Author Names

Mehwish B, Ali SS, Mirza Baig AA.

Reviewer Name

Madison Navarro, SPT

Reviewer Affiliation(s)

Duke University Doctor of Physical Therapy Division

 

Paper Abstract

Objective: To determine the effects of hip joint mobilisations and strengthening exercises on pain, physical function and dynamic balance in patients with knee osteoarthritis.  Method: The single-blind three-arm parallel randomised controlled trial was conducted at Sindh Institute of Physical Medicine and Rehabilitation, the outpatient department of Dow University of Health Sciences’ Ojha Campus, Rabia Moon Memorial Welfare Trust and the Civil Hospital, Karachi, from January to July 2021. The sample comprised patients aged at least 50 years having knee osteoarthritis grade 1-3. The patients were randomised into 3 equal groups, with group A receiving hip mobilisations along with strengthening exercises of hip and conventional knee exercises, group B receiving strengthening exercises of hip along with conventional knee interventional exercises, and group C receiving conventional knee exercises only. Pain, physical function and dynamic balance were assessed using visual analogue scale, knee injury osteoarthritis outcome score and four-step square test, respectively, at baseline and after 18th session. Data was analysed using SPSS 21.  Results: Of the 74 subjects assessed, 66(89.2%) were included; 22(33.3%) in each of the three groups. The sample had 19(28.8%) male subjects and 47(71.2%) female. The mean age in groups A, B and C were 55.64±3.56 years, 53.64±4.65 years and 54.91±4.30 years, respectively. There was significant difference among groups post-treatment (p<0.001). Significant improvement was also found in inter-group analyses of all outcomes (p<0.001).  Conclusion: Addition of hip joint mobilisations provided better results compared to the other two groups.

 

Clinical Trial Number: https://clinicaltrials.gov/ct2/show/NCT04769531.

Keywords: Clinical trial Manual therapy, Knee osteoarthritis, Lower extremity manual therapy, Musculoskeletal, Posture, Resistance training. (JPMA 73: 749; 2023)

DOI: https://doi.org/10.47391/JPMA.6223

Submission completion date: 14-02-2022 – Acceptance date: 20-10-2022

 

NIH Risk of Bias Tool

Quality Assessment of Controlled Intervention Studies

  1. Was the study described as randomized, a randomized trial, a randomized clinical trial, or an RCT?
  • Yes
  1. Was the method of randomization adequate (i.e., use of randomly generated assignment)?
  • Yes
  1. Was the treatment allocation concealed (so that assignments could not be predicted)?
  • Yes
  1. Were study participants and providers blinded to treatment group assignment?
  • No
  1. Were the people assessing the outcomes blinded to the participants’ group assignments?
  • Yes
  1. Were the groups similar at baseline on important characteristics that could affect outcomes (e.g., demographics, risk factors, co-morbid conditions)?
  • Yes
  1. Was the overall drop-out rate from the study at endpoint 20% or lower of the number allocated to treatment?
  • Yes
  1. Was the differential drop-out rate (between treatment groups) at endpoint 15 percentage points or lower?
  • Yes
  1. Was there high adherence to the intervention protocols for each treatment group?
  • Yes
  1. Were other interventions avoided or similar in the groups (e.g., similar background treatments)?
  • Cannot Determine, Not Reported, or Not Applicable
  1. Were outcomes assessed using valid and reliable measures, implemented consistently across all study participants?
  • Yes
  1. 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
  1. Were outcomes reported or subgroups analyzed prespecified (i.e., identified before analyses were conducted)?
  • Yes
  1. 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

Incorporating hip mobilizations and hip strengthening exercises into rehab programs for patients with knee OA was more effective at improving pain than conventional knee exercises alone.

Key Finding #2

Incorporating hip mobilizations and hip strengthening exercises into rehab programs for patients with knee OA was more effective at increasing dynamic balance than conventional knee exercises alone.

Key Finding #3

Incorporating hip mobilizations and hip strengthening exercises into rehab programs for patients with knee OA was more effective at improving physical function than conventional knee exercises alone.

 

Please provide your summary of the paper

Sixty-six participants with knee osteoarthritis were randomly assigned to one of three treatment groups: Group A received hip mobilizations (anterior posterior glide, posterior anterior glide, caudal glide, posterior anterior glide with abduction, flexion and lateral rotation; 3 sets at 120 oscillations per minute) along with hip and knee strengthening exercises. Group B received hip and knee strengthening exercises, and Group C received knee strengthening exercises only. 18 sessions occurred over the course of 4 weeks. The Knee Injury and Osteoarthritis Outcome Score (KOOS) for physical functions, VAS for pain intensity, and four-step square test (FSST) were administered at baseline and after the last session. Group A showed significant inter-group difference (P<.001) in respect to improvements in KOOS, FSST, and VAS scores. The results suggest that adding hip mobilizations and strengthening exercises to knee osteoarthritis rehabilitation results in better outcomes for patients in regards to pain levels, dynamic balance, and physical function.

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 study align with previous research that has found that incorporating hip mobilizations and strengthening exercises into physical therapy for knee osteoarthritis significantly improves a variety of outcomes for patients. The findings of this study are feasible to incorporate into clinical practice, as all physical therapists should be skilled at administering hip mobilizations. Further, this study reiterates to clinicians the importance of analyzing joints outside of the primarily affected joint in their clinical decision making.