scholarly journals Functional Outcomes of Arthroscopic Partial Meniscectomy Versus Physical Therapy for Degenerative Meniscal Tears Using a Patient-Specific Score: A Randomized Controlled Trial

2020 ◽  
Vol 8 (10) ◽  
pp. 232596712095439
Author(s):  
Julia C.A. Noorduyn ◽  
Tess Glastra van Loon ◽  
Victor A. van de Graaf ◽  
Nienke W. Willigenburg ◽  
Ise K. Butter ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Physical Therapy ◽  
Controlled Trial ◽  
Partial Meniscectomy ◽  
Patient Specific ◽  
Minimal Important Change ◽  
Meniscal Tears ◽  
Escape Trial ◽  
Randomized Controlled

Background: It is unknown whether the treatment effects of partial meniscectomy and physical therapy differ when focusing on activities most valued by patients with degenerative meniscal tears. Purpose: To compare partial meniscectomy with physical therapy in patients with a degenerative meniscal tear, focusing on patients’ most important functional limitations as the outcome. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: This study is part of the Cost-effectiveness of Early Surgery versus Conservative Treatment with Optional Delayed Meniscectomy for Patients over 45 years with non-obstructive meniscal tears (ESCAPE) trial, a multicenter noninferiority randomized controlled trial conducted in 9 orthopaedic hospital departments in the Netherlands. The ESCAPE trial included 321 patients aged between 45 and 70 years with a symptomatic, magnetic resonance imaging–confirmed meniscal tear. Exclusion criteria were severe osteoarthritis, body mass index >35 kg/m2, locking of the knee, and prior knee surgery or knee instability due to an anterior or posterior cruciate ligament rupture. This study compared partial meniscectomy with physical therapy consisting of a supervised incremental exercise protocol of 16 sessions over 8 weeks. The main outcome measure was the Dutch-language equivalent of the Patient-Specific Functional Scale (PSFS), a secondary outcome measure of the ESCAPE trial. We used crude and adjusted linear mixed-model analyses to reveal the between-group differences over 24 months. We calculated the minimal important change for the PSFS using an anchor-based method. Results: After 24 months, 286 patients completed the follow-up. The partial meniscectomy group (n = 139) improved on the PSFS by a mean of 4.8 ± 2.6 points (from 6.8 ± 1.9 to 2.0 ± 2.2), and the physical therapy group (n = 147) improved by a mean of 4.0 ± 3.1 points (from 6.7 ± 2.0 to 2.7 ± 2.5). The crude overall between-group difference showed a –0.6-point difference (95% CI, –1.0 to –0.2; P = .004) in favor of the partial meniscectomy group. This improvement was statistically significant but not clinically meaningful, as the calculated minimal important change was 2.5 points on an 11-point scale. Conclusion: Both interventions were associated with a clinically meaningful improvement regarding patients’ most important functional limitations. Although partial meniscectomy was associated with a statistically larger improvement at some follow-up time points, the difference compared with physical therapy was small and clinically not meaningful at any follow-up time point. Registration: NCT01850719 ( ClinicalTrials.gov identifier) and NTR3908 (the Netherlands Trial Register).

COMPARISON OF THE EFFECT OF AQUATIC PHYSICAL THERAPY AND CONVENTIONAL PHYSICAL THERAPY IN PATIENTS WITH LUMBAR SPINAL STENOSIS (A RANDOMIZED CONTROLLED TRIAL)

2015 ◽  
Vol 18 (01) ◽  
pp. 1550002 ◽  
Author(s):  
Kaynoosh Homayouni ◽  
Mahshid Naseri ◽  
Foroozandeh Zaravar ◽  
Leila Zaravar ◽  
Hajar Karimian
Keyword(s):  
Randomized Controlled Trial ◽  
Physical Therapy ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Controlled Trial ◽  
Repeated Measure ◽  
Aquatic Therapy ◽  
Randomized Controlled ◽  
Lumbar Spinal

