Pain Education not Effective in Hip OA
Reference:Poulsen E, et al 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. Osteoarthritis Cartilage. 2013 Oct;21(10):1494-503.
This Danish RCT randomly allocated 118 patients with hip OA into one of 3 treatment groups:
1. Minimal control intervention
2. Patient education
3. Patient education plus manual therapy
Those in the minimal control intervention group were given an exercise sheet involving simple home-based stretching exercises.
Those in the patient education group received 5 sessions of pain management strategies provided by a physiotherapist.
Those in the manual therapy group received 12 sessions of trigger point release therapy, muscular stretching, and various joint manipulations provided by a chiropractor.
Result #1: At 6 weeks, 12% of the patients in the home-based stretching group reported significant improvements.Within one year, 7 still needed a hip replacement.
Result #2: At 6 weeks, 22% of the patients in the education group reported significant improvements. The patient education group did not experience pain or disability outcomes any better than the control group. Within one year, 12 still needed a hip replacement.
(i.e. 5 sessions of just patient education was pretty much useless!)
Result #3: At 6 weeks, 76% of the patient in the education combined with manual therapy group reported significant improvements. The patients who were educated and received chiropractic manual therapy had significant improvements in pain and disability compared to the other two groups. Within one year, 4 needed a hip replacement.
(i.e. 12 sessions of placing hands on patients was more effective than the hands-off approaches!)
Clinical Conclusion: There is something to be said about putting our hands on patients and performing various manual therapy techniques; whether by a chiropractor or a physiotherapist.
Sometime PTs go overboard and believe that every pain can be cured by just pain education. Even though pain education did not work for hip OA, there is evidence to show it may be effective for some patients …read on to learn more.
Posted on: December 20, 2013