Author Names
Galleher, M., Crowe, B., & Selhorst, M.
Reviewer Name
Rose O’Donoghue, SPT
Reviewer Affiliations
Duke University School of Medicine, Doctor of Physical Therapy Division
Paper Abstract
OBJECTIVE: The purposes of this study were to: (1) assess the benefit of adding manual therapy (MT) to physical therapy care in pediatric patients with anterior hip pain; (2) assess the relative risk of adverse reactions when MT is used; and (3) report the types of MT used. METHODS: This study was a retrospective chart review of patients treated in a hospital-based sports medicine clinic. The charts of 201 patients (mean age = 14.23 ± 2.15 years) met the inclusion criteria and were reviewed. Patients were grouped into those who received MT during their episode of care, and those who did not. Pain efficiency (change in pain/number of visits), number and type of adverse reactions, as well as frequency and type of manual therapy interventions used, were the outcomes of interest. RESULTS: The mean pain efficiency was significantly less if manual therapy was performed (MT = 0.60 [95% CI 0.47–0.72], no MT = 0.80 [95% CI 0.71–0.90] p = 0.01). There was no significant difference between groups in risk of adverse reactions (MT = 5, no MT = 5). The number of visits was significantly different between groups (MT = 9.43 ± 3.9 sessions, and no MT = 7.6 ± 5.2 sessions). DISCUSSION: MT did not increase the risk of an adverse reaction in pediatric patients with anterior hip pain. While it appears to be a safe intervention, it did not improve pain efficiency or patient adherence. Future research should be performed to assess the effectiveness of MT, when performed by skilled therapists, in pediatric patients with hip pain in a controlled manner.
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%?
- Cannot Determine, Not Reported, Not Applicable
- 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?
- Yes
- 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?
- No
- 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?
- Cannot Determine, Not Reported, Not Applicable
- Were the outcome assessors blinded to the exposure status of participants?
- Yes
- 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)?
- No
Key Finding #1
Manual therapy did not increase the risk of an adverse reaction in pediatric patients with anterior hip pain (no significant difference between groups).
Key Finding #2
The average pain efficiency (change in pain/number of visits) was significantly lower when manual therapy was incorporated into the treatment session.
Key Finding #3
Manual therapy was shown to be a safe intervention for pediatric patients with a diagnosis of anterior hip pain, however, it resulted in a lower pain efficiency.
Please provide your summary of the paper
This study examined the potential benefits and risks of adding manual therapy to physical therapy care in pediatric patients with anterior hip pain. While manual therapy was shown to be a safe intervention, it was actually significantly less efficient in reducing pain among patients in this population. Since this was a retrospective study and there was limited reporting of outcome measures, there were limitations as to what could be analyzed (effect of manual therapy on function, level of disability, quality of manual therapy received, etc). Without the ability to evaluate the quality of manual therapy performed, there was no way to control for differences between therapists and their techniques used. Further studies are needed in which the manual therapy received can be standardized among patients.
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 concluded that there is no increased risk of adverse reactions when incorporating manual therapy into the treatment of pediatric patients with anterior hip pain. This means that it is a safe treatment method for this population. While there was less pain improvement in those who received manual therapy, every patient responds differently so implementing some form of manual may be beneficial depending on the patient’s reported pain response.
