PAIN+ CPN

Sit RWS, Chan KKW, Zou D, et al. Clinic-Based Patellar Mobilization Therapy for Knee Osteoarthritis: A Randomized Clinical Trial. Ann Fam Med. 2018 Nov;16(6):521-529. doi: 10.1370/afm.2320. (Original study)
Abstract

PURPOSE: We performed a phase 2 randomized clinical trial to evaluate the preliminary effectiveness of a clinic-based patellar mobilization therapy (PMT) in patients with knee osteoarthritis.

METHODS: We recruited 208 patients with knee osteoarthritis at primary care clinics in Hong Kong. Patients were randomly assigned (1:1) to the intervention group or the control group. The intervention group received 3 PMT treatment sessions from primary care physicians at 2-month intervals, with concomitant prescription of a home-based vastus medialis oblique muscle exercise. The control group received PMT after the study period. The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain score. Secondary outcomes included the WOMAC composite, function, and stiffness scores; the visual analog scale score for pain; objective physical function tests (30-s chair stand, 40-m walk test, timed up and go test, and EuroQol-5D). All outcomes were evaluated at baseline and at 24 weeks through intention-to-treat analysis.

RESULTS: We observed no baseline between-group differences. The WOMAC pain score showed greater improvement in the intervention group than in the control group at 24 weeks (between-group difference - 15.6, 95% CI, - 20.5 to - 10.7, P <.001). All secondary outcomes also demonstrated significant between-group differences.

CONCLUSIONS: Patellar mobilization therapy has the potential to reduce pain and improve function and quality of life for patients with knee osteoarthritis. Future clinical trials with comparison to other active comparator controls will help determine the overall efficacy and facilitate the deployment of PMT in real-world practice.

Ratings
Discipline Area Score
Rehab Clinician (OT/PT) 5 / 7
Physician 4 / 7
Comments from MORE raters

Rehab Clinician (OT/PT) rater

This is quite a high quality study - pedro would be around 8/10, which shows good significant changes to patients. There is definitely a growing body of evidence to assess and manage patients with PFJ OA, and the role of the patella in managing knee pain.

Rehab Clinician (OT/PT) rater

This article confirms what has been been demonstrated previously. Active strengthening is beneficial for patients with AO. It can not be determined due to lack of control group that the patellar mobilization had any positive contribution. The study design should have had an active control group to have made this study valuable.

Rehab Clinician (OT/PT) rater

The key finding that 'patellar mobilization therapy has the potential to reduce pain and improve function and quality of life for patients with knee osteoarthritis' provides a evidence-based treatment option for this client group. A concern would be the time needed for the mobilization, especially when one considers that this client group is often managed with educational approaches.

Rehab Clinician (OT/PT) rater

Although this is a good study, they added both mobilization and strengthening but concluded that the improvements were from the mobilization. There is already good evidence to support the strengthening program in knee OA decrease pain. How can they be sure it wasn't the exercise that made the difference and the patella mobs were irrelevant??
Comments from PAIN+ CPN subscribers

No subscriber has commented on this article yet.