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Patient education with or without manual therapy compared to a control group in patients with osteoarthritis of the hip.A proof of principle three-arm parallel group randomized clinical trial.
MedLine Citation:
PMID:  23792189     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVE: To investigate the effectiveness of a patient education (PE) program with or without the added effect of manual therapy (MT) compared to a minimal control intervention (MCI).
METHODS: In a single-centre university hospital setting, a total of 118 patients with clinical and radiographic unilateral hip OA from primary care were randomized into one of three groups: PE, PE plus MT or MCI. The PE was taught by a physiotherapist involving five sessions. The MT was delivered by a chiropractor involving 12 sessions and the MCI included a home stretching program. Primary outcome was self-reported pain severity on an 11-box numeric rating scale (NRS) immediately following a 6-week intervention period. Patients were followed for one year.
RESULTS: Primary analysis included 111 patients (94%). In the combined group (PE+MT), a clinically relevant reduction in pain severity compared to the MCI of 1.90 points (95% CI (0.9 - 2.9) was achieved. Effect size (Cohen's d) for the PE+MT minus the MCI was 0.92 (95% CI 0.41 - 1.42). Number needed to treat for PE+MT was 3 (95% CI 2 - 7). No difference was found between the PE and MCI groups, with mean difference 0.0 (95% CI -1.0 - 1.0). At 12 months, not including patients receiving hip surgery the statistically significant difference favoring PE+MT was maintained.
CONCLUSIONS: For primary care patients with osteoarthritis of the hip, a combined intervention of manual therapy and patient education was more effective than a minimal control intervention. Patient education alone was not superior to the minimal control intervention. Trial registration:clinicaltrials.govNCT01039337.
Authors:
Erik Poulsen; Jan Hartvigsen; Henrik W Christensen; Ewa M Roos; Werner Vach; Søren Overgaard
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-6-20
Journal Detail:
Title:  Osteoarthritis and cartilage / OARS, Osteoarthritis Research Society     Volume:  -     ISSN:  1522-9653     ISO Abbreviation:  Osteoarthr. Cartil.     Publication Date:  2013 Jun 
Date Detail:
Created Date:  2013-6-24     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9305697     Medline TA:  Osteoarthritis Cartilage     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2013. Published by Elsevier Ltd.
Affiliation:
Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark; Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark. Electronic address: e.poulsen@nikkb.dk.
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