Discuss the typica l clinical presentation of the diagnosis , Hip Osteoarthritis(OA)

Discuss the typica l clinical presentation of the diagnosis , Hip Osteoarthritis(OA), included possible therapeutic exercise treatment intervention, also recommendations for the management of the condition.

Introduction: First about OA and then write about Hip OA

Describe the pathophysiology of the diagnosis and the expected clinical presentation anticipated. If it varies, them describe common variations.

Discuss etiology and demographics related to the diagnosis(I.e., is this dx more common in men than women, what age, group ect)

Very important only use the articles provides, not citation work submitted via turnitin!!!!
Exercise for Osteoarthritis of the Hip Nolwenn Poquet, Matthew Williams, Kim L. Bennell

highlights the findings and application of Cochrane reviews and other evidence pertinent to the practice of physical therapy. The Cochrane Library is a respected source of reliable evidence related to health care. Cochrane systematic reviews explore the evidence for and against the effectiveness of appropri- ate interventions—medications, sur- gery, education, nutrition, exercise— and the evidence for and against the use of diagnostic tests for specific conditions. Cochrane reviews are designed to facilitate the decisions of clinicians, patients, and others in health care by providing a careful review and interpretation of research studies published in the scientific lit- erature.1 Each article in this PTJ series summarizes a Cochrane review or other scientific evidence on a single topic and presents clinical scenarios based on real patients or programs to illustrate how the results of the review can be used to directly inform clinical decisions. This article focuses on an adult patient with osteoarthri- tis of the hip. Can exercise help this patient?

Osteoarthritis (OA) is the most common form of arthritis and is characterized by a progressive degeneration of the joint, affecting most frequently the hands, knees, and hips. Radiographic signs of OA include joint space narrowing, sub- chondral bone sclerosis, and osteophyte formation. The loss of cartilage is often associated with synovium inflammation,2

thickening of the capsule, and muscle weakness.3,4 Osteoarthritis is a leading cause of disability, especially in the elderly population, with pain and func- tional limitation being the main associ- ated symptoms.5

Management strategies for OA of the hip include a combination of nonpharmaco- logical and pharmacological modalities. Education, exercise, and weight loss are considered to be core treatments by international guidelines6–10 and should be considered as the first management option, before medications. When med- ication is needed, the treatment starts with paracetamol or nonsteroidal anti- inflammatory drugs (NSAIDs), with opi- oids reserved for patients with refractory severe pain. Prescription of NSAIDs should always follow a close consider- ation of the patient’s comorbidities and the related risk factors. Joint replace- ment surgery should be considered for patients with substantial pain or func- tional limitation despite optimal conser- vative care.

Land-based therapeutic exercises are used to relieve symptoms of hip OA, aim- ing to improve muscle strength, joint range of motion, physical function, and aerobic capacity. Fransen et al11 con- ducted a Cochrane systematic review to assess the effectiveness of exercise on pain, physical function, and quality of life for adults with hip OA. The review included studies evaluating any type of land-based exercise programs, super- vised or performed at home. The inter- vention had to be compared with any other active treatment (excluding another exercise program) or a placebo. Outcome data were extracted at the end of the treatment and at longer-term

follow-up. Treatment compliance and adverse events also were assessed. The search was up-to-date on February 2013.

Take-Home Message Ten randomized controlled trials (549 participants) were included in this Cochrane review,11 half of these trails (419 participants) focusing on people with hip OA only12–16 and the rest includ- ing a mixed population with knee and hip OA.17–21 Seven of the 10 included studies were considered at low risk of bias based on methodological rating. High-quality evidence supported a signif- icantly greater reduction in pain and physical function in the exercise group compared with the control group at the end of the treatment and at longer-term follow-up (3–6 months). Low-quality evi- dence showed no difference in terms of quality of life compared with the control group. There was large variability in exercise treatment dosage, from 6 to 36 sessions over 6 to 12 weeks, each session lasting 30 to 60 minutes. Treatment ses- sions were provided to groups of patients15,16,18–20 or individually13,14,17,21

and could be completed via a home exer- cise program.14,16 One study specifically evaluated a tai chi program for arthritis19; the other studies included traditional exercise programs with muscle strength- ening, functional training, and fitness training. Additional descriptions of the results are presented in Table 1.

