Effects of medical exercise therapy in patients with hip osteoarthritis: A randomized controlled trial with six months follow-up. A pilot study (original) (raw)
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Archives of Physical Medicine and Rehabilitation, 2013
Background: Osteoarthritis (OA) of the hip is a major cause of functional disability and reduced quality of life. Management options aim to reduce pain and improve or maintain physical functioning. Current evidence indicates that therapeutic exercise has a beneficial but short-term effect on pain and disability, with poor long-term benefit. The optimal content, duration and type of exercise are yet to be ascertained. There has been little scientific investigation into the effectiveness of manual therapy in hip OA. Only one randomized controlled trial (RCT) found greater improvements in patient-perceived improvement and physical function with manual therapy, compared to exercise therapy.
Exercise therapy for the management of osteoarthritis of the hip joint: a systematic review
Arthritis Research & Therapy, 2009
Introduction Recent guidelines pertaining to exercise for individuals with osteoarthritis have been released. These guidelines have been based primarily on studies of knee-joint osteoarthritis. The current study was focused on the hip joint, which has different biomechanical features and risk factors for osteoarthritis and has received much less attention in the literature. The purpose was to conduct a systematic review of the literature to evaluate the exercise programs used in intervention studies focused solely on hip-joint osteoarthritis, to decide whether their exercise regimens met the new guidelines, and to determine the level of support for exercise-therapy interventions in the management of hip-joint osteoarthritis.
Physical therapy, 2015
The effect of exercise on specific impairments and activity limitations in patients with hip osteoarthritis (OA) is limited. To evaluate long-term results of exercise therapy and patient education on range of motion (ROM), muscle strength, physical fitness, walking capacity and pain during walking in patients with hip OA. Randomized clinical trial SETTING: University Hospital PATIENTS: One hundred and nine patients with clinical and radiographic hip OA, included at a university hospital, were randomly allocated to exercise therapy and patient education (exercise group) or patient education only (control group). All patients participated in a patient education program consisting of three group meetings led by two physical therapists. Two other physical therapists were responsible for providing the exercise therapy program, consisting of 2-3 weekly sessions of strengthening, functional and stretching exercises over 12-weeks. Both interventions were conducted at a sports medicine clini...
Effectiveness of exercise in patients with osteoarthritis of hip or knee: nine months' follow up
Annals of the Rheumatic Diseases, 2001
Objective-To determine whether the effects of an exercise programme in patients with osteoarthritis of hip or knee are sustained at six and nine months' follow up. Methods-A randomised, single blind, clinical trial was conducted in a primary care setting. Patients with osteoarthritis of hip or knee (ACR criteria) were selected. Two intervention groups were compared. Both groups received treatment from their general practitioner, including patient education and drug treatment if necessary. The experimental group also received exercise treatment from a physiotherapist in primary care. The treatment period was 12 weeks, with an ensuing 24 week follow up. The main outcome measures were pain, drug use (non-steroidal anti-inflammatory drugs), and observed disability. Results-201 patients were randomly allocated to the exercise or control group, and 183 patients completed the trial. At 24 weeks exercise treatment was associated with a small to moderate eVect on pain during the past week (diVerence in change between the two groups −11.5 (95% CI −19.7 to −3.3). At 36 weeks no diVerences were found between the groups. Conclusions-Beneficial eVects of exercise decline over time and finally disappear.
Exercise Therapy Program in Rehabilitation of Patients with Primary Hip Osteoarthritis
Journal of Physical Education and Sport, 2013
The distresses of the hip represent a wide chapter of interest in medical rehabilitation pathology. Also, by the increase in the average age population, hip osteoarthritis has become a common degenerative restrictive disease to the "third age" patient. The aim of the current study was to determine whether an 8-weeks intervention program comprising of a patient group based on medication, exercise therapy and electrotherapy is more efficacious in terms of effects on pain, functional performance and health status in individuals with primary hip osteoarthritis compared to participants treated only with medication and electrotherapy. The purpose of this study was to describe and demonstrate the use of an 8-weeks intervention program consisting of exercise therapy and electrotherapy in patients with primary hip osteoarthritis compared to participants treated only with medication and electrotherapy. The results of this study are encouraging, suggesting that the application of an exercise therapy program associated with classic physiotherapy treatment can lead to better and persistent outcomes in patients with primary hip OA. We consider that the combined therapy can be a better option in the hip OA rehabilitation management and that randomized clinical trials must be extended in the future, regarding exercise therapy and its effects. Eventually this combined therapy can be used on larger groups of patients to further confirm our obtained results and to promote the utility of therapeutic exercise program.
