Osteoarthritis Patients May Not Benefit From Physical Therapy

Physical therapy for osteoarthritis did not significantly improve pain intensity and physical function

(RxWiki News) Physical therapy is a commonly recommended treatment for patients with osteoarthritis. Yet, new research questions whether it does much good for patients with painful hip osteoarthritis.

A recent study found that physical therapy did not significantly improve pain or physical function in patients with hip osteoarthritis, compared to sham (placebo) therapy.

The researchers concluded that these findings should raise questions about the value of physical therapy for these patients.

"Talk to an orthopedist about the best treatment for osteoarthritis."

The lead author of this study was Kim L. Bennell, PhD, from the Centre for Health in the Department of Exercise and Sports Medicine in the School of Health Sciences at the University of Melbourne in Melbourne, Victoria, Australia.

The study included 102 adults aged 50 years and older with hip osteoarthritis. These patients had reported pain in their groin and hip area for at least three months.

Osteoarthritis is the most common type of arthritis in which the cartilage between bones wears down over time.

The researchers recruited the patients between May 2010 and April 2012, and conducted follow-up for an average of six months until February 2013.

The participants had to have at least moderate difficulties performing daily activities and an average pain intensity score of 40 or more in the past week.

Pain intensity was measured by questionnaires and ranged from a score of 0 to 100, with 100 indicating the worst possible pain.

The researchers randomly split the participants into two groups, both of which involved 10 individual physical therapy sessions over the course of 12 weeks, and then continuation of therapy methods at home for another 24 weeks.

There were 49 participants in the active treatment group, and 53 participants in the sham treatment group.

The participants in the active treatment group were given manual therapy techniques (e.g., deep tissue massage and muscle stretches), weekly home exercises, education and advice, and when appropriate, a walking stick.

The participants in the sham treatment group were given an inactive ultrasound, and inert gel (placebo treatment) was applied to the hip region. This group did not receive exercise instruction or manual therapy.

Ultrasounds send soundwaves through body tissue to help regenerate damaged tissue and show an image of an internal part of the body. An inactive ultrasound is a placebo (fake) ultrasound that provides an image but does not help tissue growth.

At week 13 and 36, the researchers measured the participants’ average pain level and physical function.

The findings showed that the active group had an average pain intensity score of 59 at the beginning of the study, and a score of 40 at 13 weeks.

The sham group had an average pain intensity score of 58 at the beginning of the study, dropping to 35 by 13 weeks.

Pain intensity scores differed between the two groups by an average of 7 points, with the sham group reporting overall lower pain at week 13.

The researchers found that the participants in the sham group had minimally better physical function than those in the active group by week 13. However, the difference between the groups was not significant.

Of those in the active group, 41 percent reported a total of 26 mild adverse effects at the end of follow-up, whereas only 14 percent of the sham group reported a total of nine adverse effects.

Adverse effects were mostly mild, and involved pain or stiffness in the hip, back or other areas.

The findings revealed that in the active group, pain intensity decreased by an average of 18 points, compared with 23 points in the sham group.

The change in physical function within the sham group was significant; the change in physical function within the active group was not.

“These results question the benefits of such a physical therapy program for this patient population," Dr. Bennell and team concluded.

The study was limited because the therapists who administered each treatment were not blinded; that is, they were aware of the difference in treatments and which group received which treatment. Also, not all the participants kept to their at-home treatment regimen, and the study group only included patients over 50 years old. As such, these findings may not be generalizable to younger patients, different physical therapy programs or patients with milder symptoms.

This study was published on May 20 in JAMA.

The National Health and Medical Research Council provided funding.

Review Date: 
May 20, 2014