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Comparison of non-thrust manipulation versus muscle energy techniques in management of patients with knee osteoarthritis: a randomized clinical trial
Witwit RT, Shadmehr A, Mir SM, Fereydounnia S, Jalaie S
NeuroQuantology 2022;20(6):6843-6859
clinical trial
8/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND: The objective of this study is to compare the effectiveness of Non-thrust Manipulation and Muscle Energy Techniques (MET) both with supervised exercises and Transcutaneous Electrical Nerve Stimulation (TENS) to demonstrate the most appropriate treatment approach from these two intervention methods for Knee Osteoarthritis (KOA) management. MATERIALS AND METHODS: This study included 42 participants who were suffering from grade II primary KOA. The first group (N = 21) received non-thrust manipulation and the second group (N = 21) received MET. Both groups received the same supervised exercises and TENS 1 program, three times a week, consisting of 10 sessions total. The Visual Analogue Scale (VAS), Western Ontario and McMaster Universities index (WOMAC), Passive Knee Extension test (PKE), 6 Minute Walking Test (6MWT), 30 Second Chair Stand Test (30CST), and Tibio-Femoral Angle (TFA) were measured at baseline and after completing the 10th session. RESULTS: The results showed statistically significant improvement for all outcome measurements in both within groups separately (p < 0.001). Statistics results of between groups comparisons showed that there were significant differences in the mean of improvement of VAS at rest and during activity (p = 0.01, p = 0.002, respectively), WOMAC scores (p = 0.001), PKE ROM (p = 0.000), 30CST (p = 0.015), and TFA (p = 0.001). Except for the 6MWT distance, there was no significant difference (p = 0.519). CONCLUSIONS: Both non-thrust manipulation and MET are effective treatment strategies in the management of KOA. For greater effect on improving pain and physical function, non-thrust manipulation may be used. MET may be used for greater improvement in knee extension ROM in patients with KOA.

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