title: Physical therapy interventions for knee pain secondary to osteoarthritis: a systematic review.
abstract: BACKGROUND
  Osteoarthritis is a leading cause of disability. Nonsurgical treatment is a key first step.
  
  
  OBJECTIVE
  Systematic literature review of physical therapy (PT) interventions for community-dwelling adults with knee osteoarthritis.
  
  
  METHODS
  MEDLINE, the Cochrane Library, the Physiotherapy Evidence Database, Scirus, Allied and Complementary Medicine, and the Health and Psychosocial Instruments bibliography database.
  
  
  METHODS
  193 randomized, controlled trials (RCTs) published in English from 1970 to 29 February 2012.
  
  
  METHODS
  Means of outcomes, PT interventions, and risk of bias were extracted to pool standardized mean differences. Disagreements between reviewers abstracting and checking data were resolved through discussion.
  
  
  RESULTS
  Meta-analyses of 84 RCTs provided evidence for 13 PT interventions on pain (58 RCTs), physical function (36 RCTs), and disability (29 RCTs). Meta-analyses provided low-strength evidence that aerobic (11 RCTs) and aquatic (3 RCTs) exercise improved disability and that aerobic exercise (19 RCTs), strengthening exercise (17 RCTs), and ultrasonography (6 RCTs) reduced pain and improved function. Several individual RCTs demonstrated clinically important improvements in pain and disability with aerobic exercise. Other PT interventions demonstrated no sustained benefit. Individual RCTs showed similar benefits with aerobic, aquatic, and strengthening exercise. Adverse events were uncommon and did not deter participants from continuing treatment.
  
  
  CONCLUSIONS
  Variability in PT interventions and outcomes measures hampered synthesis of evidence.
  
  
  CONCLUSIONS
  Low-strength evidence suggested that only a few PT interventions were effective. Future studies should compare combined PT interventions (which is how PT is generally administered for pain associated with knee osteoarthritis).
  
  
  BACKGROUND
  Agency for Healthcare Research and Quality.
authors.affiliation: Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College Street, Room 432, New Haven, CT 06520, USA.
authors.forename: Shi-Yi
authors.initials: SY
authors.lastname: Wang
authors.forename: Becky
authors.initials: B
authors.lastname: Olson-Kellogg
authors.forename: Tatyana A
authors.initials: TA
authors.lastname: Shamliyan
authors.forename: Jae-Young
authors.initials: JY
authors.lastname: Choi
authors.forename: Rema
authors.initials: R
authors.lastname: Ramakrishnan
authors.forename: Robert L
authors.initials: RL
authors.lastname: Kane
mesh_terms: D057186:Comparative Effectiveness Research; D006801:Humans; D020370:Osteoarthritis, Knee / Q000150:complications* / Q000628:therapy*; D059408:Pain Management / Q000379:methods*; D026741:Physical Therapy Modalities / Q000009:adverse effects; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic