title: Full kinetic chain manual and manipulative therapy plus exercise compared with targeted manual and manipulative therapy plus exercise for symptomatic osteoarthritis of the hip: a randomized controlled trial.
abstract: OBJECTIVE
  To determine the short-term effectiveness of full kinematic chain manual and manipulative therapy (MMT) plus exercise compared with targeted hip MMT plus exercise for symptomatic mild to moderate hip osteoarthritis (OA).
  
  
  METHODS
  Parallel-group randomized trial with 3-month follow-up.
  
  
  METHODS
  Two chiropractic outpatient teaching clinics.
  
  
  METHODS
  Convenience sample of eligible participants (N=111) with symptomatic hip OA were consented and randomly allocated to receive either the experimental or comparison treatment, respectively.
  
  
  METHODS
  Participants in the experimental group received full kinematic chain MMT plus exercise while those in the comparison group received targeted hip MMT plus exercise. Participants in both groups received 9 treatments over a 5-week period.
  
  
  METHODS
  Western Ontario and McMasters Osteoarthritis Index (WOMAC), Harris hip score (HHS), and Overall Therapy Effectiveness, alongside estimation of clinically meaningful outcomes.
  
  
  RESULTS
  Total dropout was 9% (n=10) with 7% of total data missing, replaced using a multiple imputation method. No statistically significant differences were found between the 2 groups for any of the outcome measures (analysis of covariance, P=.45 and P=.79 for the WOMAC and HHS, respectively).
  
  
  CONCLUSIONS
  There were no statistically significant differences in the primary or secondary outcome scores when comparing full kinematic chain MMT plus exercise with targeted hip MMT plus exercise for mild to moderate symptomatic hip OA. Consequently, the nonsignificant findings suggest that there would also be no clinically meaningful difference between the 2 groups. The results of this study provides guidance to musculoskeletal practitioners who regularly use MMT that the full kinematic chain approach does not appear to have any benefit over targeted treatment.
authors.affiliation: Department of Research, Cleveland Chiropractic College, Los Angeles, CA, USA.
authors.forename: James W
authors.initials: JW
authors.lastname: Brantingham
authors.forename: Gregory
authors.initials: G
authors.lastname: Parkin-Smith
authors.forename: Tammy Kay
authors.initials: TK
authors.lastname: Cassa
authors.forename: Gary A
authors.initials: GA
authors.lastname: Globe
authors.forename: Denise
authors.initials: D
authors.lastname: Globe
authors.forename: Henry
authors.initials: H
authors.lastname: Pollard
authors.forename: Katie
authors.initials: K
authors.lastname: deLuca
authors.forename: Muffit
authors.initials: M
authors.lastname: Jensen
authors.forename: Stephan
authors.initials: S
authors.lastname: Mayer
authors.forename: Charmaine
authors.initials: C
authors.lastname: Korporaal
mesh_terms: D000704:Analysis of Variance; D015444:Exercise; D005260:Female; D006801:Humans; D008297:Male; D026882:Manipulation, Chiropractic / Q000379:methods*; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000628:therapy*; D010147:Pain Measurement; D012720:Severity of Illness Index