Treatment effectiveness and fidelity of manual therapy to the knee: A systematic review and meta‐analysis

Abstract

Manual therapy (MT) is a commonly used treatment for knee osteoarthritis (OA) but to date only one systematic review has explored its effectiveness. The purpos e of the present study was to perform a systematic review and meta-analysis of the literature, to determine the effectiveness and fidelity of studies using MT techniques in individuals with knee OA. Relevant studies were assessed for inclusion. Effectiveness was measured using effect sizes, and methodological bias and treatment fidelity were both explored. Effect sizes were calculated using standardized mean differences (SMD) based on pooled data depending on statistical and clinical heterogeneity, as well as risk of bias. The search captured 2,969 studies; after screening, 12 were included. Four had a low risk of bias and high treatment fidelity. For self-reported function, comparing MT with no treatment resulted in a large effect size (standardized mean difference [SMD] 0.84), as did adding MT to a comparator treatment (SMD 0.78). A significant difference was found for pain when adding MT to a comparator treatment (SMD 0.73). The findings in the present meta-analytical review support the use of MT versus a number of different comparators for improvement in self-reported knee function. Lesser support is present for pain reduction, and no endorsement of functional performance can be made at this time.

Reference values and changes in infant sleep–wake behaviour during the first 12 months of life: a systematic review

“…This Quality Index evaluates the methodological quality of randomized and non‐randomized studies, and is comprised of 27 items, aggregated in five sub‐scales. In accordance with previous studies, a modified version of the Quality Index was applied (Galland et al ., ; Mohan et al ., ; Salamh et al ., ). As some items did not apply to this review's studies, the authors selected 14 from the total 27 items of the Quality Index of Downs and Black () to score the selected non‐randomized studies.…”

Dolor en la Artrosis de Rodilla

“…14,15 Las causas de dolor óseo se deben a periostitis asociadas a la formación de osteofitos y fracturas subcondrales, como consecuencia de la disminución de la irrigación sanguínea y el aumento de la presión intra-ósea, además de la reducción del drenaje venoso del hueso. [16][17][18] Por otra parte, las causas de dolor sinovial ocurren como consecuencia de la irritación de las terminaciones nerviosas sensoriales dentro de la capa sinovial, que cubre los osteofitos y la propia inflamación del tejido sinovial por prostaglandinas, leucotrienos y citocinas, que estimulan los nociceptores, además de la distención articular y el edema. [19][20][21] El dolor de la artrosis de rodilla también es de origen muscular, a través de la inestabilidad articular típica de esos enfermos, aumenta el estrés sobre la articulación y por ende la activación de los nociceptores.…”

We need to debate the value of manipulative therapy and recognize that we do not always understand from what to attribute our success

“…Can we all admit that the correct treatment is the one that gives the patient the most benefit and the least harm? There is evidence that including manual therapy care as part of the conservative management of patients with musculoskeletal conditions results in cost effective improvements in pain, function and satisfaction [5][6][7]. Objectively measuring clinical reasoning is a difficult task and 5 'expert' clinicians may use 5 different approaches to achieve a favorable outcome.…”