarthritis”. Journal of Current Treatment Options in Rheum, Vol. 2, pp. 111–125, 2016.

[49] Zeng, C. Li, H. Yang, T. “Electrical stimulation for pain relief in knee osteoarthritis: systematic review and network meta-analysis”. Journal of osteoarthritis and cartilage, Vol. 23, pp.189-202, 2014.

[50] Zakir, A. Ahmed, S. Aziz, S. “Effectiveness of manual therapy versus exercise therapy for the management of knee osteoarthritis in Karachi Pakistan”. International Journal of Physiotherapy, Vol. 3, pp. 86-93, 2016.

[51] Rodrigues da Silva, J. de Rezende, M. Spada, T. Francisco, L. “Educational program promoting regular physical exercise improves functional capacity and daily living physical activity in subjects with knee osteoarthritis”. Journal of BMC Musculoskeletal Disorders, Vol. 18, pp. 546, 2017.

[52] Ouédraogo, D. Zabsonré, J. Kenagnon, A. Kaboré, F. “Quality of Life of Patients with Knee Osteoarthritis with Questionnaire OAKHQOL (OsteoArthritis of Knee Hip Quality of Life) in Rheumatology Consultation in Burkina Faso (West Africa)”. Open Journal of Rheumatology and Autoimmune Diseases, Vol. 4, pp. 219-225, 2014.

[53] Courtney, C. Steffen, A. Fernández-de-las-peñas, C. Kim, J. Chmell, S. “Joint Mobilization Enhances Mechanisms of Conditioned Pain Modulation in Individuals with Osteoarthritis of the Knee”. Journal of orthopaedic & sports physical therapy, Vol. 46, No. 3, pp. 168-176, 2016.

[54] Zhang, W. Ouyang, H. Dass, C. and Xu, J. “Current research on pharmacologic and regenerative therapies for osteoarthritis”. Journal of Bone Research, Vol. 4, pp. 15040, 2016.

[55] Murray, C. Vos, T. Lozano, R. Naghavi, M. Flaxman, A. “Disability adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: A systematic analysis for the global burden of disease study 2010”. The Lancet, Vol. 380, pp. 2197-2223, 2012.