Physical Therapy: Just as Effective as Surgery

03/25/2013

Photo: Physical therapy for the knee

A new study shows that physical therapy for the knee is just as affective as surgery; © panthermedia.
net/Wavebreakmedia Ltd

A new study showing that physical therapy is just as effective as surgery in patients with meniscal tears and arthritis of the knee should encourage many health care providers to reconsider their practices in the management of this common injury.

The study showed no significant differences in functional improvement after 6 months between patients who underwent surgery with postoperative physical therapy and those who received standardized physical therapy alone. "This study demonstrates what physical therapists have long known," explained Paul A. Rockar Jr., President of the American Physical Therapy Association (APTA). "Surgery may not always be the best first course of action. A physical therapist, in many cases, can help patients avoid the often unnecessary risks and expenses of surgery. This study should help change practice in the management of symptomatic meniscal tears in patients with knee osteoarthritis."

According to lead physical therapist for the trial Clare Safran-Norton, "our findings suggest that a course of physical therapy in this patient population may be a good first choice since there were no group differences at 6 months and 12 months in this trial. These findings should help surgeons, physicians, physical therapists, and patients in decision-making regarding their treatment options."

Researchers at 7 major universities and orthopedic surgery centers around the country studied 351 patients aged 45 years or older who had a meniscal tear and mild-to-moderate osteoarthritis of the knee. Patients were randomly assigned to groups who received either surgery and postoperative physical therapy or standardized physical therapy. Within 6-12 months, patients who had physical therapy alone showed similar improvement in functional status and pain as those who had undergone arthroscopic partial meniscectomy surgery.

Patients who were given standardized physical therapy — individualized treatment and a progressive home exercise program — had the option of "crossing over" to surgery if substantial improvements were not achieved. Thirty percent of patients crossed over to surgery during the first 6 months. At 12 months these patients reported similar outcomes as those who initially had surgery. Seventy percent of patients remained with standardized physical therapy.

Physical therapist and APTA member Mary Ann Wilmarth, chief of physical therapy at Harvard University, said, "Physical therapists are experts in improving mobility and restoring motion. The individualized treatment approach is very important in the early phases of rehabilitation in order to achieve desired functional outcomes and avoid setbacks or complications."

MEDICA.de; Source: American Physical Therapy Association