title: Effects of exercise and manual therapy on pain associated with hip osteoarthritis: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To explore the effects of exercise (water-based or land-based) and/or manual therapies on pain in adults with clinically and/or radiographically diagnosed hip osteoarthritis (OA).
  
  
  METHODS
  A systematic review and meta-analysis was performed, with patient reported pain assessed using a visual analogue scale (VAS) or the Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain subscale. Data were grouped by follow-up time (0-3 months=short term; 4-12 months=medium term and; >12 months=long term), and standardised mean differences (SMD) with 95% CIs were used to establish intervention effect sizes. Study quality was assessed using modified PEDro scores.
  
  
  RESULTS
  19 trials were included. Four studies showed short-term benefits favouring water-based exercise over minimal control using the WOMAC pain subscale (SMD -0.53, 95% CI -0.96 to -0.10). Six studies supported a short-term benefit of land-based exercise compared to minimal control on VAS assessed pain (SMD -0.49, 95% CI -0.70 to -0.29). There were no medium (SMD -0.23, 95% CI -0.48 to 0.03) or long (SMD -0.22, 95% CI -0.51 to 0.06) term benefits of exercise therapy, or benefit of combining exercise therapy with manual therapy (SMD -0.38, 95% CI -0.88 to 0.13) when compared to minimal control.
  
  
  CONCLUSIONS
  Best available evidence indicates that exercise therapy (whether land-based or water-based) is more effective than minimal control in managing pain associated with hip OA in the short term. Larger high-quality RCTs are needed to establish the effectiveness of exercise and manual therapies in the medium and long term.
authors.affiliation: School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Lucy
authors.initials: L
authors.lastname: Beumer
authors.affiliation: School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Jennie
authors.initials: J
authors.lastname: Wong
authors.affiliation: School of Health and Rehabilitation Sciences, Indiana University, Indianapolis, Indiana, USA.
authors.forename: Stuart J
authors.initials: SJ
authors.lastname: Warden
authors.affiliation: Australian Centre for Research into Injury and Sport and its Prevention (ACRISP), Federation University Australia, Ballarat, Victoria, Australia.
authors.forename: Joanne L
authors.initials: JL
authors.lastname: Kemp
authors.affiliation: School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Paul
authors.initials: P
authors.lastname: Foster
authors.affiliation: School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria, Australia.
authors.forename: Kay M
authors.initials: KM
authors.lastname: Crossley
mesh_terms: D005081:Exercise Therapy; D006801:Humans; D026201:Musculoskeletal Manipulations; D015207:Osteoarthritis, Hip / Q000628:therapy*; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D016032:Randomized Controlled Trials as Topic
keywords: Hip; Osteoarthritis; Physiotherapy