Case #29: Applying Evidence to a Patient With Osteoarthritis of the Hip Can exercise help this patient? Mrs J is a 71-year-old woman with 10 years’ insidious onset of bilateral hip pain, right side worse than left side. Symptoms initially settled but have returned over the last 10 months and have progressively worsened. Previously very active, Mrs J retired as a nurse 2 years ago and has become more and more sedentary, increasing her weight by 5 kg (weight�65.8 kg, body mass index [BMI]�26.89 kg/m2). She lives at home alone and has some difficulty in


Find the case archive at http://ptjournal.apta.org/ collection/leap-linking-evidence- and-practice.

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Table 1. Key Results From the 2014 Cochrane Review by Fransen et al11,a

10 RCTs were included, with a total of 549 participants. Only 2 RCTs had more than 50 participants in each allocation group.

The search was up-to-date on February 2013.

7 of the 10 included trials were at low risk of bias according to the Cochrane risk of bias scale.

Participants were adults with hip OA diagnosed using the American College of Rheumatology clinical and radiographic criteria or on the basis of chronic anterior joint pain without radiographic confirmation. They were recruited from the community, general practice, or specialist clinics.

Intervention was any land-based therapeutic exercise program; one study included a specific tai chi program. Exercise dosage varied widely: – Frequency: 5 studies – 1 time/wk; 3 studies – 2 times/wk; 2 studies – 3 times/wk.

With eventual additional booster sessions or daily home exercises. – Intensity: not specified in the majority of the studies. When provided, it was the number of repetitions, the level of effort, or a progression scale. – Duration of each session: from 30 min (3 studies) to 60 min (3 studies). – Duration of the program: half of the studies included a 12-wk program, and the other half included shorter programs of 6, 7, or 8 wk.

Comparators included usual care, patient education, and wait-list controls.

Exercise interventions showed significantly better outcomes compared with the control groups immediately after treatment, with small but clinically important effect on pain and physical function.

➢ Pain 9 studies–549 participants

Quality of the evidence: high (GRADE)

SMD�–0.38; 95% CI�–0.55, –0.2

The effect size was considered small to moderate, favoring exercise over the control group to reduce pain, equivalent to a reduction of 8 points (95% CI�4, 11) on a 0 to 100 pain scale.

Pain was measured using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale (4 studies), the visual analog scale (VAS) (4 studies), or the numerical rating scale (NRS) (1 study).

➢ Physical function 9 studies–521 participants

Quality of the evidence: high (GRADE)

SMD�–0.33; 95% CI�–0.54, –0.05

The effect size was considered small to moderate, favoring exercise over the control group to improve physical function, equivalent to an improvement of 7 points (95% CI�1, 12) on a 0 to 100 physical function scale.

Physical function was measured using the WOMAC physical function subscale (6 studies), the Influence of Rheumatic Disease on General Health and Lifestyle (IRGL) mobility subscale (2 studies), and the Groningen Activity Restriction Scale (GARS) (1 study).

➢ Quality of life 3 studies–183 participants

Quality of the evidence: low (GRADE)

SMD�0.07; 95% CI�–0.23, 0.36

No statistically significant difference was found between groups.

➢ Withdrawals 7 studies–715 participants

Quality of the evidence: moderate (GRADE)

Risk difference�0.01; 95% CI�–0.01, 0.04

There was no significantly increased risk of withdrawal in the exercise group compared with the control group.

Similar results were found at longer-term follow-up (3–6 mo), with sustained significant reduction of pain and improvement of physical function for the exercise group.

➢ Pain 6 studies–391 participants

Quality of the evidence: high (GRADE)

SMD�–0.38; 95% CI�–0.58, –0.18

➢ Physical function 6 studies–365 participants

Quality of the evidence: high (GRADE)

SMD�–0.37; 95% CI�–0.57, –0.16

a RCTs�randomized controlled trials; OA�osteoarthritis; GRADE�Grading of Recommendations Assessment, Development and Evaluation; SMD�standardized mean difference; CI�confidence interval.

Case #29 OA Hip Exercise


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