Author Names

Orellana, M., Valenzuela, J., Diaz, M., Gold, M., and Rubio, J.

Reviewer Name

Abigail Fortenberry, SPT

Reviewer Affiliation(s)

Duke University, SPT

 

Paper Abstract

  • Introduction: Osteoarthritis (OA) is the most common joint disease, increases with age and it is estimated that in those over 60 years of age more than 80 % have OA in at least one joint. Currently, the evidence regarding manual therapy (MT) in hip OA has had unclear results. Therefore, the main objective of this study is to determine the effectiveness and recommendation of MT in the hip OA. And secondary objectives, (I) review the existing literature on the intervention of MT in hip OA, (II) calculate the effectiveness of MT techniques in hip OA and (III) determine if there are benefits after the MT intervention in hip OA.
  • Methods: A systematic search was carried out in electronic databases, in order to compile the available literature between the years 2000 and 2019, taking as reference the PRISMA statement for systematic reviews. Letters to the editor, bibliographic reviews and gray literature were excluded.
  • Results: After reviewing 30 articles, we included 7 RS and 14 RCTs. 7 RCTs measured pain intensity of OA in response to MT vs. a control group. 4 RCTs measuring pain intensity in hip OA using MT + exercises Seven RCTs measured function in subjects with hip OA in response to MT vs. CG. Two RCTs evaluated the effects of MT + Ex on function.
  • Discussion: Although the results were in favor of manual therapy, compared to the control group, these were not statistically significant, so we propose to carry out new primary studies to eliminate some biases in program execution and improve intervention in both groups.

 

NIH Risk of Bias Tool

Quality Assessment of Systematic Reviews and Meta-Analyses

  1. Is the review based on a focused question that is adequately formulated and described?
  • Yes
  1. Were eligibility criteria for included and excluded studies predefined and specified?
  • Yes
  1. Did the literature search strategy use a comprehensive, systematic approach?
  • Yes
  1. Were titles, abstracts, and full-text articles dually and independently reviewed for inclusion and exclusion to minimize bias?
  • Yes
  1. Was the quality of each included study rated independently by two or more reviewers using a standard method to appraise its internal validity?
  • Yes
  1. Were the included studies listed along with important characteristics and results of each study?
  • Yes
  1. Was publication bias assessed?
  • Yes
  1. Was heterogeneity assessed? (This question applies only to meta-analyses.)
  • Yes

 

Key Finding #1

Quality of life for patients with OA and the use of manual therapy were not statistically significant

Key Finding #2

The decrease in pain with manual therapy favors the control group, but results were not statistically significant with the manual therapy intervention.

Key Finding #3

Overall perception of manual therapy by the patients did not demonstrate a clear preference towards neither the control nor interventional group.

Key Finding #4

The functionality outcome measure did not demonstrate statistical significance for either the control or interventional group of MT.

 

Please provide your summary of the paper

After reading and determining the appropriateness of each article based on the criteria, the authors included 7 systematic reviews and 14 primary studies. Overall, the results of the review suggested that there may be favor towards MT, but it lacks statistical significance when considering control vs. MT regarding hip OA outcomes. The authors also noted the most common treatment of hip OA is a combination of therapeutic exercise and MT, and that MT should be used as a compliment to treatment, but not as an absolute. This study included some limitations, the most prominent being a limited number of included studies, and the publication bias of each article could not be assessed within the author’s parameters. Therefore, the authors indicated the need for additional studies and reviews to explore the effect of MT on hip OA outcomes.

Please provide your clinical interpretation of this paper.  Include how this study may impact clinical practice and how the results can be implemented.

My interpretation of this paper included a deeper understanding of the prevalence and widespread effects of osteoarthritis in the hip. It stressed the importance of continuing to explore manual therapy as an adjunct treatment for OA, and we need more research studies across multiple populations to investigate more manual therapy options. I also appreciated that they included studies that were written in both english and spanish, and I think incorporating other languages expands research ten-fold. This paper is a quality foundational systematic review to encourage more research into the impact of MT on hip OA.