Table 31Osteoarthritis hip pain: exercise

Author, Year, Followup, Pain Duration, Study QualityInterventionPopulationFunction and Pain OutcomesOther Outcomes

Abbott, 2013

9.75 months

Duration of pain: 9 months

Fair

A. Exercise therapy (n=51/22 hip ): 7 sessions of strengthening, stretching, and neuromuscular control over 9 weeks, with 2 booster sessions at week 16. Individual exercises prescribed as needed. Home exercise prescribed 3 times weekly

B. Usual care (n=51/23 hip ): Routine care provided by patient’s own GP and other healthcare providers

A vs. B (total population, includes knee )

Age: 67 vs. 66

Females: 49% vs. 63%

% hip : 43.1% vs. 45.1%

WOMAC (0-240): 95.5 vs. 93.8

A vs. B (hip only)

9.75 months

WOMAC mean change from baseline: −12.4 vs. 6.6

Juhakoski, 2011

3, 9, and 21 months

Duration of pain: Mean 8.3 to 8.5 years

Fair

A. Exercise + usual care (n=57): 12 strengthening and stretching exercise sessions of 45 minutes once per week, with 4 booster sessions 1 year later

B. Usual care (n=56): normal routine care offered by patient’s own GP.

All patients attended an hour-long session on basic principles of nonoperative treatment of hip

A vs. B

Age: 67 vs. 66 years

Female: 68% vs. 72%

Duration of pain: 8.3 to 8.5 years

Baseline WOMAC function (0-100): 24.7 vs. 28.9

Baseline WOMAC pain (0-100): 21.5 vs. 29.1

A vs. B

3 months

WOMAC function: 22.6 vs. 30.1, (difference −7.5, 95% −13.9 to −1.0)

WOMAC pain: 23.4 vs. 28.9 (difference −5.5, 95% −13.0 to 2.0)

9 months

WOMAC function: 24.6 vs. 27.6 (difference −3.0, 95% −9.2 to 3.2)

WOMAC pain: 22.9 vs. 25.0 (difference −2.1, 95% −9.2 to 5.0)

21 months

WOMAC function: 24.4 vs. 30.0 (difference −5.6, 95% −12.9 to 1.7)

WOMAC pain: 24.1 vs. 27.9 (difference −3.8, 95% −12.0 to 4.4)

A vs. B

3 months

Weak opioid use (p=0.73):

Not using: 82.5% vs. 87.7%

1-6 times/week: 10.5% vs. 8.8%

Daily: 7.0% vs. 3.5%

9 months

Mean doctor visits for hip : 0.5 vs. 0.8, p=0.07

Mean physiotherapy visits for hip : 1.3 vs. 2.0, p=0.05

Weak opioid use (p=0.12):

Not using: 81.0% vs. 93.1%

1-6 times/week: 10.4% vs. 1.7%

Daily: 8.6% vs. 5.2%

21 months

Mean doctor visits (between 9 and 21 month followup) for hip : 0.5 vs. 1.1, p=0.05

Mean physiotherapy visits (between 9 and 21 month followup) for hip : 0.4 vs. 1.3, p<0.001

Weak opioid use (p=0.70):

Not using: 80.7% vs. 85.2%

1-6 times/week: 12.3% vs. 7.4%

Daily: 7.0% vs. 7.4%

Tak, 2005

6 months, 3 years

Duration of pain:

Poor

A. Exercise (n=45): Eight weekly group sessions of strength training, information on a home exercise program, ergonomic advice, and dietary advice

B. Usual care (n=49): Subject-initiated contact with GP. Reference group (n=) consisting of weekly stress management sessions for 10 weeks

A vs. B

Age: 68 vs. 69

Female: 64% vs. 71%

Baseline (0-100): 71.1 vs. 71.0

Baseline GARS (18-72): 22.8 vs. 25.3

Baseline -136 physical (0-100): 7.2 vs. 7.6

Baseline pain (0-10): 3.8 vs. 4.2

Baseline pain subscale (0-44): 27.9 vs. 28.8

A vs. B

3 months

: 75.4 vs. 71.1, (difference 4.3, 95% −2.2 to 10.8)

