The aim of the present study was to assess the effectiveness of chiropractic manipulation in patients with osteo-arthritis (OA) of the hip. The investigation took the form of a prospective, single-blinded, controlled, pilot clinical trial. Eight volunteers completed the trial from an initial public response (n = 38) to local newspaper and poster advertising. Two withdrew after recruitment (n = 10). All volunteers suffered from hip pain or were previously diagnosed with hip OA. Four patients received chiropractic manipulation of the hip. Four patients received sham treatment using a deactivated Activator Instrument (with the tension turned down to '0'). Each patient received a total of six treatments over a period of 3 weeks. Outcome was measured at the first treatment (baseline), third treatment, sixth treatment and at a one-month follow-up visit. The Numerical pain Rating Scale 101 (NPRS-101), and the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) Index were used as subjective outcome measures. The objective outcome measures took the form of rang of motion measurement of the hip using a goniometer and distance from the lateral femoral condyle to the table in the Fabere (orthopaedic test) position. The data was assessed using descriptive statistics and effect-size calculations (Cohen's d). Intra- and inter-group statistical analyses were performed using the two-tailed paired and unpaired t-tests at the 95% confidence level (alpha = 0.05), respectively. Power analysis was also conducted at an 80% confidence level (beta = 0.02). Statistical analysis of intra-group data did not reveal any significant results (a = 0.05) and power was not satisfactory. At the final treatment, the sham group showed a 1.2% reduction in NPRS-101 scores compared to 21.2% in the manipulation group. Similarly, the WOMAC scores showed a decrease of 5.4% and 22.3% for the sham and manipulation groups, respectively. Average effect size for the NPRS-101 was medium (25%) for the sham group and very large (101%) for the subjects undergoing manipulation, while the average WOMAC scores were medium (36%) for the sham group and very large (276%) for the subjects undergoing manipulation. Changes in the objective measures were less obvious. Inter-group statistical analysis revealed the Power to be unsatisfactory. Only the WOMAC questionnaire provided some statistically significant results. Diagrammatic comparison of mean values showed the manipulation group to the NPRS-101 and the WOMAC. The effect size for both subjective measures at all treatment intervals was seen to be very large (> 80%) when comparing the two groups. The differences in objective measures were less apparent. The small sample size and other methodological problems preclude a definitive statement of efficacy. However, based on descriptive statistics and effect-size calculations, the present study cautiously suggests that manipulative therapy may have noteworthy short-term clinical benefits over sham treatment in patients with OA of the hip. Furthermore, the present study suggests that at least six treatments over a 3-week period are required to obtain optimum clinical results. The outcomes of this study support the need for further investigations into manipulative therapy for OA of the hip.

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