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Hip osteoarthritis (HOA) affects 30 million Americans or more, and is a leading cause of disability, suffering, and pain. Standard treatments are minimally effective and carry significant risk and expense. This study assessed treatment effects of a chiropractic protocol for HOA.
Eighteen individuals, who did not qualify due to low baseline Western...
Context in source publication
Context 1
... particular cohort of 18 patients, with HOA, qualified for this SGPPD study due to not meeting the inclusion criteria for the current HOA RCT, a WOMAC score N960 mm. Thus, not randomized into the RCTs, this convenience sample spanned an age range of 40 to 85 as compared to the 2 other RCTs (40-59 and 60-85 years of age), as seen in Figure 1. ...
Similar publications
Osteoarthritis is the most common musculoskeletal disorder, estimated to affect 3 million Australians. Previous studies support structured exercise programs and manipulation for hip osteoarthritis; however, no trials have examined treatment of the lower limb kinetic chain. The purpose of this case series was to report hip range of motion and pain s...
Citations
... A pre-post intervention design was used for this proof of concept, feasibility pilot study [78]. The primary objectives were to (1) estimate adherence to the supervised exercise program, (2) estimate long-term retention rate and willingness to respond to a 6-month follow-up, and (3) establish the viability of the treatment model through the impact on participants' pain ratings, activity of daily living (ADL), and global rating of change after the 6-week supervised program. ...
Abstract Background Patellofemoral joint (PFJ) osteoarthritis (OA) is prevalent in middle-aged and older adults. Despite this, there are minimal studies which have examined conservative interventions for PFJ OA. Weakness of proximal lower extremity muscles is associated with PFJ OA. It is unknown if a hip muscle strengthening and lumbopelvic-hip core stabilization program will improve symptoms and function in persons with PFJ OA. This study examined the feasibility and impact of a 6-week hip muscle strengthening and core stabilization program on pain, symptoms, physical performance, peak muscle torques, and quality of life in persons with PFJ OA. Methods Ten females with PFJ OA and ten age- and sex-matched controls participated in baseline tests. PFJ OA participants attended ten twice-a-week hip strengthening and core stabilization exercise sessions. Outcome measures included questionnaires, the Timed-Up-and-Go, and peak isometric torque of hip and quadriceps muscles. Data were tested for normality; parametric and non-parametric tests were used as appropriate. Results At baseline, the PFJ OA group had significantly worse symptoms, slower Timed-Up-and-Go performance, and lower muscle torques than control participants. PFJ OA group adherence to supervised exercise sessions was adequate. All PFJ OA participants attended at least nine exercise sessions. Five PFJ OA participants returned 6-month follow-up questionnaires, which was considered fair retention. The PFJ OA participants’ self-reported pain, symptoms, function in daily living, function in sport, and quality of life all improved at 6 weeks (P
... This trial has generated an interest both inside and outside the chiropractic profession for initiating randomized clinical trials involving manual treatment for this patient group. [15][16][17][18][19] However, so far, diagnosis and management of patients with hip OA in chiropractic practice are documented only through case reports, case series, and pilot studies, 17,20,21 although textbooks describe specific manual chiropractic treatment methods for the hip joint. 22,23 Furthermore, it is not known just how common hip OA is in chiropractic practice or how often a doctor of chiropractic (DC) is the first health care person to diagnose a patient with hip OA. ...
... The literature suggests vigorous and sustained interest in the application of peripheral or extremity MT for lower extremity conditions; the effectiveness of MT procedures, particularly in conjunction with rehabilitation (such as exercise therapy and advice) for some common lower extremity disorders, is cautiously supported by this review; questions of effectiveness, especially cost-effectiveness, need to be undertaken. [94][95][96] This review cites earlier 1,2 but new or previously undetected MT studies for hip OA and disorders, 23,[97][98][99][100][101][102][103][104] knee OA and disorders, [105][106][107][108][109][110][111][112][113] 146,147 A new and expanding category has been added in this review: (a) decreased proprioception, balance, and function from foot and/or ankle injury or from decreased range of motion (ROM), myofascial, and/or joint dysfunction and injuries. [126][127][128][148][149][150] These investigations included single-group pretest-posttest studies, case series, and reports for assessing hip MT (with exercise) for hip OA, knee MT for hip OA, and the effect of hip MT for knee OA. ...
The purpose of this study is to update a systematic review on manipulative therapy (MT) for lower extremity conditions.
