title: Exercise and manual physiotherapy arthritis research trial (EMPART): a multicentre randomised controlled trial.
abstract: 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
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: School of Physiotherapy, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland. hfrench@rcsi.ie
authors.forename: Helen P
authors.initials: HP
authors.lastname: French
authors.forename: Tara
authors.initials: T
authors.lastname: Cusack
authors.forename: Aisling
authors.initials: A
authors.lastname: Brennan
authors.forename: Breon
authors.initials: B
authors.lastname: White
authors.forename: Clare
authors.initials: C
authors.lastname: Gilsenan
authors.forename: Martina
authors.initials: M
authors.lastname: Fitzpatrick
authors.forename: Paul
authors.initials: P
authors.lastname: O'Connell
authors.forename: David
authors.initials: D
authors.lastname: Kane
authors.forename: Oliver
authors.initials: O
authors.lastname: Fitzgerald
authors.forename: Geraldine M
authors.initials: GM
authors.lastname: McCarthy
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005081:Exercise Therapy; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D026201:Musculoskeletal Manipulations / Q000379:methods*; D015207:Osteoarthritis, Hip / Q000503:physiopathology / Q000534:rehabilitation*; D010147:Pain Measurement; D012720:Severity of Illness Index; D016037:Single-Blind Method; D016896:Treatment Outcome