Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark.
Osteoarthritis Cartilage. 2013 Oct;21(10):1494-503. doi: 10.1016/j.joca.2013.06.009. Epub 2013 Jun 21.
To investigate the effectiveness of a patient education (PE) program with or without the added effect of manual therapy (MT) compared to a minimal control intervention (MCI).
In a single-center university hospital setting, a total of 118 patients with clinical and radiographic unilateral hip osteoarthritis (OA) from primary care were randomized into one of three groups: PE, PE plus MT or MCI. The PE was taught by a physiotherapist involving five sessions. The MT was delivered by a chiropractor involving 12 sessions and the MCI included a home stretching program. Primary outcome was self-reported pain severity on an 11-box numeric rating scale (NRS) immediately following a 6-week intervention period. Patients were followed for 1 year.
Primary analysis included 111 patients (94%). In the combined group (PE + MT), a clinically relevant reduction in pain severity compared to the MCI of 1.90 points (95% confidence interval (CI) 0.9-2.9) was achieved. Effect size (Cohen's d) for the PE + MT minus the MCI was 0.92 (95% CI 0.41-1.42). Number needed to treat for PE + MT was 3 (95% CI 2-7). No difference was found between the PE and MCI groups, with mean difference 0.0 (95% CI -1.0 to 1.0). At 12 months, not including patients receiving hip surgery the statistically significant difference favoring PE + MT was maintained.
For primary care patients with OA of the hip, a combined intervention of MT and PE was more effective than a MCI. PE alone was not superior to the MCI.
clinicaltrials.govNCT01039337.
比较患者教育（PE）计划加或不加手动治疗（MT）与最小对照干预（MCI）的效果。
在单中心大学医院环境中，共纳入来自初级保健的 118 名单侧髋关节骨关节炎（OA）的临床和影像学患者，随机分为三组：PE 组、PE 加 MT 组或 MCI 组。PE 由物理治疗师教授，共 5 次；MT 由脊椎指压治疗师实施，共 12 次；MCI 包括家庭伸展计划。主要结局为 6 周干预后即刻的自我报告的数字评分量表（NRS）疼痛严重程度。患者随访 1 年。
主要分析包括 111 名患者（94%）。在联合组（PE+MT）中，与 MCI 相比，疼痛严重程度有临床意义的降低了 1.90 分（95%置信区间（CI）为 0.9-2.9）。PE+MT 减去 MCI 的效应大小（Cohen's d）为 0.92（95%CI 为 0.41-1.42）。PE+MT 的治疗需要数为 3（95%CI 为 2-7）。PE 组与 MCI 组之间无差异，平均差异为 0.0（95%CI -1.0 至 1.0）。在 12 个月时，不包括接受髋关节手术的患者，仍保持了有利于 PE+MT 的统计学显著差异。
对于初级保健髋关节 OA 患者，MT 和 PE 的联合干预比 MCI 更有效。PE 单独治疗并不优于 MCI。
clinicaltrials.govNCT01039337。
