title: Exercise and manual physiotherapy arthritis research trial (EMPART) for osteoarthritis of the hip: a multicenter randomized controlled trial.
abstract: OBJECTIVE
  To determine the effectiveness of exercise therapy (ET) compared with ET with adjunctive manual therapy (MT) for people with hip osteoarthritis (OA); and to identify if immediate commencement of treatment (ET or ET+MT) was more beneficial than a 9-week waiting period for either intervention.
  
  
  METHODS
  Assessor-blind randomized controlled trial with a 9-week and 18-week follow-up.
  
  
  METHODS
  Four academic teaching hospitals in Dublin, Ireland.
  
  
  METHODS
  Patients (N=131) with hip OA recruited from general practitioners, rheumatologists, orthopedic surgeons, and other hospital consultants were randomized to 1 of 3 groups: ET (n=45), ET+MT (n=43), and waitlist controls (n=43).
  
  
  METHODS
  Participants in both the ET and ET+MT groups received up to 8 treatments over 8 weeks. Control group participants were rerandomized into either ET or ET+MT groups after 9 week follow-up. Their data were pooled with original treatment group data: ET (n=66) and ET+MT (n=65).
  
  
  METHODS
  The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) physical function (PF) subscale. Secondary outcomes included physical performance, pain severity, hip range of motion (ROM), anxiety/depression, quality of life, medication usage, patient-perceived change, and patient satisfaction.
  
  
  RESULTS
  There was no significant difference in WOMAC PF between the ET (n=66) and ET+MT (n=65) groups at 9 weeks (mean difference, .09; 95% confidence interval [CI] -2.93 to 3.11) or 18 weeks (mean difference, .42; 95% CI, -4.41 to 5.25), or between other outcomes, except patient satisfaction with outcomes, which was higher in the ET+MT group (P=.02). Improvements in WOMAC, hip ROM, and patient-perceived change occurred in both treatment groups compared with the control group.
  
  
  CONCLUSIONS
  Self-reported function, hip ROM, and patient-perceived improvement occurred after an 8-week program of ET for patients with OA of the hip. MT as an adjunct to exercise provided no further benefit, except for higher patient satisfaction with outcome.
authors.affiliation: School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, 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: Aoife
authors.initials: A
authors.lastname: Caffrey
authors.forename: Ronán
authors.initials: R
authors.lastname: Conroy
authors.forename: Vanessa
authors.initials: V
authors.lastname: Cuddy
authors.forename: Oliver M
authors.initials: OM
authors.lastname: FitzGerald
authors.forename: Martina
authors.initials: M
authors.lastname: Fitzpatrick
authors.forename: Clare
authors.initials: C
authors.lastname: Gilsenan
authors.forename: David
authors.initials: D
authors.lastname: Kane
authors.forename: Paul G
authors.initials: PG
authors.lastname: O'Connell
authors.forename: Breon
authors.initials: B
authors.lastname: White
authors.forename: Geraldine M
authors.initials: GM
authors.lastname: McCarthy
mesh_terms: D005081:Exercise Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000534:rehabilitation*; D017060:Patient Satisfaction; D026741:Physical Therapy Modalities; D016059:Range of Motion, Articular