Physical Therapy as a Conservative Treatment
Strong evidence supports the use of physical therapy as a treatment to improve function and reduce pain for patients with osteoarthritis of the hip and mild to moderate symptoms.

Rationale

There were 9 high quality studies (Bennell et al, Beselga et al, Fernandes et al, French et al, Hoesksma et al, Koybasi et al, Pister et al, Poulsen et al, Svege, et al) and 3 moderate quality studies (Nguyen et al, Svege et al, Tak et al) that were initially identified as evaluating the effect of physical therapy for individuals with hip osteoarthritis. One of the moderate quality studies (Nguyen et al) was excluded from this recommendation because it did not include interventions that are typical of physical therapy.

Patients included in the majority of these studies had mild or moderate symptoms, although this was defined differently between studies. Mild to moderate OA was qualified as being hip pain of at least 40 out of 100, but not being scheduled for hip surgery (Bennell et al), having a Harris Hip Score between 60 and 95 (Fernandes et al), not requiring a walking aid during ambulation (Beselga et al), or other similar criteria.

There was conflicting evidence pertaining to the effectiveness of physical therapy on pain and function in individuals with symptomatic hip osteoarthritis. In a high quality sham-controlled study, Beselga et al. found an immediate effect of joint mobilization on patient symptoms. In two other high quality studies, patients had greater improvements in pain with physical therapy compared to either a control group (Poulson et al) or a group that did not receive joint mobilization in addition to exercise (French et al). In one moderate quality study, physical therapy reduced pain and improved function compared to a non-active control group. In another moderate quality study an exercise intervention improved pain and function to a greater extent than a control group, sham ultrasound group, and active ultrasound group. Despite evidence to support physical therapy, two high quality studies found no benefit of physical therapy compared to a placebo group (Bennell et al) or a group that received only patient education (Fernandes et al).

To address this conflicting evidence, we performed a meta-analysis to determine the potential effect of physical therapy on pain and function at different follow-up periods. This analysis revealed that there was a net positive benefit of physical therapy on functional outcomes at 6 to 12 month follow-up. The analysis also revealed a positive effect of physical therapy on reducing pain at up to a 9-month follow-up. Given the cumulative positive effect of physical therapy on functional and pain, there is strong evidence to support physical therapy on improving outcomes at up to 9 months after treatment.


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