No abstract

BackgroundOsteoarthritis (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.Methods and designAn assessor-blind multicentre RCT will be undertaken to compare the effect of a combination of manual therapy and exercise therapy, exercise therapy only, and a waiting-list control on physical function in hip OA. One hundred and fifty people with a diagnosis of hip OA will be recruited and randomly allocated to one of 3 groups: exercise therapy, exercise therapy with manual therapy and a waiting-list control. Subjects in the intervention groups will attend physiotherapy for 6–8 sessions over 8 weeks. Those in the control group will remain on the waiting list until after this time and will then be re-randomised to one of the two intervention groups. Outcome measures will include physical function (WOMAC), pain severity (numerical rating scale), patient perceived change (7-point Likert scale), quality of life (SF-36), mood (hospital anxiety and depression scale), patient satisfaction, physical activity (IPAQ) and physical measures of range of motion, 50-foot walk and repeated sit-to stand tests.DiscussionThis RCT will compare the effectiveness of the addition of manual therapy to exercise therapy to exercise therapy only and a waiting-list control in hip OA. A high quality methodology will be used in keeping with CONSORT guidelines. The results will contribute to the evidence base regarding the clinical efficacy for physiotherapy interventions in hip OA.Trial RegistrationNumber: NCT00709566

Background:The muscle system provides essential support to a joint, and muscle weakness and atrophy may occur in the presence of joint pathology, such as osteoarthritis (OA). The gluteal muscles -gluteus medius and gluteus maximus -provide an important stability role in the hip joint and evidence exists for gluteal weakness in hip OA. Therefore, rehabilitation should address such dysfunction.Objectives: To identify the use of gluteal strengthening in exercise-based randomised controlled trials or randomised clinical trials of hip OA. Methods: A structured literature search was undertaken to review the evidence for use of gluteal strengthening in hip OA clinical trials. Results: Eleven randomised controlled or randomised clinical trials of strengthening-based exercise in hip OA were identified and searched for evidence of gluteal strengthening. None of the studies reported specific strengthening of the gluteal muscles and details of the strengthening regimes used were poorly described in most of the studies. This lack of specificity may be one of the reasons why only small effect sizes and short-term benefits have been found for exercise therapy in the management of hip OA.

Objectives To appraise the quality of clinical practice guidelines (CPGs) for physical therapy management of nontraumatic shoulder pain disorders. Design Systematic review of CPGs. Literature Search Two reviewers independently conducted a search of 7 databases and 7 gray literature sources. Study Selection Criteria We included systematically developed CPGs for physical therapy management of nontraumatic musculoskeletal conditions of the shoulder in adults that were available in full text in the English language. We excluded CPGs for physical therapy management of surgically treated shoulder pain disorders. Data Synthesis Three reviewers independently rated the quality of included CPGs using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument. Data were compiled into tables that displayed AGREE II domain scores for each CPG and mean item scores across the CPGs. Results We included 9 CPGs. Five CPGs focused on rotator cuff disorders, 2 focused on frozen shoulder, and 2 covered a range of soft tissue shoulder diagnoses. Three CPGs were judged as high quality (all were 5 or more years old) and 6 were judged as low quality. The quality domains in which CPGs were rated highest were “scope and purpose” (all CPGs scored greater than 50% and 4 scored greater than 80%) and “clarity of presentation” (all CPGs scored greater than 50% and 7 scored greater than 80%). The domains in which CPGs were rated most poorly were “applicability” (6 CPGs scored 40% or less) and “editorial independence” (4 CPGs scored less than 40%). Conclusion There were no high-quality, contemporary CPGs to guide physical therapy management of nontraumatic shoulder pain. J Orthop Sports Phys Ther 2021;51(2):63–71. Epub 25 Dec 2020. doi:10.2519/jospt.2021.9397

Connell P. Measuring patient satisfaction with exercise therapy for knee osteoarthritis: evaluating the utility of the physiotherapy outpatient survey. Musculoskeletal Care. 2010;8(2):61-7. Conclusion: High levels of satisfaction were reported in this subsample of knee OA patients participating in an RCT evaluating the effects of different exercise approaches for knee OA. -Use Licence -Satisfaction varied depending on the satisfaction domain, with lower satisfaction with outcome compared to other aspects of care. A stronger relationship between satisfaction with outcome and clinical outcomes compared to other features of satisfaction was also found. The POPS is a useful questionnaire to evaluate the multidimensional aspects of satisfaction with physiotherapy for OA.