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Abstract
Hip osteoarthritis: manual therapy and exercise therapy
published in January - February 2020 - in Il Fisioterapista - issue n.1
Massimo Bitocchi

Objective: The aim of this article was to assess the statistical data reported in the literature regarding the role of manual therapy and exercise therapy in hip osteoarthritis. Introduction: Hip osteoarthritis is one of the major causes of disability in the elderly. Joint pain and functional disability are the main symptoms. Etiological factors include both localized factors (such as malformations or joint injuries) and systemic factors (such as sex, ethnic background, and metabolic diseases). Despite the widespread use clinically of manual therapy, there is little scientific evidence to substantiate its effectiveness in reducing pain or improving function in hip osteoarthritis.
Method: To this end, we searched the current literature for relevant studies, without over employing a specific methodological criterion for identifying and analyzing the literature.
Results: Exercise therapy was better than control in post-treatment for pain (SMD −0.27, 95% CI−0.5 to−0.04) and physical function (SMD −0.29, 95%CI−0.47to−0.11) but not for quality of life (SMD −0.06, 95%CI−0.27to0.16), while at follow-up it was better for pain (SMD −0.24, 95%CI−0.41to−0.06) and physical function (SMD −0.33,95%CI−0.5to−0.15). Manual therapy was better than control in post-treatment for pain (SMD −0.71, 95%CI−1.08to−0.03) and physical function (SMD −0.71, 95%CI−1.08to−0.33); at follow-up it was better for pain (SMD −0.43, 95%CI−0.8to−0.06) and for physical function (SMD-0.47, 95%CI-0.84to-0.1). Finally, combined treatment was better than control in post-treatment for pain (SMD-0.43,95%CI- 0.78to-0.08) and physical function (SMD −0.38,95%CI− 0.73to−0.04) but there was no difference for quality of life (SMD −0.17, 95% CI −0.59to0.25) while at follow-up it was better for pain (SMD 0.25,95%CI- 0.35to0.84) and for physical function (SMD 0.09,95%CI-0.5to0.68).
Conclusion: For the primary outcomes (pain and physical function), there is high quality evidence that exercise therapy is better than control at both post-treatment and follow-up. There is low quality evidence that manual therapy is better than control for primary outcomes (pain and physical function) at both post-treatment and follow-up, and low quality evidence that combined treatment is better than control for primary outcomes (pain and physical function) at post-treatment but not at follow-up.