A review of literature was conducted using MEDLINE, MANTIS, Science Direct, Index to Chiropractic Literature, and PEDro from March 2008 to May 2011. Inclusion criteria required peripheral diagnosis and MT with or without adjunctive care. Clinical trials were assessed for quality using a modified Scottish Intercollegiate Guidelines Network (SIGN) ranking system.
In addition to the citations used in a 2009 systematic review, an additional 399 new citations were accessed: 175 citations in Medline, 30 citations in MANTIS, 98 through Science Direct, 54 from Index to Chiropractic Literature, and 42 from the PEDro database. Forty-eight clinical trials were assessed for quality.
Regarding MT for common lower extremity disorders, there is a level of B (fair evidence) for short-term and C (limited evidence) for long-term treatment of hip osteoarthritis. There is a level of B for short-term and C for long-term treatment of knee osteoarthritis, patellofemoral pain syndrome, and ankle inversion sprain. There is a level of B for short-term treatment of plantar fasciitis but C for short-term treatment of metatarsalgia and hallux limitus/rigidus and for loss of foot and/or ankle proprioception and balance. Finally, there is a level of I (insufficient evidence) for treatment of hallux abducto valgus. Further research is needed on MT as a treatment of lower extremity conditions, specifically larger trials with improved methodology.
... In addition to targeted hip MMT, joint mobilization and joint manipulation were applied to joints and soft tissues in the kinematic chain on the side of the affected hip. 18,26,28,29,32,39 Treatment was applied to areas, such as the low back, knee, and ankle, at the discretion of the treating practitioner (see appendix 1, see fig 1). 19,27,28,39 General advice was provided in the same fashion as for the comparison group, with no additional treatment provided between the ninth visit (week 5) and 3-month follow-up. ...
... 18,26,28,29,32,39 Treatment was applied to areas, such as the low back, knee, and ankle, at the discretion of the treating practitioner (see appendix 1, see fig 1). 19,27,28,39 General advice was provided in the same fashion as for the comparison group, with no additional treatment provided between the ninth visit (week 5) and 3-month follow-up. ...
To determine the short-term effectiveness of full kinematic chain manual and manipulative therapy (MMT) plus exercise compared with targeted hip MMT plus exercise for symptomatic mild to moderate hip osteoarthritis (OA).
Parallel-group randomized trial with 3-month follow-up.
Two chiropractic outpatient teaching clinics.
Convenience sample of eligible participants (N=111) with symptomatic hip OA were consented and randomly allocated to receive either the experimental or comparison treatment, respectively.
Participants in the experimental group received full kinematic chain MMT plus exercise while those in the comparison group received targeted hip MMT plus exercise. Participants in both groups received 9 treatments over a 5-week period.
Western Ontario and McMasters Osteoarthritis Index (WOMAC), Harris hip score (HHS), and Overall Therapy Effectiveness, alongside estimation of clinically meaningful outcomes.
Total dropout was 9% (n=10) with 7% of total data missing, replaced using a multiple imputation method. No statistically significant differences were found between the 2 groups for any of the outcome measures (analysis of covariance, P=.45 and P=.79 for the WOMAC and HHS, respectively).
There were no statistically significant differences in the primary or secondary outcome scores when comparing full kinematic chain MMT plus exercise with targeted hip MMT plus exercise for mild to moderate symptomatic hip OA. Consequently, the nonsignificant findings suggest that there would also be no clinically meaningful difference between the 2 groups. The results of this study provides guidance to musculoskeletal practitioners who regularly use MMT that the full kinematic chain approach does not appear to have any benefit over targeted treatment.
... In a review evaluating the effects of manual therapy on pain reduction in patients with knee or hip OA, beneficial effect of manual therapy including muscle stretching, traction, and manipulation for reducing pain both in the short and long-term compared with exercise therapy has been designated as a silver level evidence in patients with hip OA [74]. A subsequent case series of 18 patients with hip OA, receiving a specific program including hip manipulation plus active assistive stretching together with full kinetic chain treatment, also reported improvement in hip OA pain [99]. ...
SUMMARY Osteoarthritis (OA), which is highly prevalent in the general population, is one of the leading causes of pain and physical disability. A large number of nonpharmacological interventions are available for the management of pain in patients with OA. These include education and self-management, weight reduction, various forms of exercises, physical agents/modalities, complementary therapies, manual therapy, unloading strategies such as braces and orthoses, and balneotherapy. The aim of this article is to assess the evidence of effectiveness of nonpharmacological interventions pertaining to physiatry to identify best practices for pain management in OA.
