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Effects of exercise and manual therapy on pain associated with hip osteoarthritis: a systematic review and meta-analysis
  1. Lucy Beumer1,
  2. Jennie Wong1,
  3. Stuart J Warden2,
  4. Joanne L Kemp3,
  5. Paul Foster1,
  6. Kay M Crossley1,4
  1. 1School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
  2. 2School of Health and Rehabilitation Sciences, Indiana University, Indianapolis, Indiana, USA
  3. 3Australian Centre for Research into Injury and Sport and its Prevention (ACRISP), Federation University Australia, Ballarat, Victoria, Australia
  4. 4School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria, Australia
  1. Correspondence to Professor Kay M Crossley, BAppSc (Physio), PhD, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora VIC 3086, Australia; k.crossley{at}


Aim 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.

  • Osteoarthritis
  • Hip
  • Physiotherapy

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