Clinical Question

Is physical therapy useful for reducing pain and improving function in adults with hip osteoarthritis?

Bottom Line

In this study, physical therapy was no more effective than sham therapy in reducing pain and improving function in adults with hip osteoarthritis. (Level of Evidence = 1b)

Synopsis

These investigators identified adults 50 years or older who met the standard criteria for hip osteoarthritis, with an average pain intensity of at least 40 (on a 100-mm visual analog scale) and at least moderate difficulty with daily activities. Eligible patients (N = 102) randomly received (concealed allocation assignment) active physical therapy or sham physical therapy. All participants attended 10 individual therapy sessions: two during the first week, one weekly for six weeks, and then one every other week. Active intervention consisted of manual therapy techniques, including manipulation, mobilization, massage, and stretches; home exercises; education and advice; and a walking stick, if appropriate. The sham intervention included inactive ultrasonography and light application of inert gel to the hip region, but no exercise instructions or manual therapy. The study was 80% powered to detect a predetermined clinically significant difference between the two treatment groups, if one existed. Complete follow-up occurred for 94% of participants at 13 weeks and 81% at 36 weeks. Although the treating therapists were not masked to treatment group assignment, a single masked assessor evaluated outcomes using standard scoring tools based on patient self-reports at 13 and 36 weeks. Statistical analysis found no significant evidence that patients could reliably tell to which intervention group they were assigned.

Using intention-to-treat and per-protocol analyses, no significant between-group differences were found for changes in pain or physical function. Likewise, medication use and co-interventions were similar for both groups. Adverse events occurred significantly more often in the active intervention group (41% vs. 14%), including increased hip pain, back pain, stiffness, and pain in other regions.

Study design: Randomized controlled trial (double-blinded)

Funding source: Government

Allocation: Concealed

Setting: Outpatient (primary care)

Reference: BennellKLEgertonTMartinJet alEffect of physical therapy on pain and function in patients with hip osteoarthritis: a randomized clinical trial. JAMA2014; 311( 19): 1987– 1997.