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Evidence summaries

Exercise for Osteoarthritis of the Hip

Therapeutic exercise programmes can reduce pain and improve physical function among people with symptomatic hip OA. Level of evidence: "B"

A Cochrane review [Abstract] 1 included 10 RCTs with 549 participants. Only five of the 10 RCTs exclusively recruited people with symptomatic hip OA (419 participants). There was no significant difference in pain or physical function outcomes compared with five studies recruiting participants with hip or knee OA (130 participants).

Evidence from nine trials (549 participants) indicated that exercise reduced pain (SMD) -0.38, 95% CI -0.55 to -0.20) and improved physical function (SMD -0.38, 95% CI -0.54 to -0.05) immediately after treatment. Pain and physical function were estimated to be 29 points on a 0- to 100-point scale (0 was no pain or loss of physical function) in the control group; exercise reduced pain by an equivalent of 8 points (95% CI 4 to 11 points; NNTB 6) and improved physical function by an equivalent of 7 points (95% CI 1 to 12 points; NNTB 6). Only three small studies (183 participants) evaluated quality of life, with no benefit of exercise demonstrated (SMD -0.07, 95% CI -0.23 to 0.36). Evidence from seven trials (715 participants) indicated an increased likelihood of withdrawal from the exercise allocation (event rate 6%) compared with the control group (event rate 3%), but this difference was not significant (risk difference 1%; 95% CI -1% to 4%).

The reduction in pain was sustained at least three to six months after ceasing monitored treatment (five RCTs, 391 participants): pain (SMD -0.38, 95% CI -0.58 to -0.18). Pain was estimated to be 29 points on a 0- to 100-point scale (0 was no pain) in the control group, the improvement in pain translated to a sustained reduction in pain intensity of 8 points (95% CI 4 to 12 points) compared with the control group (0 to 100 scale). The improvement in physical function was also sustained (five RCTs, 367 participants): physical function (SMD -0.37, 95% CI -0.57 to -0.16). Physical function was estimated to be 24 points on a 0- to 100-point scale (0 was no loss of physical function) in the control group, the improvement translated to a mean of 7 points (95% CI 4 to 13) compared with the control group.

Comment: The quality of evidence is downgraded by study quality: the outcomes (pain, physical function, quality of life) were participant reported and results may be vulnerable to detection bias as blinding was not possible.

    References

    • Fransen M, McConnell S, Hernandez-Molina G et al. Exercise for osteoarthritis of the hip. Cochrane Database Syst Rev 2014;(4):CD007912. [PubMed]

Primary/Secondary Keywords