The Cochrane library, 2015
BackgroundExercise or physical activity is recommended for improving pain and functional status in people with knee or hip osteoarthritis. These are complex interventions whose effectiveness depends on one or more components that are often poorly identified. It has been suggested that health benefits may be greater with high‐intensity rather than low‐intensity exercise or physical activity.ObjectivesTo determine the benefits and harms of high‐ versus low‐intensity physical activity or exercise programs in people with hip or knee osteoarthritis.Search methodsWe searched the Cochrane Central Register of Controlled Trials (CENTRAL; issue 06, 2014), MEDLINE (194 8 to June 2014) , EMBASE (198 0 to June 2014), CINAHL (1982 to June 2014), PEDro (1929 to June 2014), SCOPUS (to June 2014) and the World Health Organization (WHO) International Clinical Registry Platform (to June 2014) for articles, without a language restriction. We also handsearched relevant conference proceedings, trials, and reference lists and contacted researchers and experts in the field to identify additional studies.Selection criteriaWe included randomized controlled trials of people with knee or hip osteoarthritis that compared high‐ versus low‐intensity physical activity or exercise programs between the experimental and control group.High‐intensity physical activity or exercise programs training had to refer to an increase in the overall amount of training time (frequency, duration, number of sessions) or the amount of work (strength, number of repetitions) or effort/energy expenditure (exertion, heart rate, effort).Data collection and analysisTwo review authors independently assessed study eligibility and extracted data on trial details. We contacted authors for additional information if necessary. We assessed the quality of the body of evidence for these outcomes using the GRADE approach.Main resultsWe included reports for six studies of 656 participants that compared high‐ and low‐intensity exercise programs; five studies exclusively recruited people with symptomatic knee osteoarthritis (620 participants), and one study exclusively recruited people with hip or knee osteoarthritis (36 participants). The majority of the participants were females (70%). No studies evaluated physical activity programs. We found the overall quality of evidence to be low to very low due to concerns about study limitations and imprecision (small number of studies, large confidence intervals) for the major outcomes using the GRADE approach. Most of the studies had an unclear or high risk of bias for several domains, and we judged five of the six studies to be at high risk for performance, detection, and attrition bias.Low‐quality evidence indicated reduced pain on a 20‐point Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain scale (mean difference (MD) ‐0.84, 95% confidence interval (CI) ‐1.63 to ‐0.04; 4% absolute reduction, 95% CI ‐8% to 0%; number needed to treat for an additional beneficial outcome (NNTB) 11, 95% CI 14 to 22) and improved physical function on the 68‐point WOMAC disability subscale (MD ‐2.65, 95% CI ‐5.29 to ‐0.01; 4% absolute reduction; NNTB 10, 95% CI 8 to 13) immediately at the end of the exercise programs (from 8 to 24 weeks). However, these results are unlikely to be of clinical importance. These small improvements did not continue at longer‐term follow‐up (up to 40 weeks after the end of the intervention). We are uncertain of the effect on quality of life, as only one study reported this outcome (0 to 200 scale; MD 4.3, 95% CI ‐6.5 to 15.2; 2% absolute reduction; very low level of evidence).Our subgroup analyses provided uncertain evidence as to whether increased exercise time (duration, number of sessions) and level of resistance (strength or effort) have an impact on the exercise program effects.Three studies reported withdrawals due to adverse events. The number of dropouts was small. Only one study systematically monitored adverse effects, but four studies reported some adverse effects related to knee pain associated with an exercise program. We are uncertain as to whether high intensity increases the number of adverse effects (Peto odds ratio 1.72, 95% CI 0.51 to 5.81; ‐ 2% absolute risk reduction; very low level of evidence). None of the included studies reported serious adverse events.Authors' conclusionsWe found very low‐quality to low‐quality evidence for no important clinical benefit of high‐intensity compared to low‐intensity exercise programs in improving pain and physical function in the short term. There was insufficient evidence to determine the effect of different types of intensity of exercise programs.We are uncertain as to whether higher‐intensity exercise programs may induce more harmful effects than those of lower intensity; this must be evaluated by further studies. Withdrawals due to adverse events were poorly monitored and not reported systematically in each group. We downgraded the evidence to low or very low because of the risk of bias, inconsistency, and imprecision.The small number of studies comparing high‐ and low‐intensity exercise programs in osteoarthritis underscores the need for more studies investigating the dose–response relationship in exercise programs. In particular, further studies are needed to establish the minimal intensity of exercise programs needed for clinical effect and the highest intensity patients can tolerate. Larger studies should comply with the Consolidated Standards of Reporting Trials (CONSORT) checklist and systematically report harms data to evaluate the potential impact of highest intensities of exercise programs in people with joint damage.
Arthritis & Rheumatism, 1999
Methods. A computerized literature search of Medline, Embase, and Cinahl was carried out. Randomized clinical trials on exercise therapy for OA of the hip or knee were selected if treatment had been randomly allocated and if pain, self-reported disability, observed disability, or patient's global assessment of effect had been used as outcome measures. The validity of trials was systematically assessed by independent reviewers. Effect sizes and power estimates were calculated. A best evidence synthesis was conducted, weighting the studies with respect to their validity and power.
Development of a Therapeutic Exercise Program for Patients With Osteoarthritis of the Hip
Physical Therapy, 2010
No detailed exercise programs specifically for patients with hip osteoarthritis (OA) have been described in the literature. This lack of data creates a gap between the recommendation that people with OA should exercise and the type and dose of exercises that they should perform. The purpose of this case report is to describe and demonstrate the use of a therapeutic exercise program for a patient with hip OA.