Physiotherapy for knee arthritis - a randomised trial

A recent article in the Annals of Rheumatic Diseases (1) studied physiotherapy treatments for knee joint arthritis and compared it to a placebo: The study was carried out at the Centre for Health, Exercise and Sports Medicine, School of Physiotherapy, University of Melbourne.

They used 119 volunteers. The physiotherapy included exercise, massage, taping and mobilization, followed by 12 weeks of self management. The placebo was sham ultrasound and light application of non-therapeutic gel followed by no treatment. The outcomes measured were pain and global change. They also measured quality of life indexes, quadriceps strength and balance.

Both groups showed similar pain reductions after 12 weeks. Pain at 24 weeks was reduced in both groups as well. Global improvement was reported in 70% of the physiotherapy participants at 12 weeks and 59% at 24 weeks. Similarly, global improvement was reported by 72% of placebo participants at 12 weeks and by 49% at 24 weeks.

The author concluded that the physiotherapy program tested in the trial was no more effective than regular contact with a therapist, at reducing pain and disability.

The study outlines the specific details of the treatments included. The fact that there were improvements in both groups was probably consistent with the placebo effect. The author suggested that the improvements seen following intervention could reflect just the natural history of the condition. Typically, chronic conditions do fluctuate over time. Patients with pain tend to seek treatment when their symptoms are at their worst. Therefore the next change in their symptoms is likely to be an improvement. Placebo effects are common in individuals with knee osteoarthritis and have been shown in previous studies with injections, arthroscopic procedures and medication. Typically improvements from sham interventions range from 16 – 40%. From this, one could conclude that there is some measurable benefit obtained by seeing a therapist with or without actual treatment.

We should look critically at people requiring ongoing treatment as it is likely that the interventions are not making any significant difference to the long-term outcome.

As with many other interventions, we should look at functional outcomes and upgrading and/or return to work to assess the effectiveness overall.

I would welcome any feedback or comments or questions regarding this study. Contact Dr David Allen on 98977699 or david allen@qoh.com.au..