Frequency of manual therapy treatment for people with knee osteoarthritis

Manual therapy provided by a physiotherapist at a frequency of once per week for six weeks or twice per week for three weeks. For the once per week group, the target treatment interval will be seven days (minimum six days, maximum nine days). For the twice per week group intervals between treatments will be three or four days (minimum two days, maximum five days). Reasons for not booking appointments on the target day will be recorded, as will the reasons for selection of an alternative day within the acceptable range. If appointments cannot be scheduled within the acceptable range, they will be recorded as "missed", with a reason. Each manual therapy treatment session will last for 45 minutes and include mobilisation of joints by the physiotherapist, and stretching applied to the soft tissues. During the sessions the physiotherapist will deliver a standardised information package including education about osteoarthritis, and advice such as control of body weight and maintenance of regular exercise. This will be done as per usual practice of conversing with the participant as treatment is performed, and will include a summary at the end of the session. The participants will be encouraged to repeat back the information to ensure they have understood it, and will also be given a flyer containing the same information. On completion of the course of manual therapy, participants will be prescribed an individualised home exercise programme in line with best practice for osteoarthritis. They will attend for an additional 45 min treatment session following either the three week or six week assessment, depending on group allocation. The physiotherapist will teach the exercise programme and check the performance of the exercises by the participant. The programme will be multi modal and include aerobic, strengthening, stretching and neuromuscular coordination exercises. Participants will be advised to perform the home exercise programme two to three times per week, and should be completed in 20-30 mins. Following six month follow-up assessment, the home exercise programme will be checked for accuracy of performance, difficulty due to pain, or exercises becoming too easy. Participants will be asked to estimate how often per week they completed the home exercise programme. When participants have improved their strength, flexibility or general fitness, exercises will be progressed to ensure they are still tailored to produce therapeutic benefit.