Shi-Yi Wang, MD, PhD; Becky Olson-Kellogg, PT, DPT, GCS; Tatyana A. Shamliyan, MD, MS; Jae-Young Choi, PhD; Rema Ramakrishnan, MPH; Robert L. Kane, MD
Grant Support: By AHRQ (under contract 290-2007-10064-I).
Potential Conflicts of Interest: Ms. Olson-Kellogg, Drs. Shamliyan and Kane, and Mr. Choi: Grant (money to institution): Agency for Healthcare Research and Quality. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M11-2838.
Requests for Single Reprints: Tatyana A. Shamliyan, MD, MS, Division of Health Policy and Management, University of Minnesota School of Public Health, D330-5 Mayo (MMC 729), 420 Delaware Street Southeast, Minneapolis, MN 55455; e-mail, firstname.lastname@example.org.
Current Author Addresses: Dr. Wang: Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College Street, Room 432, New Haven, CT 06520.
Dr. Olson-Kellogg: Program in Physical Therapy, University of Minnesota Medical School, 398 Children's Rehab (MMC 388), 420 Delaware Street Southeast, Minneapolis, MN 55455.
Drs. Shamliyan and Kane: Division of Health Policy and Management, University of Minnesota School of Public Health, D330-5 Mayo (MMC 729), 420 Delaware Street Southeast, Minneapolis, MN 55455.
Dr. Choi: Division of Business, Hallym University, 10314 Dasan Hall, Chuncheon-si, Kangwon-do 200702, Republic of Korea.
Ms. Ramakrishnan: University of South Florida, College of Public Health, 13201 Bruce B. Downs Boulevard, MDC 56, Tampa, FL 33612-3805.
Author Contributions: Conception and design: S.Y. Wang, T.A. Shamliyan, R.L. Kane.
Analysis and interpretation of the data: S.Y. Wang, B. Olson-Kellogg, T.A. Shamliyan, R. Ramakrishnan, R.L. Kane.
Drafting of the article: S.Y. Wang, B. Olson-Kellogg, T.A. Shamliyan.
Critical revision of the article for important intellectual content: S.Y. Wang, T.A. Shamliyan, R.L. Kane.
Final approval of the article: S.Y. Wang, B. Olson-Kellogg, T.A. Shamliyan, R.L. Kane.
Statistical expertise: S.Y. Wang, T.A. Shamliyan.
Obtaining of funding: R.L. Kane.
Administrative, technical, or logistic support: T.A. Shamliyan, R.L. Kane.
Collection and assembly of data: S.Y. Wang, B. Olson-Kellogg, T.A. Shamliyan, J-Y. Choi.
Osteoarthritis is a leading cause of disability. Nonsurgical treatment is a key first step.
Systematic literature review of physical therapy (PT) interventions for community-dwelling adults with knee osteoarthritis.
MEDLINE, the Cochrane Library, the Physiotherapy Evidence Database, Scirus, Allied and Complementary Medicine, and the Health and Psychosocial Instruments bibliography database.
193 randomized, controlled trials (RCTs) published in English from 1970 to 29 February 2012.
Means of outcomes, PT interventions, and risk of bias were extracted to pool standardized mean differences. Disagreements between reviewers abstracting and checking data were resolved through discussion.
Meta-analyses of 84 RCTs provided evidence for 13 PT interventions on pain (58 RCTs), physical function (36 RCTs), and disability (29 RCTs). Meta-analyses provided low-strength evidence that aerobic (11 RCTs) and aquatic (3 RCTs) exercise improved disability and that aerobic exercise (19 RCTs), strengthening exercise (17 RCTs), and ultrasonography (6 RCTs) reduced pain and improved function. Several individual RCTs demonstrated clinically important improvements in pain and disability with aerobic exercise. Other PT interventions demonstrated no sustained benefit. Individual RCTs showed similar benefits with aerobic, aquatic, and strengthening exercise. Adverse events were uncommon and did not deter participants from continuing treatment.
Variability in PT interventions and outcomes measures hampered synthesis of evidence.
Low-strength evidence suggested that only a few PT interventions were effective. Future studies should compare combined PT interventions (which is how PT is generally administered for pain associated with knee osteoarthritis).
Agency for Healthcare Research and Quality.
Appendix Table 1.
Physical Therapy Interventions Eligible for Review
Strength of Evidence Grades, Definitions, and Operationalization
Appendix Table 2.
Types of Exercise Interventions
Appendix Table 3.
Measurement and Frequency of Outcomes in Pooled Analyses
Appendix Table 4.
MCIDs in Scales Measuring Pain and Function in Adults With Knee Osteoarthritis
Summary of evidence search and selection.
RCT = randomized, controlled trial.
Risk of bias in 193 randomized, controlled trials (RCTs) that examined physical therapy in adults with knee osteoarthritis.
Comparative Effectiveness of Physical Therapy Interventions in Adults With Knee Osteoarthritis
Risk for disability in activities of daily living in adherence subgroups.
The attention control group is used as the reference.
Adverse Events Reported With Physical Therapy for Knee Osteoarthritis
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Shi-Yi Wang, Becky Olson-Kellogg, Tatyana A. Shamliyan, Jae-Young Choi, Rema Ramakrishnan, Robert L. Kane. Physical Therapy Interventions for Knee Pain Secondary to Osteoarthritis: A Systematic Review. Ann Intern Med. 2012;157:632–644. doi: 10.7326/0003-4819-157-9-201211060-00007
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Published: Ann Intern Med. 2012;157(9):632-644.
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