Author Names

Sampath K, Mani R, Miyamori T, Tumilty S.

Reviewer Name

Jaime Pardee, SPT

Reviewer Affiliations

Duke University School of Medicine, Doctor of Physical Therapy Division

 

Paper Abstract

Objective: To determine whether manual therapy or exercise therapy or both is beneficial for people with hip osteoarthritis in terms of reduced pain, improved physical function and improved quality of life.  Methods: Databases such as Medline, AMED, EMBASE, CINAHL, SPORTSDiscus, PubMed, Cochrane Library, Web of Science, Physiotherapy Evidence Database, and SCOPUS were searched from their inception till September 2015. Two authors independently extracted and assessed the risk of bias in included studies. Standardised mean differences for outcome measures (pain, physical function and quality of life) were used to calculate effect sizes. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach was used for assessing the quality of the body of evidence for each outcome of interest.  Results: Seven trials (886 participants) that met the inclusion criteria were included in the meta-analysis. There was high quality evidence that exercise therapy was beneficial at post-treatment (pain-SMD-0.27,95%CI-0.5to-0.04;physical function-SMD-0.29,95%CI-0.47to-0.11) and follow-up (pain-SMD-0.24,95%CI- 0.41to-0.06; physical function-SMD-0.33,95%CI-0.5to-0.15). There was low quality evidence that manual therapy was beneficial at post-treatment (pain-SMD-0.71,95%CI-1.08to-0.33; physical function-SMD-0.71,95%CI-1.08to-0.33) and follow-up (pain-SMD-0.43,95%CI-0.8to-0.06; physical function-SMD-0.47,95%CI-0.84to-0.1). Low quality evidence indicated that combined treatment was beneficial at post-treatment (pain-SMD-0.43,95%CI-0.78to-0.08; physical function-SMD-0.38,95%CI-0.73to-0.04) but not at follow-up (pain-SMD0.25,95%CI-0.35to0.84; physical function-SMD0.09,95%CI-0.5to0.68). There was no effect of any interventions on quality of life.  Conclusion: An Exercise therapy intervention provides short-term as well as long-term benefits in terms of reduction in pain, and improvement in physical function among people with hip osteoarthritis. The observed magnitude of the treatment effect would be considered small to moderate.

 

NIH Risk of Bias Tool

Quality Assessment of Systematic Reviews and Meta-Analyses

Is the review based on a focused question that is adequately formulated and described?

  • Yes

Were eligibility criteria for included and excluded studies predefined and specified?

  • Yes

Did the literature search strategy use a comprehensive, systematic approach?

  • Yes

Were titles, abstracts, and full-text articles dually and independently reviewed for inclusion and exclusion to minimize bias?

  • Yes

Was the quality of each included study rated independently by two or more reviewers using a standard method to appraise its internal validity?

  • Yes

Were the included studies listed along with important characteristics and results of each study?

Was publication bias assessed?

  • Yes

Was heterogeneity assessed? (This question applies only to meta-analyses.)

  • Yes

 

Key Finding #1

There was high-quality evidence that exercise was more effective than the control group at follow-up for the pain outcome.

Key Finding #2

There was low-quality evidence for pain outcome that manual therapy was better than the control post-treatment.

Key Finding #3

Low-quality evidence showed that manual therapy was more effective than the control for follow-up treatments.

Key Finding #4

There was low-quality evidence that combined treatment was more effective than the control for pain and physical function.

 

Please provide your summary of the paper

This study was conducted to answer whether manual therapy alone, exercise therapy alone, or combined treatment can reduce pain, improve physical function and quality of life in individuals with hip osteoarthritis. A meta-analysis was conducted that included 886 participants that met the inclusion criteria. There was high-quality evidence that exercise therapy was beneficial for patients post-treatment and at follow-up. There was low-quality evidence that combined treatment was effective at post-treatment but not at the follow-up treatment. None of the interventions had an impact on quality of life. The study concluded that therapeutic exercise intervention provides short-term and long-term benefits for pain reduction and improved physical function in individuals with hip osteoarthritis.

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 highlights the importance of combining therapeutic exercise with manual therapy to improve physical function and reduce pain in patients with hip osteoarthritis. Ultimately, therapeutic exercise has higher-quality evidence to support it, but these findings can support that manual therapy techniques are safe and beneficial for patients with hip osteoarthritis. More research is needed in this area of physical therapy to support these findings further.