退化性膝關節炎運動治療合併徒手治療之加乘效果: 系統性回顧與統合分析

Background and Purpose: Exercise therapy is the first-line management for patients with knee osteoarthritis. Recently published systematic reviews and clinical practice guidelines suggested that exercise therapy should be combined with manual therapy for improving intervention efficacy in cases of pain. However, no consensus has been reached due to lacking up-to-date evidence support in the literature. Therefore, the purpose of this systematic review and meta-analysis was to investigate the effects of manual therapy in addition to exercise therapy for patients with knee osteoarthritis. Methods: We searched related databases and identified studies on knee osteoarthritis before May 2016, in comparing exercise plus manual therapy to exercise therapy alone on functional enhancement and pain reduction. Results: A total of nine studies were included. The analysis showed that exercise plus manual therapy resulted in superior functional improvement both in the short-term (pooled effect size = -0.517) and long-term (pooled effect size= -0.287) as compared to exercise alone. Also, the analysis favored the combination of exercise and manual therapy in the long-term pain reduction effect (pooled effect size = -0.528). Conclusions: When compared to only exercise therapy, exercise plus manual therapy showed significantly better improvement in functional performance and pain reduction, especially in the long-term effect.