Author Names
Brun, A. and Sandrey, M.
Reviewer Name
Hunter Dula, SPT
Reviewer Affiliation(s)
Duke University School of Medicine Doctor of Physical Therapy Division
Paper Abstract
Context: Joint mobilizations have been studied extensively in the literature for the glenohumeral joint and talocrural joint (ankle). Consequently, joint mobilizations have been established as an effective means of improving range of motion (ROM) within these joints. However, there is a lack of extant research to suggest these effects may apply within another critical joint in the body, the hip. Objective: To examine the immediate effects of hip joint mobilizations on hip ROM and functional outcomes. Secondarily, this study sought to examine the efficacy of a novel hip mobilization protocol. Design: A prospective exploratory study. Setting: Two research labs. Patients or Other Participants: The study included 19 active male (n = 8) and female (n = 11) college students (20.56 [1.5] y, 171.70 [8.6] cm, 72.23 [12.9] kg). Interventions: Bilateral hip mobilizations were administered with the use of a mobilization belt. Each participant received hip joint mobilization treatments once during 3 weekly sessions followed immediately by preintervention and postintervention testing/measurements. Testing for each participant occurred once per week, at the same time of day, for 3 consecutive weeks. Hip ROM was the first week, followed by modified Star Excursion Balance Test the second week and agility T test during the third week. Main Outcomes Measures: Pretest and posttest measurements included hip ROM for hip flexion, extension, abduction, adduction, internal and external rotation, as well as scores on the modified Star Excursion Balance Test (anterior, posterolateral, and posteromedial directions) and agility T test. Results: A significant effect for time was found for hip adduction, internal and external rotation ROM, as well as the posterolateral and posteromedial directions of the modified Star Excursion Balance Test. A separate main effect for both limbs was found for adduction and internal rotation ROM. Conclusion: Isolated immediate changes in ROM and functional outcomes were evident. Further evaluation is needed.
NIH Risk of Bias Tool
Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies
- Was the research question or objective in this paper clearly stated?
- Yes
- Was the study population clearly specified and defined?
- Yes
- Was the participation rate of eligible persons at least 50%?
- Yes
- Were all the subjects selected or recruited from the same or similar populations (including the same time period)? Were inclusion and exclusion criteria for being in the study prespecified and applied uniformly to all participants?
- Cannot Determine, Not Reported, Not Applicable
- Was a sample size justification, power description, or variance and effect estimates provided?
- No
- For the analyses in this paper, were the exposure(s) of interest measured prior to the outcome(s) being measured?
- Yes
- Was the timeframe sufficient so that one could reasonably expect to see an association between exposure and outcome if it existed?
- Yes
- For exposures that can vary in amount or level, did the study examine different levels of the exposure as related to the outcome (e.g., categories of exposure, or exposure measured as continuous variable)?
- No
- Were the exposure measures (independent variables) clearly defined, valid, reliable, and implemented consistently across all study participants?
- Yes
- Was the exposure(s) assessed more than once over time?
- Yes
- Were the outcome measures (dependent variables) clearly defined, valid, reliable, and implemented consistently across all study participants?
- Yes
- Were the outcome assessors blinded to the exposure status of participants?
- Cannot Determine, Not Reported, Not Applicable
- Was loss to follow-up after baseline 20% or less?
- Yes
- Were key potential confounding variables measured and adjusted statistically for their impact on the relationship between exposure(s) and outcome(s)?
- Yes
Key Finding #1
There was a significant change in hip adduction, internal and external rotation ROM when comparing pre and post test measurements.
Key Finding #2
There was a significant difference in both the posterolateral and posteromedial directions of the modified Star Excursion Balance Test when comparing pre and post test measurements.
Key Finding #3
There was no significant change in agility scores on the T test when comparing pre and post test measurements.
Key Finding #4
Isolated immediate changes in ROM and functional outcomes were evident, but further evaluation needs to be done.
Please provide your summary of the paper
Active college aged students with near to normal hip range of motion participated in a prospective exploratory study looking to determine the effects of hip joint mobilizations on hip ROM, balance, and agility. Each participant participated in 3 30-60 minute sessions, 7 days apart. During the first session hip ROM was measured using a digital goniometer pre and post Maitland hip joint mobilizations using a Mulligan mobilization belt for all hip motions. During the second session, balance was measured using the mSEBT pre and post mobilization using the same technique as the first week. During the third and final session, agility was measured using the T test pre and post mobilization using the same technique as the first week. Hip internal rotation, external rotation, and adduction range of motion, as well as the posterolateral and posteromedial directions on the mSEBT significantly improved post hip mobilization. significantly improved post hip mobilization. There was no significant difference shown in agility testing post intervention. This study showed it could be beneficial to use hip mobilizations in recreationally active college aged individuals to improve certain hip ROMs and balance scores, but further research needs to be done in populations with restricted hip ROM and hip pathologies.
Please provide your clinical interpretation of this paper. Include how this study may impact clinical practice and how the results can be implemented.
Physical therapy intervention, specifically mobilization techniques, can immediately improve hip ROM and balance in individuals with near to normal hip range of motion. While this cannot be verified in individuals with hip pathologies, hip mobilizations can be a useful tool to improve certain hip ROMs and balance in young and active patients.
