Garcia W1, Garnatz R1, Lam-Tran D1, Milton A1, Sorensen M1, Whitman J2
1California State University Sacramento, Physical Therapy, Sacramento, United States, 2Evidence In Motion Institute of Healtth Professions, Roseville, United States
Background: Osteoarthritis (OA) is the most common cause of pain in the hip joint in adults over the age of 50. The prevalence of hip OA is 0.9 and 1.6 per 1000 per year in men and woman, respectively. Primary symptoms of OA include pain, joint stiffness, crepitus, and limitation of movement in weight bearing joints, which often leads to functional impairments, including limitations in ambulation. Current evidence supports the use of manual therapy and exercise for individuals with hip OA. Bodyweight supported treadmill training (BWSTT) has been proposed as an intervention for individuals with limitations in ambulation, addressing gait speed and endurance. Evidence supports BWSTT for patients with lumbar spinal stenosis, hip arthroplasty, and hip fracture.
Purpose: The purpose of this case series was to: 1) determine short-term clinical outcomes for individuals with signs and symptoms of hip OA after a multimodal approach that included manual therapy, exercise, and BWSTT; and 2) determine outcomes in physical performance measures from pre- to post-intervention.
Methods: Six females and 1 male, median age 68 years (range, 68-76 years) were recruited from the community, and participated in a course of eight 1-hour treatment sessions consisting of: manual therapy targeting the hips, lumbar spine, and knees as needed; therapeutic exercise; and 30-minutes of body weight supported treadmill training (BWSTT). Amount of support during BWSTT was determined by the subjects self-report of pain reduction. Pre- and post-treatment outcome measures included average pain rating via the Numeric Pain Rating Scale (NPRS), the Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC), Global Rate of Change (GROC), 5 time sit-stand (5TSS), the stair climbing test, and the 6-minute walk test (6MWT).
Results: The mean GROC score for all subjects was 5.0 (+2.3) indicating a rating of “quite a bit better”. The mean improvement in NPRS score was 2.9 points (+1.8), exceeding the MCID of 2 points. Mean improvement on the WOMAC for all subjects was 18.5 +24.8 pts (median 15 pts, range -25 to 51), and the mean increase in 6MWT distance was 60.5 +80.1 meters (median 39 meters, range -3 to 230). Only one patient did not improve during the study, resulting in a negative change score on the WOMAC of 25 points, no change in average pain rating, and a GROC score of 0. For the BWSTT, the percent of body weight reduction used during training improved (mean decrease of 5.0 +5.6%), and the self-selected treadmill speed also improved (mean 0.4 +0.4 mph).
Conclusion(s): Overall, patients with hip OA responded positively to a multimodal rehabilitation approach including BWSTT, manual therapy, and exercise. Interestingly, despite overall clinically important improvements in pain, function, and treadmill training metrics, these gains did not appear to translate to gait endurance improvements while walking on level ground.
Implications: Though patients participating in a multimodal rehabilitation approach including manual therapy, exercise, and BWSTT demonstrated clinically important improvements in pain and function, these changes may not correspond with gait endurance improvements in the short term.
Keywords: Hip osteoarthritis, manual therapy, body weight supported treadmill training
Funding acknowledgements: No funding was received for this project and none of the authors have any conflict of interests to report
Purpose: The purpose of this case series was to: 1) determine short-term clinical outcomes for individuals with signs and symptoms of hip OA after a multimodal approach that included manual therapy, exercise, and BWSTT; and 2) determine outcomes in physical performance measures from pre- to post-intervention.
Methods: Six females and 1 male, median age 68 years (range, 68-76 years) were recruited from the community, and participated in a course of eight 1-hour treatment sessions consisting of: manual therapy targeting the hips, lumbar spine, and knees as needed; therapeutic exercise; and 30-minutes of body weight supported treadmill training (BWSTT). Amount of support during BWSTT was determined by the subjects self-report of pain reduction. Pre- and post-treatment outcome measures included average pain rating via the Numeric Pain Rating Scale (NPRS), the Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC), Global Rate of Change (GROC), 5 time sit-stand (5TSS), the stair climbing test, and the 6-minute walk test (6MWT).
Results: The mean GROC score for all subjects was 5.0 (+2.3) indicating a rating of “quite a bit better”. The mean improvement in NPRS score was 2.9 points (+1.8), exceeding the MCID of 2 points. Mean improvement on the WOMAC for all subjects was 18.5 +24.8 pts (median 15 pts, range -25 to 51), and the mean increase in 6MWT distance was 60.5 +80.1 meters (median 39 meters, range -3 to 230). Only one patient did not improve during the study, resulting in a negative change score on the WOMAC of 25 points, no change in average pain rating, and a GROC score of 0. For the BWSTT, the percent of body weight reduction used during training improved (mean decrease of 5.0 +5.6%), and the self-selected treadmill speed also improved (mean 0.4 +0.4 mph).
Conclusion(s): Overall, patients with hip OA responded positively to a multimodal rehabilitation approach including BWSTT, manual therapy, and exercise. Interestingly, despite overall clinically important improvements in pain, function, and treadmill training metrics, these gains did not appear to translate to gait endurance improvements while walking on level ground.
Implications: Though patients participating in a multimodal rehabilitation approach including manual therapy, exercise, and BWSTT demonstrated clinically important improvements in pain and function, these changes may not correspond with gait endurance improvements in the short term.
Keywords: Hip osteoarthritis, manual therapy, body weight supported treadmill training
Funding acknowledgements: No funding was received for this project and none of the authors have any conflict of interests to report
Topic: Musculoskeletal: lower limb
Ethics approval required: Yes
Institution: California State University, Sacramento
Ethics committee: Institutional Review Board
Ethics number: 15-16-148
All authors, affiliations and abstracts have been published as submitted.
