Article

OBJECTIVES: To determine the effectiveness of exercise therapy (ET) compared with
ET with adjunctive manual therapy (MT) for people with hip osteoarthritis (OA);
and to identify if immediate commencement of treatment
(ET or ET+MT) was more
beneficial than a 9-week waiting period for either intervention. DESIGN:
Assessor-blind randomized controlled trial with a 9-week and 18-week follow-up.
SETTING: Four academic teaching hospitals in Dublin, Ireland. PARTICIPANTS:
Patients (N=131) with hip OA recruited from general practitioners,
rheumatologists, orthopedic surgeons, and other hospital consultants were
randomized to 1 of 3 groups: ET (n=45), ET+MT (n=43), and waitlist controls
(n=43). INTERVENTIONS: Participants in both the ET and ET+MT groups received up
to 8 treatments over 8 weeks. Control group participants were rerandomized into
either ET or ET+MT groups after 9 week follow-up. Their data were pooled with
original treatment group data: ET (n=66) and ET+MT (n=65). MAIN OUTCOME MEASURES:
The primary outcome was the Western Ontario and McMaster Universities
Osteoarthritis Index (WOMAC) physical function (PF) subscale. Secondary outcomes
included physical performance, pain severity, hip range of motion (ROM),
anxiety/depression, quality of life, medication usage, patient-perceived change,
and patient satisfaction. RESULTS: There was no significant difference in WOMAC
PF between the ET (n=66) and ET+MT (n=65) groups at 9 weeks (mean difference,
.09; 95% confidence interval [CI] -2.93 to 3.11) or 18 weeks (mean difference,
.42; 95% CI, -4.41 to 5.25), or between other outcomes, except patient
satisfaction with outcomes, which was higher in the ET+MT group (P=.02).
Improvements in WOMAC, hip ROM, and patient-perceived change occurred in both
treatment groups compared with the control group. CONCLUSIONS: Self-reported
function, hip ROM, and patient-perceived improvement occurred after an 8-week
program of ET for patients with OA of the hip. MT as an adjunct to exercise
provided no further benefit, except for higher patient satisfaction with outcome.
CI - Copyright (c) 2013 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS