A randomized controlled trial of osteopathic manipulative treatment following knee or hip arthroplasty.
BACKGROUND
Preliminary study results suggest that osteopathic manipulative treatment (OMT) may reduce pain, improve ambulation, and increase rehabilitation efficiency in patients undergoing knee or hip arthroplasty.


OBJECTIVE
To determine the efficacy of OMT in patients who recently underwent surgery for knee or hip osteoarthritis or for a hip fracture.


METHODS
Randomized controlled trial involving hospital and postdischarge phases.


METHODS
Hospital-based acute rehabilitation unit.


METHODS
A total of 42 women and 18 men who were hospitalized between October 1998 and August 1999.


METHODS
Patients were randomly assigned to groups that received either OMT or sham treatment in addition to standard care. Manipulation was individualized and performed according to study guidelines regarding frequency, duration, and technique.


METHODS
Changes in Functional Independence Measure (FIM) scores and in daily analgesic use during the rehabilitation unit stay; length of stay; rehabilitation efficiency--defined as the FIM total score change per rehabilitation unit day; and changes in Medical Outcomes Study Short Form-36 scores from rehabilitation unit admission to 4 weeks after discharge.


RESULTS
Of 19 primary outcome measures, the only significant difference between groups was decreased rehabilitation efficiency with OMT (2.0 vs 2.6 FIM total score points per day; P = .01). Stratified analyses demonstrated that poorer OMT outcomes were confined to patients with osteoarthritis who underwent total knee arthroplasty (length of stay, 15.0 vs 8.3 days; P = .004; rehabilitation efficiency, 2.1 vs 3.4 FIM total score points per day; P < .001).


CONCLUSIONS
The OMT protocol used does not appear to be efficacious in this hospital rehabilitation population.
Licciardone
John C
JC
University of North Texas Health Science Center at Fort Worth-Texas College of Osteopathic Medicine, 3500 Camp Bowie Blvd, Fort Worth, TX 76107, USA. jlicciar@hsc.unt.edu
Stoll
Scott T
ST
Cardarelli
Kathryn M
KM
Gamber
Russell G
RG
Swift
Jon N
JN
Winn
William B
WB
D000368:Aged; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D015897:Comorbidity; D004311:Double-Blind Method; D005260:Female; D005593:Fracture Fixation, Internal; D006304:Health Status; D006620:Hip Fractures / Q000534:rehabilitation* / Q000601:surgery*; D006801:Humans; D008297:Male; D026301:Manipulation, Osteopathic; D015207:Osteoarthritis, Hip / Q000534:rehabilitation* / Q000601:surgery*; D020370:Osteoarthritis, Knee / Q000534:rehabilitation* / Q000601:surgery*; D016896:Treatment Outcome