Efficacy of Specified Manual Therapies in Combination with a Supervised Exercise Protocol for Managing Pain Intensity and Functional Disability in Patients with Knee Osteoarthritis

Figures & data

Figure 1 A CONSORT (2010) flow diagram of study procedure (enrollment, allocation, follow-up and analysis).

Table 1 Details of the Interventions Given to Both Group A and Group B (N=32)

Group A

Group B

• Supervised exercise protocol containing both strengthening and stretching exercises • Strengthening exercises includes a sets/group of exercises such as  • Static quad set in knee extension  • Standing terminal knee extension  • Seated leg press  • Partial squats (weight-lessened with arm support as needed), and  • Step-ups • Stretching exercises includes the stretching of different muscle groups in different positions such as  • Standing calf stretch  • Supine hamstring muscle stretch  • Prone quadriceps femoris muscle stretch

• Supervised exercise protocol containing both strengthening and stretching exercises of quadriceps muscles as given in group A • Manual therapy including both myofascial mobilization and manipulation techniques  • Myofascial mobilization technique  • Myofascial manipulation technique

Table 2 Baseline Measurements (Mean±SD) for All the Variables [N=32] Using Unpaired t-Test

Variables (N=32)		Group A (Mean±SD)	Group B (Mean±SD)	Group A vs B (∆MD±SD)	t-Test for Equality of Means
					t-value	p-value
Sex	Male	10	9
	Female	6	7
Age (yrs.)		53.25±3.91	54.19±4.93	−0.94±-1.02	−0.60	0.556^ns
WOMAC		51.75±5.56	48.12±15.51	3.63±-9.95	0.88	0.386^ns
NRPS		5.19±0.83	5.00±1.32	0.19±-0.49	0.48	0.634^ns

Note: ^nsNon-significant value if p>0.05.

Abbreviations: WOMAC, The Western Ontario and McMaster Universities Osteoarthritis Index; NPRS, numeric pain rating scale; SD, standard deviation; ∆MD, mean difference.

Table 3 Comparison (Mean±SD) of the Variables (WOMAC & NPRS) Between the Groups at Different Time-Intervals Using Unpaired t-Test (N=32)

Variables (N=32)		Group A (Mean±SD)	Group B (Mean±SD)	Group A vs B (∆MD±∆SD)	Unpaired t-Test
					t -value	p-value
NPRS	NPRS1	5.19±0.83	5.00 ±1.32	0.19±0.49	0.48	0.634^ns
	NRPS2	3.63±1.02	2.94±1.24	0.69±0.22	1.71	0.097^ns
	NPRS4	4.56±1.26	4.25±0.93	0.31±0.33	0.80	0.432^ns
WOMAC	WOMAC1	51.75±5.56	48.12±15.51	3.63±9.95	0.88	0.386^ns
	WOMAC2	36.81±7.08	25.94±10.51	10.87±3.43	3.43	0.002*
	WOMAC4	45.00±6.53	37.00±13.68	8.00±7.15	2.11	0.043*

Notes: *Significant value if p<0.05; ^nsNon-significant value if p>0.05; SD, standard deviation.

Abbreviations: WOMAC, The Western Ontario and McMaster Universities Osteoarthritis Index; NPRS, numeric pain rating scale; NPRS1, NPRS scores at baseline (pre-intervention); NPRS2, NPRS scores at 2 weeks post-intervention; NPRS4, NPRS scores at 4 weeks post-intervention; WOMAC1, WOMAC scores at baseline (pre-intervention); WOMAC2, WOMAC scores at 2 weeks post-intervention; WOMAC 4, WOMAC scores at 4 weeks post-intervention.

Table 4 Pairwise Comparisons of Mean Differences (∆MD) for the Outcomes NPRS and WOMAC Within the Group Using Repeated Measures ANOVA (N=32)

Outcomes	Time-Intervals (Pairwise)	Group A		Group B
		∆MD±SE	p-value	∆MD±SE	p-value
NPRS scores	NPRS1 vs NPRS2	1.56±0.13	0.001**	2.06±0.17	0.001**
	NPRS2 vs NPRS4	−0.94±0.14	0.001**	−1.31±0.12	0.001**
	NPRS1 vs NPRS4	0.62±0.15	0.003*	0.75±0.19	0.005*
WOMAC scores	WOMAC1 vs WOMAC2	14.94±0.76	0.001**	22.19±1.83	0.001**
	WOMAC2 vs WOMAC4	−8.19±0.46	0.001**	−11.06±1.33	0.001**
	WOMAC1 vs WOMAC4	6.75±0.68	0.001**	11.12±1.32	0.001**

Notes: *Significance value if p<0.05; **Highly significant value if p<0.01.

Abbreviations: WOMAC, The Western Ontario and McMaster Universities Osteoarthritis Index; NPRS, numeric pain rating scale; NPRS1, NPRS scores at baseline (pre-intervention); NPRS2, NPRS scores at 2 weeks post-intervention; NPRS4, NPRS scores at 4 weeks post-intervention; WOMAC1, WOMAC scores at baseline (pre-intervention); WOMAC2, WOMAC scores at 2 weeks post-intervention; WOMAC 4, WOMAC scores at 4 weeks post-intervention; ∆MD, mean differences; SE, standard error.