Effectiveness of manual therapy vs conventional physical therapy with neuromuscular training in the management of knee osteoarthritis: A randomized clinical controlled trial

Background: Osteoarthritis (OA) is a chronic degenerative disorder mainly affecting the knee joint. Objective: The objective of the study was to evaluate the effectiveness of manual therapy (MT) with neuromuscular training (NMT) and conventional physical therapy (CPT) with NMT for chronic knee OA. Methods: Randomized, double-blinded controlled study design conducted at government hospitals for the period of 12 months. Sixty subjects aged 40 and 70 were randomly assigned into experimental (MT + NMT) and control (CPT + NMT) groups using the block randomization method. The outcome measures are pain, Knee Flexion ROM, disability, balance, and quality of life, which were measured at baseline, three and six weeks. The effects of treatment were examined utilizing separate 2-by-3 mixed-model analyses of variance using SPSS 25.0. Results: Demographic characteristics such as age, gender, height and weight did not show any statistically significant differences between the groups (p > 0.05). The experimental group (EG) showed a significant reduction in pain compared to the control group (CG) after 3 weeks of intervention (mean between-group difference 1.5 (95 %CI: 1.21to1.78). This was maintained during a 6-week follow-up of 2.6 (95 %CI: 2.31–2.88). At three weeks, patients showed a significantly greater flexion ROM improvement in the EG as well as in the six-week follow-up. Similarly, functional disability, balance and quality of life were significantly better in the EG at the 3 and 6-week follow-ups respectively. Conclusions: Our study results showed a significant improvement in the clinical outcomes following the application of manual therapy with neuromuscular training in managing chronic Knee Osteoarthritis. Clinical significance of the study: The clinical significance of studies on OA knee physical therapy for researchers, physicians, and patients resides in the potential to optimize care, reduce pain and disability, and enhance quality of life. Research shows the efficacy of exercise therapy and educational programs in enhancing clinical practice, empowering patients in self-management, and reducing healthcare costs. For researchers: Research on physical therapy for OA knee contributes to the growing body of evidence supporting targeted therapies, such as exercise therapy and educational programs. Recent studies inform physical therapy practices, creating an essential evidence base for developing and refining clinical recommendations. This research can identify the most effective types of exercises, appropriate dosages, and delivery methods tailored to various subgroups of individuals with knee OA. For clinicians: By employing evidence-based therapies, clinicians can enhance measures of outcomes, such as pain, mobility, physical function, and quality of life. Clinicians determine the most suitable therapies for individual patients by evaluating criteria such as severity of the disease, patient preferences, and the available resources. For patients: Enhanced analgesic strategies and effective physical therapy can help patients keep their independence and engage more fully in daily life by enabling them to engage in activities and reducing their dependency on medication without the possibility of negative side effects. Education and self-management strategies can enable patients to take control of their health and make informed decisions regarding their care; in certain instances, physical therapy may postpone or even eliminate the necessity for knee replacement surgery by enhancing pain relief and functionality.