Physical Therapy for Knee Osteoarthritis

A Comprehensive Overview

Knee osteoarthritis (OA) is a degenerative joint condition that affects millions of people worldwide. As the condition progresses, it can lead to pain, stiffness, and decreased mobility. One of the primary non-surgical interventions recommended for managing knee OA is physical therapy. Let's delve into the research-backed benefits and considerations of physical therapy for knee OA.

Benefits of Physical Therapy for Knee Osteoarthritis

• Pain Reduction and Improved Function: Exercise therapy has been shown to be effective in reducing pain and activity limitations in patients with knee OA. Improved upper leg muscle strength is one of the mechanisms underlying its beneficial effects.
• Enhanced Walking Ability: Exercise therapy can improve the amount of time spent walking, gait velocity, and potentially the total distance walked for individuals with knee OA.
• Improved Quality of Life: Exercise significantly reduces pain and improves function, performance, and quality of life in people with knee and hip OA.
• Muscle Strengthening: Muscle impairments associated with knee OA significantly affect physical function. Targeted therapy can be effective in reducing pain and improving function.
• Cartilage Health: Contrary to some beliefs, physical activity is beneficial, rather than detrimental, to joint health, emphasizing the importance of optimizing cartilage health in preventing OA.
• Diverse Exercise Programs: There are a variety of choices for strengthening exercise programs, offering positive recommendations for healthcare professionals and knee OA patients.

Considerations in Physical Therapy

• Quadriceps Strengthening: Some studies suggest that regimens aimed at strengthening the quadriceps muscle may increase structural damage of the joint in some patients with knee OA.
• Optimal Exercise Regimen: While exercise reduces pain and improves function in patients with OA of the knee, the optimal exercise regimen has yet to be determined.
• Combination with Other Modalities: The addition of Transcutaneous Electrical Nerve Stimulation (TENS) to exercise training might produce better overall improvement in physical outcomes.
• Psychosocial Focus: Physiotherapists may improve the management of knee OA by focusing more on the psychosocial aspects, being proactive with advice, and offering longer-term reviews.

Financial Superiority of Physical Therapy for Knee Osteoarthritis

Knee osteoarthritis (OA) is not only a leading cause of chronic musculoskeletal pain but also a significant economic burden. The widespread prescription of opioids for symptomatic knee OA, for instance, generated a staggering $14 billion in total costs in 2021, with only half being direct medical costs. Indirect costs encompassed diversion (misuse of prescriptions) and criminal justice costs.

However, when it comes to cost-effective treatments, physical therapy stands out. A study titled "Cost-Effectiveness of Physical Therapy vs Intra-articular Glucocorticoid Injection for Knee Osteoarthritis" by Rhon et al. in 2022 provides valuable insights:

• Net Benefit: The average net benefit of treating osteoarthritis of the knee with physical therapy is estimated to be $13,981 per episode of care.
• Quality-Adjusted Life Year (QALY): Patients who underwent physical therapy had a mean QALY of 0.07 higher compared to those who received intra-articular glucocorticoid injections.
• Medical Costs: Those who received physical therapy had a mean medical cost of $1,024 higher than those who got injections. However, when considering the overall net benefit and the improvement in QALY, physical therapy proves to be a more cost-effective solution.

In conclusion, while the upfront costs of physical therapy might be slightly higher than some treatments, the long-term benefits, both in terms of health outcomes and economic savings, make it a superior choice for managing knee osteoarthritis.

(Note: The above blog post is a summarized version of the research findings. For a comprehensive understanding, readers are encouraged to refer to the original research articles.)

Citations
Knoop et al., 2015
Tanaka et al., 2016
Goh et al., 2019
Alnahdi et al., 2012
Urquhart et al., 2011
Brosseau et al., 2017
Brandt, 2003
Deyle et al., 2000
Cheing & Hui-Chan, 2004
Teo et al., 2020
APTA's Economic Value Report, 2023