Behandling av pasienter med hofteleddsartrose: Er manuellterapi og trening bedre enn trening alene?

Background: Previous studies have shown that both exercise and manual therapy can reduce pain and improve function in patients with hip osteoarthritis, but no added benefit of combining the two interventions has been shown. I wanted to investigate this topic further. Objectives: To investigate if manual therapy combined with exercise is more effective than exercise alone in reducing pain and improving function in patients with hip osteoarthritis. Material and Methods: In this Single Subject Experimental Design (SSED) study, two participants with clinical and x-ray confirmed diagnosis of hip osteoarthritis were included. One participant dropped out. The intervention consisted of 4 weeks of exercise followed by 4 weeks of exercise and manual therapy in combination. Follow-up testing was conducted 4 weeks after the end of the intervention. Primary outcome measures were Numeric Pain Rating Scale (NPRS) for pain, and 30s Chair Stand Test (30s CST), 40m Fast Paced Walk Test, and Stair Climb Test (8 steps) for function. Secondary outcome measures were Patient Specific Functional Score (PSFS) and The Hip Disability and Osteoarthritis Outcome Score (HOOS). A change above 2 standard deviations from the mean at baseline was considered statistically significant. Results: During 4 weeks of exercise there was no statistically significant change in pain or physical function as seen from the primary outcome measures. During the period of combined exercise and manual therapy, the participant achieved a statistically significant improvement on the NPRS, as well as on two of three physical tests. PSFS showed statistically significant improvement on one activity during the exercise phase and on all activities during the combined period. The results were maintained to a large degree at follow up. Conclusion: The results indicate that exercise and manual therapy in combination are more efficient in reducing pain and improving function than exercise alone in patients with hip osteoarthritis