French Helen P, Cusack Tara, Brennan Aisling, White Breon, Gilsenan Clare, Fitzpatrick Martina, O'Connell Paul, Kane David, Fitzgerald Oliver, McCarthy Geraldine M
School of Physiotherapy, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland.
BMC Musculoskelet Disord. 2009 Jan 19;10:9. doi: 10.1186/1471-2474-10-9.
BACKGROUND: Osteoarthritis (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 DESIGN: An 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. DISCUSSION: This 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.
背景：髋关节骨关节炎（OA）是导致功能残疾和生活质量下降的主要原因。治疗方案旨在减轻疼痛并改善或维持身体功能。目前的证据表明，治疗性运动对疼痛和残疾有有益但短期的效果，长期益处不佳。运动的最佳内容、持续时间和类型尚待确定。关于手法治疗在髋关节OA中的有效性，科学研究较少。只有一项随机对照试验（RCT）发现，与运动疗法相比，手法治疗在患者自我感觉的改善和身体功能方面有更大的改善。 方法与设计：将进行一项评估者盲法多中心RCT，以比较手法治疗与运动疗法联合、单纯运动疗法以及等待名单对照对髋关节OA患者身体功能的影响。将招募150名诊断为髋关节OA的患者，并随机分配到3组中的一组：运动疗法组、运动疗法加手法治疗组和等待名单对照组。干预组的受试者将在8周内接受6 - 8次物理治疗。对照组的受试者将一直留在等待名单上，直到这段时间结束，然后重新随机分配到两个干预组之一。结局指标将包括身体功能（WOMAC）、疼痛严重程度（数字评分量表）、患者自我感觉的变化（7点李克特量表）、生活质量（SF - 36）、情绪（医院焦虑抑郁量表）、患者满意度、身体活动（IPAQ）以及活动范围、50英尺步行和反复坐立试验的身体测量指标。 讨论：这项RCT将比较在髋关节OA中，运动疗法加手法治疗、单纯运动疗法以及等待名单对照的有效性。将采用符合CONSORT指南的高质量方法。研究结果将为髋关节OA物理治疗干预的临床疗效证据库做出贡献。
BMC Musculoskelet Disord. 2009-1-19
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