Skilled Physical Therapy

No studies meeting inclusion criteria were identified evaluating skilled physical therapy (in-clinic or virtual, with or without manual therapy) in patients with symptomatic ankle osteoarthritis (OA).

Clinical Takeaway 

In the absence of direct evidence, expert consensus supports the use of skilled physical therapy to improve patient-reported outcomes and potentially affect disease progression or the need for invasive interventions in patients with symptomatic ankle osteoarthritis.

Clinical Implications 

Based on expert consensus: 

• Skilled physical therapy can be administered to improve patient-reported outcomes, including pain, function, and quality of life, in patients with symptomatic ankle OA.
• It may also affect progression of OA symptoms and the need for invasive interventions, although the magnitude of these effects is unknown.
• Physical therapy may include patient education and self-management strategies, progressive therapeutic exercise (strength, power, endurance, and task-specific functional training), neuromuscular and motor control interventions (balance, proprioception, and movement coordination training), manual therapy (joint mobilization, manipulation, and soft tissue techniques), gait retraining, and development and progression of a home exercise program. Individualized treatment should consider patient history, presence of instability, OA etiology, and functional status.
• Physical therapy should be integrated into a multimodal management plan, which may include activity modification, bracing, and pharmacologic interventions.

 Limitations 

• No primary studies were available; recommendations rely solely on expert consensus. 
• Effects on long-term outcomes, disease progression, or timing of invasive interventions are unknown. 
• Variation in physical therapy modalities and delivery methods has not been formally studied in ankle OA. 

Future Research 

• Conduct randomized controlled trials and high-quality observational studies assessing skilled physical therapy in ankle OA.
• Evaluate specific therapy modalities, delivery methods (in-clinic vs. virtual), and long-term outcomes.
•  Assess cost-effectiveness and integration with multimodal management strategies.

Benefits and Harms: 

• Potential benefits: Symptom relief, improved function, and potential delay of invasive interventions. 
• Potential harms: Minimal; mostly fatigue, soreness, or injury from inappropriate exercises. Serious adverse events appear uncommon, although harms are not consistently reported.

Cost-Effectiveness and Resource Utilization: 

• Physical therapy is generally accessible but requires provider time and patient commitment. 
• Virtual therapy may reduce barriers to access and cost but requires further study. 

Future Research: 

• Prospective trials to define effectiveness, optimal modalities, long-term outcomes, and cost implications are needed.