Physical therapy for hip osteoarthritis may not lead to significant benefits

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1. There was no significant difference in patient-reported outcomes after 12 weeks of physical therapy versus 12 weeks of placebo physical therapy for hip osteoarthritis. 

2. Participants in the both the physical therapy and placebo physical therapy groups reported a statistically significant decrease in hip osteoarthritis pain and increase in physical function.

 Evidence Rating Level: 2 (Good)            

Study Rundown: Although current guidelines for osteoarthritis recommend the use of physical therapy in disease treatment, there is a paucity of data to support the use of this time consuming and costly intervention. This study randomized individuals with symptomatic hip osteoarthritis to receive 12 weeks of either physical therapy or placebo physical therapy with a 24-week follow-up.  The placebo physical therapy involved the use of placebo ultrasound and gel treatment, while those in the physical therapy group received a more comprehensive treatment regimen including in-person and at-home physical therapy drills and exercises. Improvement was evaluated based on assessments made by a blinded researcher and based on self-reported outcomes captured in a patient follow-up questionnaire.

The results of this study are limited by the relatively small study sample size of 102 participants. Moreover, the chronic, waxing and waning nature of osteoarthritis symptomology may not be captured by the relatively short study follow-up period of 24 weeks. While this study suggests that placebo physical therapy is as effective as physical therapy for hip osteoarthritis, a longer study with more participants should be conducted before treatment recommendations are altered.

Click to read the study published today in JAMA

Relevant Reading: OARSI recommendations for the management of hip and knee osteoarthritis: part III: Changes in evidence following systematic cumulative update of research published through January 2009

In-Depth [randomized controlled trial]: This study randomized 102 individuals with hip osteoarthritis to receive physical therapy or placebo physical therapy for 12 weeks.  At the end of the 36-week follow up (12 weeks of therapy and 24 weeks of post-therapy follow up), 83 individuals were analyzed based on two self-report validated tools for osteoarthritis outcomes.  The difference in pain score between the two groups was 4.3 (-9.9 to 18.6) and the difference between physical function score was 0.7 (-4.5 to 10.6) at the end of the 36-week follow up. Neither of these differences was statistically significant. Pain improvements were measured based on an a 100 mm visual analog scale while improvements in physical function were measured using a 17-item osteoarthritis index ranging from 0 to 68 units. An improvement of 17.7 mm and 5.2 units, respectively, was noted for the physical therapy group. An improvement of 22.9 mm and 5.5 units, respectively, was noted for the placebo group. The relative risk of global overall improvement between the two groups was 0.91 (0.61 to 1.37) at 12 weeks and was 1.10 (0.65 to 1.86) at 36 weeks.

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