Exercise therapy and manual therapy both found
to be beneficial for hip osteoarthritis

Updated systematic review needed to include recently published studies
Manual therapy and exercise therapy are both commonly recommended as preferred first-line interventions for hip osteoarthritis (OA). Manual therapy use in this context is widespread, but there is actually little scientific evidence to support its effectiveness. Exercise therapy is also prescribed frequently, both alone and in conjunction with manual therapy, but two recent trials found no added benefits of combining the two interventions. Finally, several reviews have investigated the effects of these interventions for hip OA and identified various benefits, but a number of worthy studies have since been published. Therefore, an updated systematic review and meta-analysis was conducted to determine the effectiveness of exercise therapy or manual therapy - alone or combined - on hip OA patients.

Seven trials included in meta-analysis
Investigators searched 10 databases for randomized-controlled trials (RCTs) and controlled trials involving hip OA patients that investigated the efficacy of manual therapy, exercise therapy, or both. This led to seven trials with 886 participants being included. Outcome measures of interest included pain, physical function, and quality of life (QoL), and all studies were assessed for overall quality of evidence.

Both interventions elicit notable improvements alone, but combined benefit not as clear
On the whole, meta-analysis results were generally supportive of exercise and manual therapy. For the primary outcomes of pain and physical function, there was high-quality evidence that exercise therapy is better than control at post-treatment and follow-up. There was also low-quality evidence that manual therapy is superior to control for these primary outcomes at post-treatment and follow-up. Finally, low-quality evidence showed that a combined intervention was better than control for the primary outcomes at post-treatment, but not at follow-up. All included studies had a low risk of bias. Taken together, these findings suggest that both exercise therapy and manual therapy can provide significant pain relief and functional benefits for hip OA patients when utilized independently. The lack of long-term effectiveness of the combined intervention is worth noting, but may be explained by several possible factors, such as insufficient time spent on each intervention by the patients. Thus, future clinical trials should look at this relationship closer in a more controlled manner and also investigate the optimal treatment dosage and frequency for both interventions. In the meantime, clinicians should continue to regard physical therapist-led exercise therapy and manual therapy as essential first-line interventions for hip OA patients that are capable of brining about lasting improvements.

-Summarized by Greg Gargiulo

-As reported in the December '16 issue of Clinical Rehabilitation