Exercise and manual physiotherapy arthritis research trial (EMPART): a multicentre randomised controlled trial

Helen P French,Tara Cusack,Paul O'Connell,Geraldine M Mccarthy,Breon White,Aisling Brennan,David Kane,Oliver Fitzgerald,Clare Gilsenan,Martina Fitzpatrick

doi:10.1186/1471-2474-10-9

Abstract

BackgroundOsteoarthritis (OA) of the hip is a major cause of functional disability and reduced quality of life. Management options aim to reduce pain and improve or maintain physical functioning. Current evidence indicates that therapeutic exercise has a beneficial but short-term effect on pain and disability, with poor long-term benefit. The optimal content, duration and type of exercise are yet to be ascertained. There has been little scientific investigation into the effectiveness of manual therapy in hip OA. Only one randomized controlled trial (RCT) found greater improvements in patient-perceived improvement and physical function with manual therapy, compared to exercise therapy.Methods and designAn assessor-blind multicentre RCT will be undertaken to compare the effect of a combination of manual therapy and exercise therapy, exercise therapy only, and a waiting-list control on physical function in hip OA. One hundred and fifty people with a diagnosis of hip OA will be recruited and randomly allocated to one of 3 groups: exercise therapy, exercise therapy with manual therapy and a waiting-list control. Subjects in the intervention groups will attend physiotherapy for 6–8 sessions over 8 weeks. Those in the control group will remain on the waiting list until after this time and will then be re-randomised to one of the two intervention groups. Outcome measures will include physical function (WOMAC), pain severity (numerical rating scale), patient perceived change (7-point Likert scale), quality of life (SF-36), mood (hospital anxiety and depression scale), patient satisfaction, physical activity (IPAQ) and physical measures of range of motion, 50-foot walk and repeated sit-to stand tests.DiscussionThis RCT will compare the effectiveness of the addition of manual therapy to exercise therapy to exercise therapy only and a waiting-list control in hip OA. A high quality methodology will be used in keeping with CONSORT guidelines. The results will contribute to the evidence base regarding the clinical efficacy for physiotherapy interventions in hip OA.Trial RegistrationNumber: NCT00709566

Highlights

Osteoarthritis (OA) of the hip is a major cause of functional disability and reduced quality of life
Physical function and physical activity levels are reduced in hip OA and this can impact on quality of life [810] and has associated psychosocial impact such as depression [11,12,13]
Aim The primary aim of this study is to compare the effect of a combination of manual therapy and exercise therapy, exercise therapy only and a waiting-list control on physical function in hip OA

Summary

Introduction

Osteoarthritis (OA) of the hip is a major cause of functional disability and reduced quality of life. A World Health Organisation report identified OA as the 8th leading cause of non-fatal burden in the world in 2000, accounting for 2.6% of total years lost due to disability [3]. It is commonly associated with other medical conditions such as cardiovascular disease, respiratory disease and diabetes [4,5]. Physical function and physical activity levels are reduced in hip OA and this can impact on quality of life [810] and has associated psychosocial impact such as depression [11,12,13]

Objectives

Methods

Findings

Conclusion