Manual therapy is more efficient than exercise therapy for osteoarthritis of the hip

QuestionWhat is the effect of manual therapy or exercise therapy in patients with osteoarthritis of the hip?DesignRandomised controlled trial with concealed allocation, assessor blinding and intention to treat analysis.SettingOutpatient clinic in The Netherlands.Patients109 patients were included in this study. Criteria were limited flexion, internal rotation with pain, and morning stiffness lasting more than 60 minutes. Fifty-six patients were assigned to the manual therapy group and 53 to the exercise group.InterventionsBoth groups participated in 25-minute sessions twice a week for nine weeks. For the manual therapy group, techniques were: stretching six peri-articular muscles (10–15 minutes), and traction on the hip joint in different positions. For the exercise group, techniques were: improvement of muscle function (strength exercises for deficient muscles, endurance treadmill exercises, co-ordination exercises to stimulate balance function), and active or passive motion of the hip in different sectors. Lifestyle education was provided for both groups.OutcomesOutcomes were assessed at baseline and 5, 17, and 29 weeks. The primary outcome was patient-assessed recovery measured on a 6 point scale, in analysis dichotomised to (i) improved or (ii) stable or worse. Other outcomes included quality of life measured by the SF-36, function measured with the Harris hip score, and a walking test.Main resultsSix patients were lost to followup at five weeks, and 21 at 29 weeks. Nine patients in each group underwent hip surgery. At five weeks, 81% of subjects in the manual therapy group considered themselves improved versus 50% in the exercise group. Odds ratio for improvement was 1.92 (95%CI 1.30 to 2.60). Manual therapy was more effective in improving function as measured by the Harris score (week 5, 17, and 29), walking speed (weeks 5 and 17), and SF-36 physical function (week 5); all p < 0.05.ConclusionManual therapy (stretching and traction) has a greater effect than exercise therapy (muscle rehabilitation, passive or active motion) on osteoarthritis of the hip