Factors associated with physical therapy treatments of patients with knee osteoarthritis in Thailand

Main Article Content

ภาสกร สายสุริย์
ปราณีต เพ็ญศรี


Background: Most physical therapists (PTs) in developed countries use evidence-based physical therapy for patients with knee osteoarthritis (OA). Conversely, little is known concerning treatment used by Thai PTs in such patients.

Objective: To examine the relationship among characteristics of PTs, patients with knee OA, and type of physical therapy treatments.

Methods: This survey applied three sets of questionnaires to collect data. Questionnaire Set-A collected PTs’ information and experience in treating knee OA. Questionnaires Set-B collected patients’ information regarding history of knee OA, pain severity, disability, and function of knee (assessed by the modified Western Ontario and McMaster Universities Arthritis (WOMAC) Index). Questionnaire Set-C collected data on the physical  therapy methods. Each PT was required to collect the data of at least three consecutive patients with knee OA in the out-patient unit.  Logistic regression models were used to determine the relationship among PTs’ and patients’ characteristics and actual use of treatments including exercise, and patient education.

Result: Exercise (93.63%) was the most used treatment. Most PTs applied a combination of techniques to relieve pain and improve knee function. Exercise was associated with the total modified WOMAC score and patient’s BMI (p<0.05). Patient education was associated with the PTs’ short-course training of OA, patients with age less than 60 years, and abnormal BMI (p<0.05).

Conclusion: Most Thai PTs used exercise for treating knee OA which was in line with the clinical guidelines. Some patient characteristics influenced the PTs’ selection of treatment including patient’s age, BMI, pain, stiffness, and functions.


Download data is not yet available.

Article Details



Neogi T. The epidemiology and impact of pain in osteoarthritis. Osteoarthr Cartil. 2013; 21(9):1145-53.

Buckwalter JA, Saltzman C, Brown T. The impact of osteoarthritis: implications for research. Clin Orthop Relat Res. 2004(427 Suppl):S6-15.

Woolf AD, Pfleger B. Burden of major musculoskeletal conditions. Bull World Health Organ. 2003; 81:646-56.

Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, et al. Years lived with disability (YLDs) for 1160

sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of 873 Disease Study 2010. The lancet. 2012;380(9859):2163-96.

Zhang Y, Jordan JM. Epidemiology of osteoarthritis. Clin Geriatr Med. 2010; 26(3) :355-69.

Inthira R, Suparb A. Osteoarthritis in Adult and Older Thais Living in Rural and Urban Areas: A Comparative Study. Pacific Rim Int J Nurs Res. 2015; 19(3):187-201.

Turjane T, Sriratanavudhi C, Saengsirinavin P, Larpaiwong W, Prasong J. Cost Analysis of Intra-Articular Treatment of Cross-Linked Sodium Hyaluronate (XLHA-BDDE) for Failure Conservative Treatment Patient with Multiples Stages Knee Osteoarthritis. J Southeast Asian Med. 2020; 44(1-2):11-6.

McAlindon TE, Bannuru RR, Sullivan M, Arden N, Berenbaum F, Bierma-Zeinstra S, et al. OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthr Cartil. 2014;22(3):363-88.

Larmer PJ, Reay ND, Aubert ER, Kersten P. Systematic review of guidelines for the physical management of osteoarthritis. Arch Phys Med Rehabil. 2014; 95(2):375-89.

Kolasinski SL, Neogi T, Hochberg MC, Oatis C, Guyatt G, Block J, et al. 2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee. Arthritis Rheumatol. 2020; 72(2):220-33.

Thai Rheumatism Association. Guideline for Management of OA knee. [Internet]. [Cited 2016 August 1]. Available from: https://www.thairheumatology.org/wp-content/uploads/2016/08/Guideline-for-Management-of-OA-knee.pdf 2/.

van Doormaal MC, Meerhoff GA, Vliet Vlieland TP, Peter WF. A clinical practice guideline for physical therapy in patients with hip or knee osteoarthritis. Musculoskeletal Care 2020; 18(4):575-95.

Da Costa BR, Vieira ER, Gadotti IC, Colosi C, Rylak J, Wylie T, et al. How do physical therapists treat people with knee osteoarthritis, and what drives their clinical decisions? A population-based cross-sectional survey. Physiother Can. 2017; 69(1):30-7.

Walsh NE, Hurley MV. Evidence based guidelines and current practice for physiotherapy management of knee osteoarthritis. Musculoskeletal Care. 2009; 7(1):45-56.

