title: The effects of manual therapy or exercise therapy or both in people with hip osteoarthritis: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To determine whether manual therapy or exercise therapy or both is beneficial for people with hip osteoarthritis in terms of reduced pain, improved physical function and improved quality of life.
  
  
  METHODS
  Databases such as Medline, AMED, EMBASE, CINAHL, SPORTSDiscus, PubMed, Cochrane Library, Web of Science, Physiotherapy Evidence Database, and SCOPUS were searched from their inception till September 2015. Two authors independently extracted and assessed the risk of bias in included studies. Standardised mean differences for outcome measures (pain, physical function and quality of life) were used to calculate effect sizes. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach was used for assessing the quality of the body of evidence for each outcome of interest.
  
  
  RESULTS
  Seven trials (886 participants) that met the inclusion criteria were included in the meta-analysis. There was high quality evidence that exercise therapy was beneficial at post-treatment (pain-SMD-0.27,95%CI-0.5to-0.04;physical function-SMD-0.29,95%CI-0.47to-0.11) and follow-up (pain-SMD-0.24,95%CI- 0.41to-0.06; physical function-SMD-0.33,95%CI-0.5to-0.15). There was low quality evidence that manual therapy was beneficial at post-treatment (pain-SMD-0.71,95%CI-1.08to-0.33; physical function-SMD-0.71,95%CI-1.08to-0.33) and follow-up (pain-SMD-0.43,95%CI-0.8to-0.06; physical function-SMD-0.47,95%CI-0.84to-0.1). Low quality evidence indicated that combined treatment was beneficial at post-treatment (pain-SMD-0.43,95%CI-0.78to-0.08; physical function-SMD-0.38,95%CI-0.73to-0.04) but not at follow-up (pain-SMD0.25,95%CI-0.35to0.84; physical function-SMD0.09,95%CI-0.5to0.68). There was no effect of any interventions on quality of life.
  
  
  CONCLUSIONS
  An Exercise therapy intervention provides short-term as well as long-term benefits in terms of reduction in pain, and improvement in physical function among people with hip osteoarthritis. The observed magnitude of the treatment effect would be considered small to moderate.
authors.affiliation: Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, New Zealand kesava.kovanur-sampath@otago.ac.nz.
authors.forename: Kesava Kovanur
authors.initials: KK
authors.lastname: Sampath
authors.affiliation: Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, New Zealand.
authors.forename: Ramakrishnan
authors.initials: R
authors.lastname: Mani
authors.affiliation: Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, New Zealand.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Miyamori
authors.affiliation: Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, New Zealand.
authors.forename: Steve
authors.initials: S
authors.lastname: Tumilty
mesh_terms: D005081:Exercise Therapy; D006801:Humans; D026201:Musculoskeletal Manipulations; D015207:Osteoarthritis, Hip / Q000534:rehabilitation*
keywords: Exercise; Hip pain; Physiotherapy; manipulation; meta-analysis