A network for students interested in evidence-based health care

Manual therapy, exercise therapy or both in addition to usual care for Osteoarthritis of the hip or knee

Posted on 29th January 2014 by

Evidence Reviews
Osteoarthritis Credit: Wellcome Photo Library. Wellcome Images images@wellcome.ac.uk http://wellcomeimages.org Osteoarthritis


Hip OAOsteoarthritis (OA) is one of the most common forms of arthritis. It is a chronic condition where cartilage breaks down, which causes bones to rub against each other. Injury, obesity and/or aging joints can cause OA. The main symptoms of OA are joint pain and stiffness. Millions of people worldwide have OA. Unfortunately OA is progressive and will only worse with time. There is no cure for OA however, treatment can decrease joint pain and stiffness and improve mobility.

Abbott, J.H.: Robertson, M.C.; Chapple, C.; Pinto,D.; Wright, A.A.; Leon de la Barra,S.; Baxter, G.D.; Theis,J.C.; Campbell, A.J.; MOA Trail Team. Manual therapy, exercise therapy, or both, in addition to usual care, for osteoarthritis of the hip or knee: a randomized controlled trial. 1: clinical effectiveness. Osteoarthritis Cartilage, 2013, 21, 4, 525-534

What was the Study?

The researchers of this study gathered 206 participants all of whom met the American College of Rheumatology criteria for knee or hip OA. The purpose of this study was to evaluate the effectiveness of manual therapy + usual care, exercise therapy + usual care and a combination of manual therapy and exercise therapy + usual care to see which would be most beneficial to patients the hip or knee OA. The primary outcome measure used was the Western Ontario and McMaster osteoarthritis index (WOMAC).  Participants were randomly assigned into the manual therapy group, the exercise group, the combination group or the no treatment group. Each participant in the manual therapy, exercise and combination group attended 7-therapy session during the first 9 weeks of the study and two additional therapy sessions during week 16 of the study. In addition to the therapy sessions, participants were all given home exercise programs, based on the different groups, to complete 3 times per week at home. Outcomes were assessed at the 9-week, 6-month and 1-year mark.

What were the Results?

According to this study the combination of manual therapy and exercise did not provide additional benefit to the patients compared to manual therapy or exercise alone. The results indicated that both manual therapy and exercises were beneficial if done separately. Although the aim of this study was no to compare manual therapy to exercise the numbers indicate that manual therapy produces slightly greater benefits than exercise.

What were the Strengths and Weaknesses?

One of the major strengths of this article was the 92.3% retention rate of the participants at the 1-year follow up. This allowed the researchers to maintain the sample-size necessary in order to assess statistical significance. One of the limitations of this study is the lack the detail. The authors never describe what usual care entails. They never mention how many therapist provided care. The authors also do not list the types of exercises performed or the type of manual therapy performed. These are listed in an index that is not included within the article itself.

Take Home Message?

The results of this study do not coincide with my personal experience in the clinic and what I learned in school.  I believe that additional research should be done in this area to see which method, manual therapy, exercise or a combination of manual therapy and exercise is truly the most beneficial in decreasing joint pain and stiffness and improving functional mobility.


Jessica Gulley

I'm a third year DPT student at Elon University. I did my undergraduate at UNC Charlotte. My Physical Therapy interests are sports rehab and manual therapy. View more posts from Jessica

Leave a Reply

Your email address will not be published. Required fields are marked *

Subscribe to our newsletter

You will receive our monthly newsletter and free access to Trip Premium.