The influence of manual therapy dosing on outcomes in patients with hip osteoarthritis: a systematic review

ABSTRACT

Objective

To 1) Determine if specific dosing parameters of manual therapy are related to improved pain, disability, and quality of life outcomes in patients with hip osteoarthritis and 2) to provide recommendations for optimal manual therapy dosing based on our findings.

Design

A systematic review of randomized controlled trials from the PubMed, CINAHL, and OVID databases that used manual therapy interventions to treat hip osteoarthritis was performed. Three reviewers assessed the risk of bias for included studies and extracted relevant outcome data based on predetermined criteria. Baseline and follow-up means and standard deviations for outcome measures were used to calculate effect sizes for within and between-group differences.

Results

Ten studies were included in the final analyses totaling 768 participants, and half were graded as high risk of bias. Trends emerged: 1) large effect sizes were seen using long-axis distraction, mobilization and thrust manipulation, 2) mobilization with movement showed large effects for pain and range of motion, and (3) small effects were associated with graded mobilization. Durations of 10 to 30 minutes per session, and frequency 2–3 times per week for 2–6 weeks were the most common dosing parameters.

Conclusions

There were varied effect sizes associated with pain, function, and quality of life for both thrust and non-thrust mobilizations, and mobilization with movement into hip flexion and internal rotation. Due to the heterogeneity of MT dosage, it is difficult to recommend a specific manual therapy dosage for those with hip osteoarthritis.

KEYWORDS:

• Manual therapy
• hip osteoarthritis
• dosage
• disability

Supplementary material

Supplemental data for this article can be accessed here.

Acknowledgments

None.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author contributions

MS, JS and RS developed the final study protocol, designed and analyzed the data and wrote the initial draft of the manuscript. DR and JY conceived the study idea, assisted with interpretation of results, provided feedback for drafts of the manuscript and helped supervise the process. All authors approved the final version.

Trial Registration Number

PROSPERO database registration number (CRD42020189103)

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Notes on contributors

Mark H. Shepherd

Mark Shepherd is a physical therapist who holds both a Doctorate of Physical Therapy (DPT) and a Doctorate of Science in Physical Therapy (DSc). He is board certified in orthopaedics (OCS) and is fellowship trained in orthopaedic manual physical therapy (FAAOMPT). He is the program director of Bellin College’s Orthopaedic Manual Physical Therapy Program.

Joshua Shumway

Joshua Shumway is a physical therapist who holds a Doctorate of Physical Therapy (DPT) and is board certified in orthopaedics (OCS) and is fellowship trained in orthopaedic manual physical therapy (FAAOMPT). He currently serves as the Flight Commander in the United States Air Force.

Robert T. Salvatori

Robert Salvatori is earned his Doctorate in Physical Therapy (DPT) from St. Augustine University. Prior to that, Bob obtained his Bachelor of Science in Physical Therapy from Temple University. He is board certified in orthopaedics (OCS) and is fellowship trained in orthopaedic manual physical therapy (FAAOMPT). He practices in a private practice in Oklahoma, United States.

Daniel I. Rhon

Dan Rhon is a clinician and active health services researcher. He is the Research Director for the Bellin College Doctor of Science program. He graduated with his Masters in Physical Therapy from Baylor University, followed by a DPT from Temple University and DSc from Baylor University. He completed a clinical fellowship at Brooke Army Medical Center (orthopaedic manual physical therapy) and a postdoctoral research fellowship at the University of Utah.

Jodi L. Young

Jodi Young is faculty and the Assistant Director of Research in the Bellin College DSc in Physical Therapy program. She is a Board Certified Orthopaedic Clinical Specialist through the American Physical Therapy Association and is also a fellow of the American Academy of Orthopaedic Manual Physical Therapy. She is currently working on a PhD through the University of Newcastle in Australia researching physical therapy dosing in patients with lower extremity injuries.