GARS: 23.7 vs. 26.3, (difference −2.6, 95% −6.0 to 0.8)

-136 physical: 5.1 vs. 8.4, (difference −3.3, 95% −5.3 to −1.3)

Pain : 3.5 vs. 5.1, (difference −1.6, 95% −2.6 to −0.6)

pain subscale: 29.6 vs. 26.9, (difference −0.9, 95% −4.7 to 2.9)

A vs. B

3 months

(0-10): 5.0 vs. 4.2, (difference 1.4, 95% −0.2 to 3.0)

(7-39): 28.6 vs. 27.3, (difference 0.9, 95% −0.4 to 2.2)

Teirlinck, 2016

3 and 9 months

Duration of pain: Median 1 year

Fair

A. Exercise therapy (n=101): 12 sessions over 3 months consisting of strengthening, stretching, and aerobic exercise

B. Usual care (n=102): Routine care provided by patient’s own GP

A vs. B

Age: 64 vs. 67

Females: 62% vs. 55%

Pain duration median (): 365 (810) vs. 365 (819) days

Baseline HOOS function (0-100): 35.4 vs. 32.2

Baseline HOOS pain (0-100): 37.6 vs. 38.9

Baseline ICOAP constant pain (0-20): 5.4 vs. 5.8

Baseline ICOAP intermittent pain (0-24): 8.0 vs. 8.4

Baseline ICOAP total pain (0-100): 30.4 vs. 32.2

A vs. B

3 months

HOOS function: 30.8 vs. 35.3, (adjusted difference −2.4, 95% −6.7 to 1.9)

HOOS pain: 34.4 vs. 37.2, (adjusted difference −2.2, 95% −6.2 to 1.7)

ICOAP constant pain: 4.0 vs. 5.3, (adjusted difference −0.9, 95% −1.9 to 0.1)

ICOAP intermittent pain: 7.0 vs. 7.9, (adjusted difference −0.6, 95% −1.7 to 0.6)

ICOAP total pain: 24.9 vs. 29.8, (adjusted difference −3.3, 95% −8.0 to 1.4)

9 months

HOOS function: 26.8 vs. 34.2, (adjusted difference −3.0, 95% −6.7 to 0.2)

HOOS pain: 31.6 vs. 34.6, (adjusted difference −1.6, 95% −6.2 to 3.0)

ICOAP constant pain: 3.6 vs. 4.7, (adjusted difference −0.7, 95% −1.7 to 0.4)

ICOAP intermittent pain: 6.1 vs. 7.2, (adjusted difference −0.6, 95% −1.8 to 0.6)

ICOAP total pain: 22.2 vs. 27.0, (adjusted difference −2.8, 95% −7.6 to 2.0)

A vs. B

3 months

EuroQol 5D−3L (−0.329−1.0): 0.77 vs. 0.76, (adjusted difference −0.01, 95% −0.06 to 0.04)

9 months

EuroQol 5D-3L: 0.78 vs. 0.78, (adjusted difference −0.01, 95% −0.06 to 0.04)

Total hip replacements: 6 vs. 9

= confidence interval; GARS = gait abnormality rating scale; GP = general practitioner; = Harris Hip Score; HOOS = hip disability and osteoarthritis outcome score; = Health Related Quality of Life; ICOAP = intermittent and constant pain score; = Inter-quartile range; = not reported; = osteoarthritis; QoL = quality of life; -136 = Sickness Impact Profile-136; = visual analog scale; WOMAC= Western Ontario and McMaster Universities Osteoarthritis Index

a

Unless otherwise noted, followup time is calculated from the end of the treatment period

b

Authors defined weak opioids as tramadol or codeine

c

Cluster where clusters were formed from participants selecting a time that best fit their schedule

From: Results

Cover of Noninvasive Nonpharmacological Treatment for Chronic Pain: A Systematic Review Update
Noninvasive Nonpharmacological Treatment for Chronic Pain: A Systematic Review Update [Internet].
Comparative Effectiveness Review, No. 227.
Skelly AC, Chou R, Dettori JR, et al.

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