Physical therapy may not benefit hip osteoarthritis

By Laura Cowen, medwireNews Reporter

Researchers have questioned the value of physical therapy for painful hip osteoarthritis in a study published in JAMA.

“A multimodal physical therapy program conferred no additional clinical benefit over a realistic sham for people with hip osteoarthritis and was associated with relatively frequent but mild adverse effects,” report Kim Bennell (University of Melbourne, Victoria, Australia) and colleagues.

After 12 weeks of active treatment, which included education and advice, manual therapy, home exercise, and provision of a walking stick, if needed, the patients (n=49) reported a significant improvement in mean pain score on a visual analogue scale, from 58.8 mm (range, 0–100 mm; 100 indicates worst pain possible) at baseline to 40.1 mm at week 13.

Patients receiving the sham treatment (n=53), consisting of inactive ultrasound and application of an inert gel to the hip, also reported a significant improvement in pain score, from 58.0 mm at baseline to 35.2 mm at week 13.

However, the mean between-group difference for change in pain (6.9 mm) favouring sham treatment was not statistically significant and did not meet the researchers’ predefined “clinically important” level of 18 mm.

Similarly, both groups reported improvements in function (assessed using the Western Ontario and McMaster Universities Osteoarthritis Index) after 12 weeks of treatment but the 1.4-unit (on a scale of 0–68 where 68 indicates extreme difficulty) greater improvement for sham versus active therapy was not statistically significant or clinically relevant.

The patients were followed up for a further 24 weeks after the initial therapy. During this time, those in the active group continued unsupervised home exercise while the sham group self-applied gel three times weekly. At the end of this period, there were still no significant differences in outcome between the groups.

Significantly more patients in the active group reported adverse events compared with those in the sham group, at 41% versus 14%, but the researchers note that all were mild and transient cases of increased hip pain or stiffness, or pain in the back or other regions.

All patients included in the study had radiographically confirmed hip osteoarthritis with a hip pain level of 40 mm or higher at baseline. Medication use and co-interventions were similar for both groups.

Bennell and co-authors conclude that “[t]he absence of significant between-group differences despite use of skilled therapists and excellent adherence rates to home exercise (85%) suggest that the active physical therapy program was truly ineffective.”

They add: “These results question the benefits of such a physical therapy program for this patient population.”

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