Purpose: To assess and compare the effect of aquatic and conventional physical therapy, two well-known non-operative therapeutic options in patients with lumbar spinal stenosis (LSS). Methods: 50 patients with low back pain and the diagnosis of LSS were recruited in this prospective parallel randomized controlled trial. Patients in group one were enrolled in aquatic therapy program and those in group two attended physical therapy sessions through application of physical modalities and receiving a home-based exercise program. Pain and walking ability were measured in each group before therapy, immediately after therapy and three months later. Results: Patients in both groups improved regarding pain either assessed immediately after therapy (repeated measure test, p < 0.001) or three months later (Wilcoxon test, p < 0.001 for group one and p = 0.005 for group two). Functioning improved in both groups (repeated measure test, p < 0.001) but this advantage did not remain significant after three months follow up in group two (repeated measure test, p = 0.002 in group one and p = 0.181 in group two). Patients in group one had significantly more favorable outcome than group two regarding functioning (independent samples t-test, p = 0.02) and pain (Mann–Whitney test, p = 0.001); however, this superiority didn't sustain in long term follow up. Conclusion: Aquatic therapy can provide greater short term improvement in pain and functioning than conventional physical therapy in patients with LSS especially those with limited capability for exercise on land.

scholarly journals A Comparative Study of the Effectiveness of Pharmacopuncture Therapy for Chronic Neck Pain: A Pragmatic, Randomized, Controlled Trial

2021 ◽  
Vol 11 (1) ◽  
pp. 12
Author(s):  
Kyoung-Sun Park ◽  
Suna Kim ◽  
Changnyun Kim ◽  
Ji-Yeon Seo ◽  
Hyunwoo Cho ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Physical Therapy ◽  
Neck Pain ◽  
Therapy Group ◽  
Controlled Trial ◽  
Chronic Neck Pain ◽  
Arm Pain ◽  
Randomized Controlled ◽  
Vas Score

Background: This two-arm, parallel, pragmatic, multicenter, clinical randomized, controlled trial with a 12-week follow-up period aimed to compare the effectiveness of pharmacopuncture therapy and physical therapy strategies for chronic neck pain. Methods: Eight sessions of pharmacopuncture therapy or physical therapy were administered within 2 weeks. The primary outcome was the visual analogue scale (VAS) score for neck pain. The secondary outcomes were the scores of the Northwick Park questionnaire (NPQ), VAS score for radiating arm pain, numeric rating scale (NRS) for neck and arm bothersomeness, neck disability index (NDI), patient global impression of change (PGIC), 12-item short form health survey (SF-12), and EuroQoL 5-dimension 5-level (EQ-5D-5L) instrument. The protocol was registered with Clinicaltrials.gov (NCT04035018) and CRIS (KCT0004243). Results: We randomly allocated 101 participants with chronic neck pain to the pharmacopuncture therapy (n = 50) or physical therapy group (n = 51). At the primary endpoint (week 5) the pharmacopuncture therapy group showed significantly superior effects regarding VAS score for neck pain and arm bothersomeness, NRS for neck pain, NDI, NPQ, and PGIC compared with the physical therapy group. These effects were sustained up to 12 weeks after follow-up. Conclusion: Compared with physical therapy, pharmacopuncture therapy had superior effects on the pain and functional recovery of patients with chronic neck pain.

scholarly journals Physiotherapy Based on a Biobehavioral Approach with or Without Orthopedic Manual Physical Therapy in the Treatment of Nonspecific Chronic Low Back Pain: A Randomized Controlled Trial

Pain Medicine ◽  
2019 ◽  
Vol 20 (12) ◽  
pp. 2571-2587 ◽  
Author(s):  
Mónica Grande-Alonso ◽  
Luis Suso-Martí ◽  
Ferran Cuenca-Martínez ◽  
Joaquín Pardo-Montero ◽  
Alfonso Gil-Martínez ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Low Back Pain ◽  
Back Pain ◽  
Physical Therapy ◽  
Chronic Low Back Pain ◽  
Controlled Trial ◽  
Low Back ◽  
Psychological Variables ◽  
Randomized Controlled

Abstract Objective To compare the effectiveness of a biobehavioral approach with and without orthopedic manual physical therapy on the intensity and frequency of pain in patients diagnosed with nonspecific chronic low back pain. Methods A single-blind randomized controlled trial. Fifty patients were randomly allocated into two groups: one group received biobehavioral therapy with orthopedic manual physical therapy, and the other group received only biobehavioral therapy. Both groups completed a total of eight sessions, with a frequency of two sessions per week. The somatosensory, physical, and psychological variables were recorded at baseline and during the first and third month after initiation of treatment. Results In both groups, the treatment was effective, presenting significant differences for all the variables in the time factor. There were no significant differences between groups in intensity or frequency of pain, with a large effect size (&gt;0.80), but there were intragroup differences for both intervention groups at one- and three-month follow-up. There were also no significant differences between groups in the secondary variables during the same follow-up period. Conclusions The results of this study suggest that orthopedic manual physical therapy does not increase the effects of a treatment based on biobehavioral therapy in the short or medium term, but these results should be interpreted with caution.

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