Gonartrose og manuellterapi: "Vil manuellterapeutisk mobilisering redusere smerter og øke funksjon hos en fysisk svært aktiv pasient med unilateral gonartrose?"

Background: Knee osteoarthritis is considered the most common disease in the world to affect synovial joints. There is moderate to strong evidence for using individually tailored exercise therapy as main intervention. Studies have suggested that self- managed exercise combined with manual therapy may further increase the effect of treatment in both effect size and duration of the effect. Norwegian patients visit their manual therapists for advice and / or treatment. Manual mobilization techniques are important in the pragmatic empirically based everyday scope of practice for Manual Therapists. Purpose: The purpose of this study was to evaluate the short-term effect of manual therapy mobilization techniques based on Kaltenborns techniques for knee joint mobilization in a patient that was physically active with self-managed exercise. Results were measured with KOOS (self-assessed function: Knee Dysfunction Osteoarthritis Outcome Score) and NPRS (self-assessed pain: Numeric Pain Rating Scale). Method: This study is a Single Subject Experimental Design Study (SSED). Knee Dysfunction Osteoarthritis Outcome Score (KOOS) and Numeric Pain Rating Scale (NPRS) were used for measuring. The patient in this study showed classical symptoms of knee osteoarthritis, whereas x-ray showed unilateral knee arthritis. The patient had little movement restrictions in passive testing. She was a former high jump athlete and still physically active. The intervention period was set to 6 weeks. KOOS and NPRS measurements were conducted every week during intervention and four weeks after end of intervention. Results: KOOS and NPRS showed improvements. This patient improved in “Pain”, “ADL”, “Sports” and “Quality of Life”, but not in “Symptoms” in KOOS. The total score also showed major improvements. NPRS changed from 5,5 at baseline to 2 after the intervention period. All positive changes were present four weeks after the intervention period at follow-up measurements and regarded clinically important. Conclusion: Manual therapy mobilizations may have beneficial effects in patients with knee osteoarthritis. These findings are related to self-assessed function and pain measured with KOOS and NPRS. This is supported by earlier findings