Franceschi Giulia, Scotto Irene, Maselli Filippo, Mourad Firas, Gallotti Marco
Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy.
Department of Physiotherapy, LUNEX International University of Health, Exercise and Sports, 4671 Luxembourg, Luxembourg.
J Funct Morphol Kinesiol. 2024 Dec 7;9(4):262. doi: 10.3390/jfmk9040262.
A manual approach combined with therapeutic exercise versus therapeutic exercise alone is a debated issue in the literature. The American College of Rheumatology guidelines "conditionally recommended against" manual therapy for the management of hip osteoarthritis. Manual therapy followed by exercise, instead, appears to lead to a faster return to sport than exercise alone for adductor groin pain. There is a need to understand which is the most effective treatment in the management of hip nonspecific musculoskeletal diseases. The aim of this systematic review is to determine which is the most effective treatment between manual therapy combined with therapeutic exercise and therapeutic exercise alone in subjects with hip nonspecific musculoskeletal diseases. This systematic review complies with the guidelines of the 2020 Prisma Statement. The databases consulted were Pubmed, Cinahl, and Web Of Science. The search was conducted from October 2004 to November 2023. The search string was developed following the PICO model. Free terms or synonyms (e.g., manual therapy, exercise therapy, hip disease, effectiveness) and Medical Subject Headings terms were combined with Boolean operators (AND, OR, NOT). The risk-of-bias assessment was conducted using Version 2 of the Cochrane risk-of-bias tool for randomized controlled trials and the Newcastle Ottawa Scale for observational studies. A qualitative analysis of the results was conducted through narrative synthesis of key concepts. When possible, quantitative analysis was conducted through statistical parameters. Ten articles were analyzed. Results show no differences between the interventions analyzed. Preliminary evidence seems to favor the combined intervention for the outcomes of pain, ROM, and patient satisfaction, with other studies claiming an absence of differences. Only one study claims that therapeutic exercise alone is more effective for quality of life. Preliminary evidence seems to show that manual therapy does not seem to bring any benefit in addition to therapeutic exercise in mid- and long-term functionality, especially for hip osteoarthritis. There seems to be no difference in effectiveness between manual therapy combined with therapeutic exercise and therapeutic exercise alone in individuals with hip nonspecific musculoskeletal diseases.
在文献中，手动治疗结合治疗性运动与单纯治疗性运动相比是一个有争议的问题。美国风湿病学会指南“有条件地不推荐”采用手动治疗来管理髋关节骨关节炎。相反，对于内收肌腹股沟疼痛，先进行手动治疗再进行运动似乎比单纯运动能更快恢复运动。有必要了解在髋关节非特异性肌肉骨骼疾病的管理中哪种治疗方法最有效。本系统评价的目的是确定在患有髋关节非特异性肌肉骨骼疾病的受试者中，手动治疗结合治疗性运动与单纯治疗性运动之间哪种治疗方法最有效。本系统评价符合2020年Prisma声明的指南。所查阅的数据库有Pubmed、Cinahl和科学网。检索时间为2004年10月至2023年11月。检索词是按照PICO模型制定的。自由词或同义词（如手动治疗、运动疗法、髋关节疾病、有效性）和医学主题词与布尔运算符（AND、OR、NOT）相结合。使用Cochrane随机对照试验偏倚风险工具第2版和观察性研究的纽卡斯尔渥太华量表进行偏倚风险评估。通过对关键概念的叙述性综合对结果进行定性分析。尽可能通过统计参数进行定量分析。共分析了10篇文章。结果显示所分析的干预措施之间没有差异。初步证据似乎支持联合干预在疼痛、关节活动度和患者满意度方面的结果，而其他研究则称没有差异。只有一项研究声称单纯治疗性运动对生活质量更有效。初步证据似乎表明，在中长期功能方面，除了治疗性运动外，手动治疗似乎没有带来任何益处，尤其是对于髋关节骨关节炎。在患有髋关节非特异性肌肉骨骼疾病的个体中，手动治疗结合治疗性运动与单纯治疗性运动之间的有效性似乎没有差异。
