Blog | Thursday, May 22, 2014

QD: News Every Day--Therapy for painful hip arthritis may be no better than sham treatment


Twelve weeks of physical therapy for painful hip osteoarthritis did not result in greater improvement in pain or function compared to sham treatment, a study found

To determine efficacy of physical therapy on pain and physical function in patients with hip osteoarthritis, researchers conducted a randomized, placebo-controlled, participant- and assessor-blinded trial among 102 community volunteers with hip pain levels of 40 or higher on a visual analog scale of 100 mm and hip osteoarthritis confirmed by radiograph.

Forty-nine patients in the active group and 53 in the sham group underwent 12 weeks of intervention (10 treatment sessions) and 24 weeks of follow-up from May 2010 to February 2013. Active treatment included education and advice, manual therapy, home exercise, and gait aid if needed. Sham treatment included inactive ultrasound and inert gel. For 24 weeks after treatment, the active group continued unsupervised home exercise while the sham group self-applied gel 3 times weekly.

Results appeared online at JAMA Internal Medicine.

The between-group differences for improvements in pain were not significant. For the active group, the baseline mean (standard deviation) visual analog scale score was 58.8 mm (13.3) and the week-13 score was 40.1 mm (24.6). For the sham group, the baseline score was 58.0 mm (11.6) and the week-13 score was 35.2 mm (21.4). The mean difference was 6.9 mm favoring sham treatment (95% CI, −3.9 to 17.7) and function scores were not significantly different between groups.

The baseline mean (SD) physical function score for the active group was 32.3 (9.2) and the week-13 score was 27.5 (12.9) units. The baseline score for the sham treatment group was 32.4 (8.4) units and the week-13 score was 26.4 (11.3) units, for a mean difference of 1.4 units favoring sham (95% CI, −3.8 to 6.5) at week 13.

There were no between-group differences in average pain or physical function at week 36, or in impairments, physical performance, global change, psychological status, and quality of life at weeks 13 and 36. Nineteen of 46 patients (41%) in the active group reported 26 mild adverse effects, compared to 7 of 49 (14%) in the sham group who reported 9 mild adverse events (P=0.003).

The results raise questions about the importance of physical therapy for painful hip osteoarthritis, the researchers wrote.

“The absence of significant between-group differences despite use of skilled therapists and excellent adherence rates to home exercise (85%) suggest that the active physical therapy program was truly ineffective,” they wrote.