Author Names
Shepherd MH, Shumway J, Salvatori RT, Rhon DI, Young JL.
Reviewer Name
Kyra Callens, SPT
Reviewer Affiliation(s)
Duke University School of Medicine, Doctor of Physical Therapy Division
Paper Abstract
Objective: To 1) Determine if specific dosing parameters of manual therapy are related to improved pain, disability, and quality of life outcomes in patients with hip osteoarthritis and 2) to provide recommendations for optimal manual therapy dosing based on our findings. Design: A systematic review of randomized controlled trials from the PubMed, CINAHL, and OVID databases that used manual therapy interventions to treat hip osteoarthritis was performed. Three reviewers assessed the risk of bias for included studies and extracted relevant outcome data based on predetermined criteria. Baseline and follow-up means and standard deviations for outcome measures were used to calculate effect sizes for within and between-group differences. Results: Ten studies were included in the final analyses totaling 768 participants, and half were graded as high risk of bias. Trends emerged: 1) large effect sizes were seen using long-axis distraction, mobilization and thrust manipulation, 2) mobilization with movement showed large effects for pain and range of motion, and (3) small effects were associated with graded mobilization. Durations of 10 to 30 minutes per session, and frequency 2-3 times per week for 2-6 weeks were the most common dosing parameters. Conclusions: There were varied effect sizes associated with pain, function, and quality of life for both thrust and non-thrust mobilizations, and mobilization with movement into hip flexion and internal rotation. Due to the heterogeneity of MT dosage, it is difficult to recommend a specific manual therapy dosage for those with hip osteoarthritis.
NIH Risk of Bias Tool
Quality Assessment of Systematic Reviews and Meta-Analyses
- Is the review based on a focused question that is adequately formulated and described?
- Yes
- Were eligibility criteria for included and excluded studies predefined and specified?
- Yes
- Did the literature search strategy use a comprehensive, systematic approach?
- Yes
- Were titles, abstracts, and full-text articles dually and independently reviewed for inclusion and exclusion to minimize bias?
- Yes
- Was the quality of each included study rated independently by two or more reviewers using a standard method to appraise its internal validity?
- Were the included studies listed along with important characteristics and results of each study?
- Yes
- Was publication bias assessed?
- Yes
- Was heterogeneity assessed? (This question applies only to meta-analyses.)
- Yes
Key Finding #1
Mobilizations with movement showed improvements in pain and ROM with moderate certainty evidence in patients with hip osteoarthritis.
Key Finding #2
Long-axis, high-velocity low-amplitude thrust mobilization was the most prevalent manual therapy type used in this review and showed a large effect size.
Key Finding #3
Optimal dosage parameters cannot be outlined from this review, however, trends observed may be considered by clinicians and researchers.
Please provide your summary of the paper
This systematic review determined the effectiveness of manual therapy on hip osteoarthritis, particularly in regards to pain, disability, and quality of life, to form manual therapy dosing recommendations for this population. Articles from PubMed, CINAHL, and OVID databases were screened by two reviews to ensure eligibility criteria was met. Multiple types of manual therapy were used in these studies including long-axis, high-velocity low-amplitude thrust mobilization (LA-HVLAT), mobilization with movement (MWM), and long-axis distraction with both thrust and graded mobilizations. Furthermore, duration and frequency of intervention varied with 10-60 minutes and 2-3 times per week respectively, and 70% of trails used in this review did not report dosing parameters. LA-HVLAT was the most prevalent and indicated large effect sizes, while graded mobilizations displayed small effect sizes. In regards to pain and ROM, studies indicated with moderate certainty evidence that MWM displayed large between-group improvements. Small effects were found in quality of life outcomes with high certainty evidence. The results of self-reported functional outcomes regarding disability varied based on the outcome measure used.
Please provide your clinical interpretation of this paper. Include how this study may impact clinical practice and how the results can be implemented.
The results of this systematic review indicated improvements in pain, ROM, and quality of life with the use of manual therapy in patients with hip osteoarthritis. However, studies with a variation of manual therapy types, durations, and frequency of intervention were used, along with some articles not providing dosing parameters. Therefore, while evidence aligns with the use of manual therapy, dosage recommendations cannot be given from the results of this review. Further research is indicated to determine the benefits of manual therapy in patients with hip osteoarthritis with specific dosage including technique, duration, and frequency.
