None listed
Conditions
Brief summary
We will investigate: 1) whether exercise therapy will be more effective than no exercise therapy, whether manual therapy will be more effective than no manual therapy, and whether exercise therapy with manual therapy will have an additive or interaction effect over just one mode of therapy; 2) whether, overall, physiotherapy interventions in addition to usual medical care will be more effective than usual care alone for reducing pain and disability in patients with osteoarthritis of the hip and knee; 3) whether the proportion of participants undergoing joint replacement surgery is lower in the groups receiving trial physiotherapy interventions compared to the group receiving usual care alone; and 4) the incremental cost-effectiveness of providing physiotherapy interventions for patients with OA of the hip or knee.
Interventions
1. Exercise physiotherapy: Strengthening, stretching, endurance and neuromuscular control exercises; one-hour sessions; 7 session in first 9 weeks, then 2 'booster' sessions at 4 months.
2. Manual physiotherapy: Techniques involving therapist-applied forces to improve joint and soft tissue mobility; one-hour sessions; 7 session in first 9 weeks, then 2 'booster' sessions at 4 months.
3. Combination therapy: Both exercise therapy and manual therapy; one-hour sessions; 7 session in first 9 weeks,
1. Exercise physiotherapy: Strengthening, stretching, endurance and neuromuscular control exercises; one-hour sessions; 7 session in first 9 weeks, then 2 'booster' sessions at 4 months. 2. Manual physiotherapy: Techniques involving therapist-applied forces to improve joint and soft tissue mobility; one-hour sessions; 7 session in first 9 weeks, then 2 'booster' sessions at 4 months. 3. Combination therapy: Both exercise therapy and manual therapy; one-hour sessions; 7 session in first 9 weeks, then 2 'booster' sessions at 4 months. 4. Usual care: No trial physiotherapy
Sponsors
University of Otago
Study design
Allocation
Randomised controlled trial
Intervention model
Factorial
Primary purpose
Treatment
Masking
Blinded (masking used) (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Patients referred for an orthopaedic consultation for hip or knee osteoarthritis and consideration for joint replacement surgery and who meet clinical criteria for diagnosis of osteoarthritis of the hip or knee according to American College of Rheumatology criteria
Exclusion criteria
- Previous knee or hip joint surgery; - any other surgical procedure of the lower limbs in the prior 6 months; - initiation of opioid analgesia or cortico-steroid or analgesic injection intervention for hip or knee pain within prior 30 days; - rheumatoid arthritis of the hip or knee; - physical impairments preventing safe participation in exercise, manual therapy, walking or stationary cycling, such as: uncontrolled hypertension or AHA risk-rating of A3B or higher; vision problems that affect mobility, neurogenic disorder, primary or debilitating back pain, advanced osteoporosis, body mass >155kg, unable to ambulate 10m without an assistive device; - insufficient communication ability to comprehend or comply with assessment interventions; - stated inability to complete the proposed course of intervention and follow-up.
Outcome results
None listed