21 May Hip Osteoarthritis: How Beneficial is Physical Therapy?
Professor Kim Bennell
ARC Future Fellow
Department of Physiotherapy
University of Melbourne
Parkville, Vic 3010 Australia
MedicalResearch: What are the main findings of the study?
Professor Bennell: In 102 people with painful hip osteoarthritis, we compared a ‘real’ physical therapy program involving exercise, manual therapy techniques,education and provision of a cane if appropriate to a sham physical therapy treatment that was made to look as though it was real but instead involved turned off ultrasound and gentle application of a hand crème to the hip region. Participants in both groups went to see a physical therapist on 10 occasions over 12 weeks and performed home exercises if in the ‘real’ physical therapy group or lightly applied the cream at home if in the sham group. Participants were followed for 9 months in total. We found that while both groups showed improvements in pain and physical function, the improvements were similar between the two groups. That is, the real physical therapy program did not show greater benefits over a sham treatment.
MedicalResearch: Were any of the findings unexpected?
Professor Bennell: The findings were not as we had predicted. We predicted that the ‘real’ physical therapy group would show greater improvements in pain and physical function than the sham group but instead both groups showed similar improvements across nearly all of the measures we took. This was seen both immediately after the treatment program at 12 weeks and at the 9 month followup time point.
MedicalResearch: What should clinicians and patients take away from your report?
Professor Bennell: The take home message is that receiving the specific physical therapy treatments did not add any greater benefit over simply seeing a caring physical therapist and having positive expectations about treatment. As both groups showed improvements in pain and function over time this suggests that you can gain benefits for pain and function by seeing a physiotherapist. The findings suggest that the benefits of seeing a physical therapist do not seem to relate to the specific components of treatment that we tested such as the exercise or manual therapy.
MedicalResearch: What recommendations do you have for future research as a result of this study?
Professor Bennell: Future research should investigate whether there are subgroups of patients who respond better to the active physical therapy treatments than others. We know that not everyone responds the same way to treatment whether it be drug treatments, surgery or physical therapy treatment. The challenge is to identify what are the characteristics of those patients who do respond so that we can better target treatment appropriately. In order to do this, we need to have a better understanding of the factors that determine pain and disability in people with hip osteoarthritis so that we can design and evaluate new treatments that may be more effective.
Bennell KL, Egerton T, Martin J, et al. Effect of Physical Therapy on Pain and Function in Patients With Hip Osteoarthritis: A Randomized Clinical Trial. JAMA. 2014;311(19):1987-1997. doi:10.1001/jama.2014.4591.