Physical therapy and hip osteoarthritis - Reply

摘要

In Reply Dr White and colleagues raise 4 issues. First, they are concerned about differential treatment effects according to disease severity given that half of our participants had moderate to severe hip osteoarthritis and that their experience shows that those with moderate to severe hip osteoarthritis do not respond as favorably to most conservative treatment. This is a possibility although an exploratory post hoc analysis of the data showed no significant differences in the amount of improvement in pain (P = .76) and function (P = .38) comparing disease severity subgroups with active and sham treatment.Second, White and colleagues question the dose and content of the active intervention. We evaluated a program that was designed to match common clinical practice parameters in Australia and internationally. Whether a more intensive program with a greater number of exercises and greater supervised contact time would be more effective remains to be tested. However, given that longer-term adherence is problematic, the feasibility of such a program needs to be considered in the context of a chronic disease such as osteoarthritis.Third, the authors speculate that the adverse events may have been sustained from hip thrust manipulation. We cannot ascertain the cause of the adverse events given the multimodal nature of the program. However, few adverse events were noted from this same technique in another trial of hip osteoarthritis.1