Ayanniyi O, Egwu RF, Adeniyi AF. Physiotherapy management of knee osteoarthritis in Nigeria —A survey of self-reported treatment preferences. Hong Kong Physiother J. 2017; 36:1-9.

Data based physical therapist council [Internet]. [Cited 2018 August 10]. Available from http://cpte.or.th/network/dataPT6.php.

Yamane T. Statistics: an introductory analysis. 3rd ed. New York: Harper and Row; 1973.

Peduzzi P, Concato J, Kemper E, Holford TR, Feinstein AR. A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol. 1996;49(12):1373-9.

Bellamy N, Buchanan WW, Goldsmith CH. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy with osteoarthritis of the hip or knee. J Rheumatol.1988; 15:1833–40.

Kuptniratsaikul V, Rattanachaiyanont M. Validation of a modified Thai version of the Western Ontario and McMaster (WOMAC) osteoarthritis index for knee osteoarthritis. Clin Rheumatol. 2007; 26(10):1641-5.

Brosseau L, Yonge K, Welch V, Marchand S, Judd M, Wells GA, et al. Thermotherapy for treatment of osteoarthritis. Cochrane Database Syst Rev. 2003(4).

Tüzün EH, Aytar A, Eker L, Daşkapan A. Effectiveness of two different physical therapy programmes in the treatment of knee osteoarthritis. The Pain Clinic. 2004; 16(4):379-87.

Cetin N, Aytar A, Atalay A, Akman MN. Comparing hot pack, short-wave diathermy, ultrasound, and TENS on isokinetic strength, pain, and functional status of women with osteoarthritic knees: a single-blind, randomized, controlled trial. Am J Phys Med Rehabil. 2008; 87(6):443-51.

MacKay C, Hawker GA, Jaglal SB. Qualitative study exploring the factors influencing physical therapy management of early knee osteoarthritis in Canada. BMJ open. 2018; 8(11):e023457.

Kadam UT, Jordan K, Croft PR: Clinical comorbidity in patients with osteoarthritis: a case control study of general practice consulters in England and Wales. Ann Rheum Dis 2004, 63(4):408-14.

van Dijk GM, Veenhof C, Schellevis F, Hulsmans H, Bakker JP, Arwert H, et al. Comorbidity, limitations in activities and pain in patients with osteoarthritis of the hip or knee. BMC Musculoskelet Disord 2008; 9(1):1-10.

Imoto AM, Pardo JP, Brosseau L, Taki J, Desjardins B, Thevenot O, et al. Evidence synthesis of types and intensity of therapeutic land-based exercises to reduce pain in individuals with knee osteoarthritis. Rheumatol Int. 2019; 39(7):1159-79.

Li Y, Su Y, Chen S, Zhang Y, Zhang Z, Liu C, et al. The effects of resistance exercise in patients with knee osteoarthritis: a systematic review and meta-analysis. Clin Rehabil. 2016; 30(10):947-59.

Aman JE, Elangovan N, Yeh I, Konczak J. The effectiveness of proprioceptive training for improving motor function: a systematic review. Front Hum Neurosci. 2015;8:1075.

Spitaels D, Hermens R, Van Assche D, Verschueren S, Luyten F, Vankrunkelsven P, et al. Are physiotherapists adhering to quality indicators for the management of knee osteoarthritis? An observational study. Musculoskelet Sci Pract. 2017; 27:112-23.

Ackerman IN, Osborne RH. Obesity and increased burden of hip and knee joint disease in Australia: results from a national survey. BMC Musculoskelet Disord. 2012; 13(1):1-13.

Laberge MA, Baum T, Virayavanich W, Nardo L, Nevitt M, Lynch J, et al. Obesity increases the prevalence and severity of focal knee abnormalities diagnosed using 3T MRI in middle-aged subjects—data from the Osteoarthritis Initiative. Skelet Radiol. 2012; 41(6):633-41.

Kroon FP, van der Burg LR, Buchbinder R, Osborne RH, Johnston RV, Pitt V. Self‐management education programmes for osteoarthritis. Cochrane Database Syst Rev. 2014(1): CD008963.

Taglietti M, Facci LM, Trelha CS, de Melo FC, da Silva DW, Sawczuk G, et al. Effectiveness of aquatic exercises compared to patient-education on health status in individuals with knee osteoarthritis: a randomized controlled trial. Clin Rehabil. 2018;32(6):766-76.