Efeito adicional da terapia manual associada ao exercício terapêutico na dor, funcionalidade e limiar de dor por pressão em indivíduos com osteoartrite de joelho: uma revisão sistemática com metanálise

Abstract

INTRODUCTION: Knee osteoarthritis (KOA) is a chronic degenerative disease that affects people over 40 years of age, mainly women. In KOA, the main complaint is pain and reduced functionality. There may be changes in pain processing and result in pain sensitization, which can be assessed by pressure pain thresholds (PPT). In addition to health education, exercise (EX) and weight reduction are recommended by clinical practice guidelines. Positive effects of manual therapy (MT), commonly used in clinical practice and recommended together with an EX program, have also been observed. However, the level of evidence is uncertain and there is a lack of standardization of protocols and nomenclatures, which interfere with recommendations on the additional benefit of MT in the treatment of KOA. OBJECTIVE: To synthesize the results regarding the additional effect of MT when associated with EX compared to EX alone on pain intensity, functionality and PPT in individuals with KOA. METHODS: This systematic review included studies published up to March 2024 in the following databases: PubMed/MEDLINE, PEDro, EMBASE, Cochrane Library, CINAHL, Web of Science. Clinical trials of KOA that evaluated the effect of MT associated with EX, compared with EX alone, were included. The risk of victory was assessed by the PEDro (Physiotherapy Evidence Database) scale and the level of certainty of evidence was established by GRADE (Grading of Recommendations, Assessment, Development, and Evaluations). RESULTS: Twenty-five clinical trials with a total of 2012 participants were included. The analyses indicated that there was an additional effect of MT associated with EX compared to EX alone for improving pain intensity in the immediate (mean difference (MD) = -0.53; 95% CI = [-0.97 to -0.09]) and short term (MD = -1.30; 95% CI = [-1.77 to -0.83]) and for functionality in the short (standardized mean difference (SMD) = -0.89; 95% CI = [-1.49 to -0.29]) and medium term (SMD = -0.62; 95% CI = [-1.13 to -0.10]), but MT did not present an additional long-term benefit for pain (MD 0.15; 95% CI = 0.01 to 0.29) and functionality (SMD = -0.09; 95% CI = -0.34 to 0.17). The level of evidence for the results was very low to moderate, and the risk of bias averaged 6 across studies. CONCLUSION: This review shows that MT has an additional beneficial effect on EX both immediately and in the short term, but did not show any benefit in the medium or long term for pain intensity and functionality in the population with KOA. LAY SUMMARY: If you have knee arthritis/arthrosis, your physical therapist may use massage along with exercise at the beginning of your treatment to help you decrease pain intensity and improve functionality.