Objectives:
To determine whether knowledge-based deficiencies are adequately addressed at the AO North America Basic Principles of Fracture Management course.
Design:
Pre-test, post-test.
Setting:
Eighteen national trauma courses.
Participants:
Two thousand one hundred forty-nine learners.
Intervention:
Pre- and post-course 20-item tests of basic fracture knowledge, including 14 trauma topics.
Main outcome measures:
Deficiencies were defined as <60% correct answers on the pre-course test. Post-course knowledge gaps were defined as <75% correct responses.
Results:
Deficiencies were noted in 7 of the 14 topics on the pre-course test. All topics with deficiencies on the pre-course test were shown to have statistically significant improvement in post-course test scores. All topics without deficiencies were shown to have statistically significant improvement in post-course test scores. The average overall pre-course test score was 63% (95% confidence interval [CI], 61%-65%), and the average overall post-course test score was 81% (95% CI, 79%-83%). The pre-test to post-test difference was statistically significant (P < 0.05). The control questions, covering material that was not discussed in the course, did not have statistically significant improvement in scores.
Conclusions:
Residents are entering residency programs with limited knowledge of fracture care, and significant gaps remain at the junior level at the time of course participation, suggesting that supplemental fracture courses play an important role in resident education. Validation of short-term learning is possible through a pre-test, post-test technique and can guide design changes, as opposed to relying on satisfaction surveys alone.
Level of evidence:
NA.
The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability, and Health (ICF). The purpose of these revised clinical practice guidelines is to review recent peer-reviewed literature and make recommendations related to hip pain and mobility deficits.
J Orthop Sports Phys Ther. 2017;47(6):A1–A37. doi:10.2519/jospt.2017.0301
Background
Reviews indicate that the quality of reporting of randomised controlled trials (RCTs) in the medical literature is less than optimal, poor to moderate, and require improving. However, the reporting quality of chiropractic RCTs is unknown.As a result, the aim of this study was to assess the reporting quality of chiropractic RCTs and identify factors associated with better reporting quality. We hypothesized that quality of reporting of RCTs was influenced by industry funding, positive findings, larger sample sizes, latter year of publication and publication in non-chiropractic journals. MethodsRCTs published between 2005 and 2014 were sourced from clinical trial registers, PubMed and the Cochrane Reviews. RCTs were included if they involved high-velocity, low-amplitude (HVLA) spinal and/or extremity manipulation and were conducted by a chiropractor or within a chiropractic department. Data extraction, and reviews were conducted by all authors independently. Disagreements were resolved by consensus. Outcomes: a 39-point overall quality of reporting score checklist was developed based on the CONSORT 2010 and CONSORT for Non-Pharmacological Treatments statements. Four key methodological items, based on allocation concealment, blinding of participants and assessors, and use of intention-to-treat analysis (ITT) were also investigated. ResultsThirty-five RCTs were included. The overall quality of reporting score ranged between 10 and 33 (median score 26.0; IQR = 8.00). Allocation concealment, blinding of participants and assessors and ITT analysis were reported in 31 (87 %), 16 (46 %), 25 (71 %) and 21 (60 %) of the 35 RCTs respectively. Items most underreported were from the CONSORT for Non-Pharmacological Treatments statement. Multivariate regression analysis, revealed that year of publication (t32 = 5.17, p = 0.000, 95 % CI: 0.76, 1.76), and sample size (t32 = 3.01, p = 0.005, 95 % CI: 1.36, 7.02), were the only two factors associated with reporting quality. Conclusion
The overall quality of reporting RCTs in chiropractic ranged from poor to excellent, improving between 2005 and 2014. This study suggests that quality of reporting, was influenced by year of publication and sample size but not journal type, funding source or outcome positivity. Reporting of some key methodological items and uptake of items from the CONSORT Extension for Non-Pharmacological Treatments items was suboptimal. Future recommendations were made.
The differential diagnostic evaluation of painful functional disorders of the lower extremities is in practice very often. The manual medical diagnosis can make here a valuable contribution in the determination of structural and functional pathology. Manual medical therapies seems to be effective for acute and peracute complaints. The mobilization and manipulation (thrust technique) of myofascial restrictions are either the first choice therapy or were alternatively be used concomitantly in orthopedic or internal disorders. In the following review manual medical syndromes are presented that summarize the findings from the musculoskeletal system. This alleviated the primary differential diagnostic evaluation, as well as treatment planning. The combination with osteopathic methods is very profitable. A necessary specialist differential diagnosis remains essential.
