Real-world use of manual therapy and exercise for managing knee osteoarthritis - a military health system analysis

Key Points

1. Among the 2,676 patients who received exercise and/or manual therapy, exercise dominated care: 54.3% received exercise only, 43.2% received exercise and manual therapy together, and only 1.4% received manual therapy alone.

All key points available for members only

Start free trial

Or log in here

BACKGROUND & OBJECTIVE

Exercise is consistently recommended as a first-line intervention for knee osteoarthritis because of its safety and ability to improve pain and function (1,2). Manual therapy is also used frequently in physical therapy, but recommendations are less uniform (3). Some clinical practice guidelines support manual therapy as an adjunct to exercise, while others caution against it or recommend against its routine use (4-6). One concern is that manual therapy may be delivered as a passive, stand-alone intervention that could foster dependence rather than active self-management (4-6).

The authors identified an important gap between this guideline debate and what happens in clinical practice. It was unclear how often patients with knee osteoarthritis receive exercise, manual therapy, both interventions, or neither, and whether different treatment patterns are associated with meaningful differences in downstream healthcare utilization.

The primary aims were therefore to describe system-level use of exercise and manual therapy and compare subsequent healthcare use and costs among treatment groups. A secondary aim was to examine whether the number of exercise visits was associated with the hazard of progressing to knee arthroplasty.

Exercise is consistently recommended as a first-line intervention for knee osteoarthritis because of its safety and ability to improve pain and function.

Instead of arguing primarily about whether manual therapy should or should not be included, clinicians and health systems may gain more by ensuring that patients with knee osteoarthritis receive timely education, progressive exercise, appropriate loading, and access to rehabilitation in the first place.

METHODS

This was an observational cohort study using electronic medical record and insurance claims data from the United States Military Health System (MHS), a large single-payer system serving active-duty service members, retirees, and dependents. Individuals 18 to 75 years old with

Start free trial

to unlock full access to this review and 1324 more

Or log in here