What is the evidence for manual and manipulative therapy in the treatment of osteoarthritis of the knee?
AMSTAR Rating
Summary
Patient Population:
For knee relevant studies: Participants with knee OA. Mean age (when reported) ranged from 59.3 – 68.6 years. Participants with PFPS: Mean age (when reported) ranged from 25-34 years.
Intervention:
Manipulative therapy (MT), average: 10 treatments over 6 weeks (range 1 – 24). 1 year follow-up on average. PFPS trials, average: 6.37 treatments over 4-8 weeks intervention (range 1-8). Follow-up ranged from after 1 treatment to 1 year.
Comparison:
There were 9 category 1 studies identified that included individuals with knee OA. An additional 11 studies examining the role of MT in the treatment of patellofemoral pain syndrome (PFPS). Of the studies examining MT in knee OA, 2 studies were ranked as high quality/low risk of bias, 6 as “well-conducted”/relatively low risk of bias and 1 as high risk of bias. Of the studies pertaining to PFPS, 4 were of the highest quality, 5 well-conducted and 2 at high risk of bias.
Outcome:
- The authors assigned Level B (fair) evidence for “MT of the knee and/or full kinetic chain”, “combined with multimodal or exercise therapy for short-term treatment of knee OA” and for PFPS.
- There was level C (limited) evidence for “MT of the knee and/or full kinetic chain”, “combined with multimodal or exercise therapy for long-term treatment of knee OA” (and of PFPS).
Guideline Recommendations
| Source | Recommendation |
|---|---|
| ACR (2019) | Conditionally against |
Outcomes Assessed
- Benefit
- Harm
- Inconclusive
Manipulative Therapy + Exercise
Short-term Outcomes
Long-term Outcomes
