Author Names
Hoeksma, H.L., Dekker, J., Ronday, H.K., Heering, A., Van Der Lubber, N., Vel, C., Breedveld, F., Van Den Ende, C.H.M.,
Reviewer Name
Juan Carlos Chavez Casiano
Reviewer Affiliations
Duke University School of Medicine, Doctor of Physical Therapy Division
Paper Abstract
Objective: To determine the effectiveness of a manual therapy program compared with an exercise therapy program in patients with osteoarthritis (OA) of the hip.
Methods: A single-blind, randomized clinical trial of 109 hip OA patients was carried out in the outpatient clinic for physical therapy of a large hospital. The manual therapy program focused on specific manipulations and mobilization of the hip joint. The exercise therapy program focused on active exercises to improve muscle function and joint motion. The treatment period was 5 weeks (9 sessions). The primary outcome was general perceived improvement after treatment. Secondary outcomes included pain, hip function, walking speed, range of motion, and quality of life.
Results: Of 109 patients included in the study, 56 were allocated to manual therapy and 53 to exercise therapy. No major differences were found on baseline characteristics between groups. Success rates (primary outcome) after 5 weeks were 81% in the manual therapy group and 50% in the exercise group (odds ratio 1.92, 95% confidence interval 1.30, 2.60). Furthermore, patients in the manual therapy group had significantly better outcomes on pain, stiffness, hip function, and range of motion. Effects of manual therapy on the improvement of pain, hip function, and range of motion endured after 29 weeks.
Conclusion: The effect of the manual therapy program on hip function is superior to the exercise therapy program in patients with OA of the hip.
NIH Risk of Bias Tool
Quality Assessment of Controlled Intervention Studies
- Was the study described as randomized, a randomized trial, a randomized clinical trial, or an RCT
- Yes
- Was the method of randomization adequate (i.e., use of randomly generated assignment)?
- Yes
- Was the treatment allocation concealed (so that assignments could not be predicted)?
- Yes
- Were study participants and providers blinded to treatment group assignment?
- No
- Were the people assessing the outcomes blinded to the participants’ group assignments?
- No
- Were the groups similar at baseline on important characteristics that could affect outcomes (e.g., demographics, risk factors, co-morbid conditions)?
- Yes
- Was the overall drop-out rate from the study at endpoint 20% or lower of the number allocated to treatment?
- No
- Was the differential drop-out rate (between treatment groups) at endpoint 15 percentage points or lower?
- No
- Was there high adherence to the intervention protocols for each treatment group?
- Yes
- Were other interventions avoided or similar in the groups (e.g., similar background treatments)?
- Yes
- Were outcomes assessed using valid and reliable measures, implemented consistently across all study participants?
- Yes
- Did the authors report that the sample size was sufficiently large to be able to detect a difference in the main outcome between groups with at least 80% power?
- Yes
- Were outcomes reported or subgroups analyzed prespecified (i.e., identified before analyses were conducted)?
- No
- Were all randomized participants analyzed in the group to which they were originally assigned, i.e., did they use an intention-to-treat analysis?
- Yes
Key Finding #1
The manual therapy program was found to me more effective when compared to the exercise program.
Key Finding #2
The effects of the manual therapy program were found to last up to 6 months after the end of therapy.
Key Finding #3
Beneficial effects of manual therapy on walking speed were found but further studies need to be made.
Please provide your summary of the paper
This study looked at the effect of manual therapy compared to the effects of an exercise therapy program in patients with osteoarthritis (OA) of the hip. The results showed that there was greater improvements of hip function and pain for those that were in the manual therapy group. The participants were randomly placed in one of the two groups. All participants were treated twice a week for 5 weeks. The Manual therapy session involved traction of the hip, followed by traction manipulation in each limited position. In the exercise treatment groups, programs were developed to improve muscle function, muscle length, joint mobility, pain relief, and walking. While this paper supports the idea of the use Manual Therapy in patients with OA of the hip, this was the first study to their knowledge that compared the two. Therefore, further studies are recommended.
Please provide your clinical interpretation of this paper. Include how this study may impact clinical practice and how the results can be implemented.
This study demonstrated that there were some benefits of manual therapy in patients with hip OA but other research should be done since it was the first of its kind. I think this can be used clinically by using manual therapy in conjunction with an exercises program to maximize the outcomes of our patients.
