Author Names
Fukuda TY, Aquino LM, Pereira P, Ayres I, Feio AF, de Jesus FLA, Neto MG.
Reviewer Name
Terry Brown, SPT
Reviewer Affiliation(s)
Duke DPT, Class of 2025
Paper Abstract
Background The literature is unclear on the need for hip strengthening in persons with low back pain (LBP). Objectives To investigate the effectiveness of hip strengthening exercises when added to manual therapy and lumbar segmental stabilization in patients with chronic nonspecific LBP. Methods Seventy patients with chronic nonspecific LBP were randomly assigned to either the manual therapy and lumbar segmental stabilization group or the manual therapy and lumbar segmental stabilization plus specific hip strengthening group. A 10 cm visual analogue scale and the Rolland-Morris Questionnaire were the primary clinical outcome measures at baseline, at the end of treatment (posttreatment), and 6- and 12-months posttreatment. Hip strength and kinematics were measured as secondary outcomes . Results While within-group improvements in pain, disability, and hip extensors strength occurred in both groups, there were no significant between-group differences at posttreatment or follow-ups. Mean difference in changes in pain level between groups at posttreatment and at 6- and 12-month follow-up were 0.5 points (95% confidence interval [CI]: -0.5, 1.5), 0.3 points (95% CI: -0.9, 1.5), and 0.0 points (95% CI: -1.1, 1.1), respectively. The mean differences in changes in disability were 0.8 points (95% CI: -1.3, 2.7), 0.0 points (95% CI: -2.4, 2.4), and 0.4 points (95% CI: -2.0, 2.8), respectively. Finally, we did not observe any between-group differences for any of the other outcomes at any timepoint. Conclusion The addition of specific hip strengthening does not appear to result in improved clinical outcomes for patients with nonspecific LBP. Keywords: Lumbar spine, Physical therapy, Rehabilitation
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?
- Yes
- 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?
- Yes
- Was the differential drop-out rate (between treatment groups) at endpoint 15 percentage points or lower?
- Yes
- 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)?
- Cannot Determine, Not Reported, or Not Applicable
- 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 addition of hip strengthening exercises into PT sessions did not have a positive effect on the reduction of LBP compared to normal treatment focuses.
Key Finding #2
Hip extensor strength was improved in the participants of the study and could be further tested to see if long term strengthening helps LBP.
Key Finding #3
Continuing the current route of LBP treatment of manual therapy, mobilizations, and general exercise is currently the most effective treatment for patients that present to PT.
Please provide your summary of the paper
The authors of this paper were hoping to assess if the addition of hip-specific exercises combined with manual therapy and general exercises would improve function and decrease pain and disability in patients with LBP. The study divided the 70 participants into a control group as well as an experiment group. The participants attended 2 sessions of PT a week for 5 weeks equaling 10 sessions of skilled PT. The participants were told to not take pain medication during this time and to not do the exercises outside of the session. The results of this study demonstrated virtually no difference between the two groups suggesting that hip-specific exercises did not have a significant impact on pain reduction compared to regular PT routines.
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 does not highlight the specifics of manual therapy used outside of hip mobilizations. However, it does provide detailed evidence on the impact of exercise specifics for patients who are experiencing LBP. This paper can help PTs guide their LBP patients into weekly exercise and strength training routines to decrease pain and disability and improve function.
