Effect of manual therapy on selected biomechanical outcomes of gait in people with knee osteoarthritis

The primary aim of this study is to explore whether a manual therapy intervention influences the biomechanical outcomes during gait in people with knee OA. Manual therapy is defined as skilled therapist-applied manual procedures intended to modify the quality and range of motion of the target joint and associated soft tissue structures. The manual therapy protocol will not provide or prescribe aerobic, strengthening, or neuromuscular control exercises. The physiotherapist will deliver manual therapy interventions for all participants. The detailed description of the manual therapy intervention will be recorded to ensure consistency and reproducibility by another team. It includes manual therapy technique details such as name of the technique, rationale or goal, application method including patient and therapist position, location & direction of force, frequency, intensity, duration of the session. We will also record the assessment findings, including symptom irritability, baseline pain, range of motion quality, clinical notes, and the dosage provided/progressed for each intervention session. The compliance of the intervention will be audited in percentage by another research team member who is not involved in providing treatment sessions. We will also record the number of sessions completed by each participant. Manual therapy for the knee will consist of: 1 Combination of the following treatment techniques for knee will be used for tailored intervention: • Knee flexion physiological movement with adduction or abduction • Knee extension physiological movement with adduction or abduction • Medial and lateral rotation physiological movements • Longitudinal movement caudal distraction • Antero-posterior directed accessory movements of Grade I-IV to the tibia, tibiofemoral joint • Posteroanterior directed accessory movements Grade I-IV to the tibia, tibiofemoral joint • Tibio-femoral joint Medial and lateral rotation accessory movements • Patellar gliding accessory movements Grade I-IV • Manual stretch to quadriceps, hamstring, triceps surae muscle groups 2 Secondary (non-mandatory) interventions techniques prescribed when indicated by assessment findings: • *Mobilisation with movement (MWM) consisted of a sustained manual glide of the tibia (either medial, lateral, anterior, posterior, or rotation) during active knee flexion and extension *MWM testing is mandatory. It is only included as a treatment technique when indicated i.e., pain is significantly reduced with application of joint glide. MWM will be added as a non-mandatory intervention technique. Manual therapy will be performed with the frequency of 2 sessions per week for 3 consecutive weeks. The duration for each session will be 45-60 minutes. The intensity of manual therapy will be chosen based on the assessment, clinical reasoning, and participant's tolerance. Necessary physical examination will be done to choose the treatment techniques as per recommendation of the Maitland’s peripheral manipulation textbook, and based on identified impairments (Hengeveld et al., 2005, Petty & Barnard, 2018). For example, if the knee has restricted extension, a PA or external rotation accessory movement will be selected. Each participant will receive a tailored MT intervention within one week of baseline II (4-week after the enrolment into the study). On post-intervention assessment at 8-week, participants will be educated about knee OA by providing information as suggested by Arthritis NZ and be advised to stay active as recommended by international guidelines. Hengeveld, E., Banks, K., & Maitland, G. D. (2005). Maitland's peripheral manipulation (4th ed.).Elsevier/Butterworth Heinemann. Petty, N. J., & Barnard, K. (2018). Principles of musculoskeletal treatment and management : a handbook fortherapists (Third edition ed.). Elsevier Edinburgh.