title: Patient education with or without manual therapy compared to a control group in patients with osteoarthritis of the hip. A proof-of-principle three-arm parallel group randomized clinical trial.
abstract: OBJECTIVE
  To investigate the effectiveness of a patient education (PE) program with or without the added effect of manual therapy (MT) compared to a minimal control intervention (MCI).
  
  
  METHODS
  In a single-center university hospital setting, a total of 118 patients with clinical and radiographic unilateral hip osteoarthritis (OA) from primary care were randomized into one of three groups: PE, PE plus MT or MCI. The PE was taught by a physiotherapist involving five sessions. The MT was delivered by a chiropractor involving 12 sessions and the MCI included a home stretching program. Primary outcome was self-reported pain severity on an 11-box numeric rating scale (NRS) immediately following a 6-week intervention period. Patients were followed for 1 year.
  
  
  RESULTS
  Primary analysis included 111 patients (94%). In the combined group (PE + MT), a clinically relevant reduction in pain severity compared to the MCI of 1.90 points (95% confidence interval (CI) 0.9-2.9) was achieved. Effect size (Cohen's d) for the PE + MT minus the MCI was 0.92 (95% CI 0.41-1.42). Number needed to treat for PE + MT was 3 (95% CI 2-7). No difference was found between the PE and MCI groups, with mean difference 0.0 (95% CI -1.0 to 1.0). At 12 months, not including patients receiving hip surgery the statistically significant difference favoring PE + MT was maintained.
  
  
  CONCLUSIONS
  For primary care patients with OA of the hip, a combined intervention of MT and PE was more effective than a MCI. PE alone was not superior to the MCI.
  
  
  BACKGROUND
  clinicaltrials.govNCT01039337.
authors.affiliation: Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark. Electronic address: e.poulsen@nikkb.dk.
authors.forename: E
authors.initials: E
authors.lastname: Poulsen
authors.forename: J
authors.initials: J
authors.lastname: Hartvigsen
authors.forename: H W
authors.initials: HW
authors.lastname: Christensen
authors.forename: E M
authors.initials: EM
authors.lastname: Roos
authors.forename: W
authors.initials: W
authors.lastname: Vach
authors.forename: S
authors.initials: S
authors.lastname: Overgaard
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D026882:Manipulation, Chiropractic / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000534:rehabilitation*; D010147:Pain Measurement / Q000379:methods; D010353:Patient Education as Topic / Q000379:methods*; D017060:Patient Satisfaction; D011320:Primary Health Care / Q000379:methods; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: Hip; Manual therapy; Osteoarthritis; Patient education