Knee OA: Which patients are unlikely to benefit from manual PT and exercise?
A preliminary clinical prediction rule uses 3 patient attributes to predict who will fare better with alternative treatments.
Patient height >1.71 m is the least intuitive of the predictors for nonsuccess, but that underscores the value of data-driven prediction rules. Variables regarded as unimportant in a typical clinical assessment may show clinical usefulness if validated in independent studies. It may be that in taller patients with knee OA, biomechanical forces are such that a positive response to conservative therapy is less likely—particularly in the presence of ligamentous laxity or patellofemoral dysfunction.
For most patients with knee OA, the combined intervention of manual physical therapy and exercise is clinically beneficial, relatively inexpensive, and has no known adverse effects.54 However, unique circumstances may increase the importance of determining the likelihood that a patient will benefit. A validated CPR will facilitate timely decisions for those relatively few patients requiring alternative interventions. Although the rule is preliminary and needs to be validated, these results provide current best evidence to define patients with knee OA who are unlikely to respond to manual physical therapy and exercise.
