Most people with mild to moderate knee OA can exercise successfully in a community-based program or on their own if the physician initiates discussion of the importance of physical activity, offers positive recommendations and follows up consistently. People who have more severe disease or worse symptoms may initially need more arthritis-specific instruction and supervision to learn how to exercise without increasing pain or becoming discouraged. People who attribute their activity limitation to arthritis and are currently not engaged in a regular physical activity program often will do better in group classes that address arthritis issues and self-management training. However, people for whom current pain is severe or for whom minimal activity increases pain may benefit from a more individualized therapeutic encounter.
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Explore This IssueMay 2008
Some Patients Benefit from Physical Therapy
A referral to physical therapy is appropriate if your patient is limited by pain, has a history of unsuccessful exercise attempts, exhibits gait deviations, or exhibits marked weakness or malalignment of the knee (i.e., laxity or varus or valgus deformity) or malalignment of the foot/ankle (e.g., ankle/foot pain, uneven shoe wear). A physical therapist can offer evidence-based care and assist the person with knee OA in a number of areas.8 Table 4 lists common problems that limit a person’s ability to be physically active that can be addressed by a physical therapist.
Patients are more likely to follow an exercise program if it is introduced by the physician and reinforced regularly at office visits. If the physician expresses interest, engages in discussion, offers positive suggestions, and promises to follow up on subsequent visits, the patient is more likely to attempt the activity. It is not necessary for the doctor to be an exercise specialist or have all the answers, but it is critical to express interest in what the patient is doing, be positive in your belief in the importance and feasibility of increasing patient activity, and suggest resources and make appropriate referrals. With exercise as a foundation of OA management, outcomes should improve as patients become stronger and more active and their pain and disability diminish.
Dr. Minor is professor and chair of physical therapy at the School of Health Professions at the University of Missouri in Columbia.
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- Hurley MV, Walsh NE, Mitchell HL, et al. Clinical effectiveness of a rehabilitation program integrating exercise, self-management, and active coping strategies for chronic knee pain: A cluster randomized trial. Arth Rheum. (Arth Care Res.) 2007;57:1211-1219.
- Brady TJ, Boutaugh ML. Self-management education and support. In Bartlett SJ, ed. Clinical Care in the Rheumatic Diseases. 3rd ed. Atlanta, GA: Association of Rheumatology Health Professionals; 2006: 203-210.
- Jamtvedt G, Dahme KT, Christie A, et al. Physical therapy interventions for patients with osteoarthritis of the knee: An overview of systematic reviews. Phys Ther. 2008; 88:123-135.
- Ottawa Panel evidence-based clinical practice guidelines for therapeutic exercises and manual therapy in the management of osteoarthritis. i. 2005;85:907-971.
- Roddy E, Zhang W, Doherty M, et al. Evidence-based recommendations for the role of exercise in the management of osteoarthritis of the hip or knee: The MOVE consensus. Rheumatology. 2005;44:67-71.
- Work Group Recommendations: 2002 Exercise and Physical Activity Conference, St. Louis, MO. Session V: Evidence of benefit of exercise and physical activity in arthritis. Arthritis Rheum. (Arth Care Res.) 2003; 49:453-454.
- Franklin BA, Whaley MH, Howley ET. ACSM’s Guidelines for Exercise Testing and Prescription. 6th ed. Philadephia: Lippincott Williams & Wilkins; 2000.