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Efficacy of physiotherapy management of knee joint osteoarthritis: a randomised, double blind, placebo controlled trial

K L Bennell¹, R S Hinman¹, B R Metcalf¹, R Buchbinder², J McConnell¹, G McColl³, S Green⁴, K M Crossley¹

¹ Centre for Health, Exercise and Sports Medicine, School of Physiotherapy, University of Melbourne, Parkville, Victoria, Australia
² Monash Department of Clinical Epidemiology, Cabrini Hospital and Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
³ Department of Medicine, Royal Melbourne Hospital, University of Melbourne
⁴ Monash Institute of Health Services Research, Monash University

Correspondence to:
Correspondence to:
Associate Professor Kim Bennell
Centre for Health, Exercise and Sports Medicine, School of Physiotherapy, University of Melbourne, Parkville, Victoria, Australia 3010; k.bennell{at}unimelb.edu.au

Objective: To determine whether a multimodal physiotherapy programme including taping, exercises, and massage is effective for knee osteoarthritis, and if benefits can be maintained with self management.

Methods: Randomised, double blind, placebo controlled trial; 140 community volunteers with knee osteoarthritis participated and 119 completed the trial. Physiotherapy and placebo interventions were applied by 10 physiotherapists in private practices for 12 weeks. Physiotherapy included exercise, massage, taping, and mobilisation, followed by 12 weeks of self management. Placebo was sham ultrasound and light application of a non-therapeutic gel, followed by no treatment. Primary outcomes were pain measured by visual analogue scale and patient global change. Secondary measures included WOMAC, knee pain scale, SF-36, assessment of quality of life index, quadriceps strength, and balance test.

Results: Using an intention to treat analysis, physiotherapy and placebo groups showed similar pain reductions at 12 weeks: –2.2 cm (95% CI, –2.6 to –1.7) and –2.0 cm (–2.5 to –1.5), respectively. At 24 weeks, pain remained reduced from baseline in both groups: –2.1 (–2.6 to –1.6) and –1.6 (–2.2 to –1.0), respectively. Global improvement was reported by 70% of physiotherapy participants (51/73) at 12 weeks and by 59% (43/73) at 24 weeks. Similarly, global improvement was reported by 72% of placebo participants (48/67) at 12 weeks and by 49% (33/67) at 24 weeks (all p>0.05).

Conclusions: The physiotherapy programme tested in this trial was no more effective than regular contact with a therapist at reducing pain and disability.

Abbreviations: AQoL, assessment of quality of life index; SF-36, short form 36 item general health questionnaire; VAS, visual analogue scale; WOMAC, Western Ontario and McMaster Universities osteoarthritis index

Keywords: osteoarthritis; knee; physiotherapy; randomised controlled trial

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