Clinical Outcomes Following Manual Physical Therapy and Exercise for Hip Osteoarthritis: A Case Series

Abstract

Study Design: Case series describing the outcomes of individual patients with hip osteoarthritis treated with manual physical therapy and exercise. Case Description: Seven patients referred to physical therapy with hip osteoarthritis and/or hip pain were included in this case series. All patients were treated with manual physical therapy followed by exercises to maximize strength and range of motion. Six of 7 patients completed a Harris Hip Score at initial examination and discharge from physical therapy, and 1 patient completed a Global Rating of Change Scale at discharge. Outcomes: Three males and 4 females with a median age of 62 years (range, 52-80 years) and median duration of symptoms of 9 months (range, 2-60 months) participated in this case series. The median number of physical therapy sessions attended was 5 (range, 4-12). The median increase in total passive range of motion of the hip was 82°(range, 70°-86°). The median improvement on the Harris Hip Score was 25 points (range, 15-38 points). The single patient who completed the Global Rating of Change Scale at discharge reported being ''a great deal better.'' Numeric pain rating scores decreased by a mean of 5 points (range, 2-7 points) on 0-to-10-point scale. Discussion: All patients exhibited reductions in pain and increases in passive range of motion, as well as a clinically meaningful improvement in function. Although we cannot infer a cause and effect relationship from a case series, the outcomes with these patients are similar to others reported in the literature that have demonstrated superior clinical outcomes associated with manual physical therapy and exercise for hip osteoarthritis compared to exercise alone.

A Primer on Selected Aspects of Evidence-Based Practice Relating to Questions of Treatment, Part 2: Interpreting Results, Application to Clinical Practice, and Self-Evaluation

“…The median might also be preferred over the mean when sample sizes are so small that they may not represent the target population. For example, in a case series including 7 patients with hip osteoarthritis, MacDonald et al 57 reported medians rather than means for all baseline attribute variables and for all outcome variables. If data are from nominal or ordinal scales, the mode or median scores, respectively, are reported to describe central tendency.…”

“…Clinicians may find it helpful to read one of the several case studies or case series where clinicians provide detailed description of applying current best evidence in managing patients with a variety of conditions. For example, MacDonald and colleagues 57 reported on the management of a series of patients with hip dysfunction who responded positively to novel manual therapy interventions. Similarly, Cleland et al 21 and Waldrop 82 have published case series that apply recently developed clinical prediction rules to patients.…”

The Effect of Therapeutic Exercise and Mobilization on Patients With Shoulder Dysfunction: A Systematic Review With Meta-analysis

“…10 In clinical practice, joint mobilization techniques are commonly used to supplement therapeutic exercises for a multitude of conditions. 29 Specific to the shoulder, a systematic review published in 2003 9 studied the effect of manual therapy and therapeutic exercise on shoulder impingement syndrome. However, it also included studies that looked at the effects of physical agents and other medical interventions as primary inde- been treated with some type of mobilization and/or therapeutic exercise.…”

Posttraumatic Ankle Arthritis: An Update on Conservative and Surgical Management

“…While there is research to support conservative treatment options for osteoarthritis at the hip 31,32,53 and knee, 17,18,94 evidence to support effective conservative treatment for individuals with posttraumatic ankle arthritis is lacking. There seem to be some indications that weight loss, the use of a cane for ambulation, bracing, and shoe wear modification should be included as part of a treatment program.…”