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Questions about physiotherapy for hip osteoarthritis

Tuesday 27 May 2014

Research raises questions about physiotherapy for hip osteoarthritis

A new study co-authored by a University of Otago researcher has found that combining several physiotherapy treatments does not produce greater improvements in pain or function than inactive ‘sham’ treatments among adults with hip osteoarthritis.

The findings appear in the prestigious Journal of the American Medical Association JAMA.

Hip osteoarthritis is a very common problem in adults. Exercise therapy, advice and education are recommended as first-line treatments by international clinical practice guidelines, with some more recent guidelines also recommending manual therapy. However there is little information how these treatments are best delivered.

The study, led by Professor Kim Bennell of the University of Melbourne, randomly assigned patients with hip osteoarthritis to attend 10 sessions of either active physiotherapy treatment (which included education and advice, manual therapy, exercise therapy, home exercises, and walking with an aid, if needed) or placebo treatments (which included inactive ‘sham’ ultrasound therapy and topical gel, education and advice).

Co-investigator Associate Professor Haxby Abbott of the University of Otago’s Department of Surgical Sciences says the research contains an important message for physiotherapists treating patients with hip osteoarthritis.

“The physiotherapy protocol we tested contained several different treatments all delivered at the same time. This ‘multi-modal’ approach is common practice by physiotherapists, but may not deliver the best results,” says Associate Professor Abbott.

“This study follows research we published last year, conducted in Dunedin, which showed physiotherapy protocols consisting primarily of manual therapy, or primarily of exercise therapy, was highly cost-effective and produced greater improvements than usual medical care. In contrast we found that a multi-modal combined manual therapy and exercise therapy protocol did not produce such improvements.

“This new study used essentially the same multi-modal combined manual therapy and exercise therapy protocol as was used in our previous study,” he says.

“It shows that this approach delivers results no better than an equivalent period of time spent with a caring, attentive physiotherapist delivering ‘sham’ inactive treatments, along with verbal advice in conversation. These results raise significant questions about the common multi-modal approach to physiotherapy, at least in this patient population.”

“My interpretation of the two studies together is that, when treating patients with osteoarthritis, physiotherapists should focus on delivering one mode of therapy at a time, do it well, and deliver an adequate dose of that therapy, rather than dividing their time up among many different modes of therapy.”

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