Effects of exercise and manual therapy on pain associated with hip osteoarthritis: a systematic review and meta-analysis.

Abstract

AIM:

To explore the effects of exercise (water-based or land-based) and/or manual therapies on pain in adults with clinically and/or radiographically diagnosed hip osteoarthritis (OA).

METHODS:

A systematic review and meta-analysis was performed, with patient reported pain assessed using a visual analogue scale (VAS) or the Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain subscale. Data were grouped by follow-up time (0-3 months=short term; 4-12 months=medium term and; >12 months=long term), and standardised mean differences (SMD) with 95% CIs were used to establish intervention effect sizes. Study quality was assessed using modified PEDro scores.

RESULTS:

19 trials were included. Four studies showed short-term benefits favouring water-based exercise over minimal control using the WOMAC pain subscale (SMD -0.53, 95% CI -0.96 to -0.10). Six studies supported a short-term benefit of land-based exercise compared to minimal control on VAS assessed pain (SMD -0.49, 95% CI -0.70 to -0.29). There were no medium (SMD -0.23, 95% CI -0.48 to 0.03) or long (SMD -0.22, 95% CI -0.51 to 0.06) term benefits of exercise therapy, or benefit of combining exercise therapy with manual therapy (SMD -0.38, 95% CI -0.88 to 0.13) when compared to minimal control.

CONCLUSIONS:

Best available evidence indicates that exercise therapy (whether land-based or water-based) is more effective than minimal control in managing pain associated with hip OA in the short term. Larger high-quality RCTs are needed to establish the effectiveness of exercise and manual therapies in the medium and long term.

• Authors: Lucy Beumer, Jennie Wong, Stuart J Warden, Joanne L Kemp, Paul Foster, Kay M Crossley
• Journal: British journal of sports medicine (Br J Sports Med) Vol. 50 Issue 8 Pg. 458-63 (Apr 2016) ISSN: 1473-0480 [Electronic] England
• PMID: 26612846 (Publication Type: Journal Article, Meta-Analysis, Review, Systematic Review)
• Copyright: Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Topics

• Exercise Therapy
• Humans
• Musculoskeletal Manipulations
• Osteoarthritis, Hip (therapy)
• Pain Management (methods)
• Pain Measurement
• Randomized Controlled Trials as Topic