Author Names
Kazemi, Mohsen; Legaurd, Sydney Hubbel; Lilja, Sebastian; Mahaise, Steven
Reviewer Name
Jordan Jaklic, SPT
Reviewer Affiliations
Duke University School of Medicine, Doctor of Physical Therapy Division
Paper Abstract
Objectives
This study aims to determine whether manipulative therapy of the hip joint can increase range of motion (ROM) and/or decrease pain in individuals experiencing symptomatic hip pain. Methods
Non-disabled young adults were recruited on campus of a chiropractic college for this randomized crossover study. Subjects’ hip active and passive ROM and pain perception were measured. Subjects then received a drop-piece hip manipulation (DPHM) or an alternative treatment, followed by measurement of active and passive ROM and pain.
Results
Eight males and 12 females (n=20) between the ages of 21–32 years completed the study. Statistically significant improvements in numeric pain scale (NRS) and passive abduction were observed for the manipulation group when compared to the alternative treatment. No significant change was observed for all other hip ranges.
Conclusions
DPHM of the symptomatic hip joint in a small sample of young adults resulted in statistically significant improvements in pain and passive abduction when compared to sham manipulation. Due to low sample size, further research is recommended.
NIH Risk of Bias Tool
Quality Assessment Tool for Before-After (Pre-Post) Studies With No Control Group
Was the study question or objective clearly stated?
- Yes
Were eligibility/selection criteria for the study population prespecified and clearly described?
- Yes
Were the participants in the study representative of those who would be eligible for the test/service/intervention in the general or clinical population of interest?
- No
Were all eligible participants that met the prespecified entry criteria enrolled?
- Yes
Was the sample size sufficiently large to provide confidence in the findings?
- Cannot Determine, Not Reported, Not Applicable
Was the test/service/intervention clearly described and delivered consistently across the study population?
- Yes
Were the outcome measures prespecified, clearly defined, valid, reliable, and assessed consistently across all study participants?
- No
Were the people assessing the outcomes blinded to the participants’ exposures/interventions?
- Yes
Was the loss to follow-up after baseline 20% or less? Were those lost to follow-up accounted for in the analysis?
- No
Did the statistical methods examine changes in outcome measures from before to after the intervention? Were statistical tests done that provided p values for the pre-to-post changes?
- Yes
Were outcome measures of interest taken multiple times before the intervention and multiple times after the intervention (i.e., did they use an interrupted time-series design)?
- No
If the intervention was conducted at a group level (e.g., a whole hospital, a community, etc.) did the statistical analysis take into account the use of individual-level data to determine effects at the group level?
- Cannot Determine, Not Reported, Not Applicable
Key Finding #1
There were significant improvements in passive hip abduction when using manipulation compared to the alternative technique. All other hip motions, including active hip abduction, did not have significant findings with the manipulation technique.
Key Finding #2
There were improvements in the numeric pain rating scale scores from both the manipulation technique and the alternative treatment, however; improvements were greater with manipulation.
Please provide your summary of the paper
In this paper, the researchers wanted to assess the effect manipulation would have on hip range of motion (ROM) and hip pain using the numeric pain scale. This was a randomized crossover trial in which participants received a random intervention (manipulation or alternative) the first time and the next time would receive the other intervention. The manipulation technique used was a postero-caudal long axis thrust through the affected hip that would engage a drop piece underneath the patient lying in supine. The alternative technique was described as the doctor remaining contact with the affected leg and using the other to initiate an anterior to posterior thrust into the drop piece below the patient, thus the thrust going to the table instead of through the joint. Both procedures were repeated three times. The number of participants was small (n=20) and were young adults in chiropractic school. The criteria for the study was that the participants had to have hip pain or limited hip ROM and attend the school at Canadian Memorial Chiropractic College. Hip ROM, both passive and active, and pain scores were taken pre and post intervention. Although there were significant effects found on the numeric pain scale scores, there was no clear answer to why. The authors hypothesized it may be related to the gate control theory, but it was not investigated further. Additionally, only passive hip abduction was found to have significant effects. Authors describe that manipulation can create space in a joint, yet the results of this study do not depict this statement. If the manipulation technique was supposed to gap the joint, then it is thought more active and passive hip ranges would be affected. In the discussion of this paper, it was stated that the sensors that were responsible for measuring ROM were not placed the same way each time. This ultimately may have skewed the data. Some data points had to be omitted for this reason.
Please provide your clinical interpretation of this paper. Include how this study may impact clinical practice and how the results can be implemented.
I believe that there is value to this study; however, the set up of the crossover study had errors and details that do not make it applicable to use in practice. The participant pool only assessed young adults in chiropractic school. Not only does this not represent the huge portion of the population with hip pain, student health professionals have a deep understanding on the mechanics of the body. Additionally, chiropractic students in this study may have been familiar with the manipulation technique. 85% of the students were able to guess correctly on the first visit whether they were receiving the manipulation or alternative treatment. This is likely to skew data. It is best that if this study is replicated, that it is done so with more participants with a wider range of demographics. In this study, all hip pain was considered unless there was a previous surgery, severe arthritis, avascular necrosis, full hip ROM, numbness/tingling below the knee, or the subject had a recent hip manipulation. The study did not identify conditions that would benefit from this hip manipulation. In order for this study to be implemented into clinical practice, there needs to be more information on which conditions this manipulation technique best serves. Lastly, this study only occurred over a short period of time. In order for the techniques in this study to be implemented, I believe it is important to understand the long-term effects of the treatment (whether it improves ROM and numeric pain scale scores over a period of months). Although this study shows the manipulation technique’s effectiveness in the short-term, many patients come to physical therapists looking for a more permanent fix. There is no data in this study to show it is a long-term effector of hip ROM and pain.
