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Exercise and Manual Therapy Arthritis Research Trial (EMPART) for osteoarthritis of the hip: a multicentre randomised controlled trial
French HP, Cusack T, Brennan MA, Caffrey MA, Conroy R, Cuddy MV, Fitzgerald OM, Gilsenan MC, Kane D, O'Connell PG, White MB, McCarthy GM
Archives of Physical Medicine and Rehabilitation 2013 Feb;94(2):302-314
clinical trial
8/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

OBJECTIVE: To determine the effectiveness of exercise therapy (ET) compared to ET with adjunctive manual therapy (ET+MT) for people with hip osteoarthritis (OA). A secondary aim was to identify if immediate commencement of ET or ET+MT was more beneficial than a 9 week waiting period for either intervention. DESIGN: Assessor-blind randomised controlled trial with 9 and 18 week follow-ups. SETTING: Four academic teaching hospitals, Dublin, Ireland. PARTICIPANTS: 131 patients with hip OA recruited from general practitioners, rheumatologists, orthopaedic surgeons, and other hospital consultants were randomised to one of three groups: ET (n = 45), ET+MT (n = 43) and wait-list control (n = 43). INTERVENTIONS: Participants in both ET and ET+MT groups received up to 8 treatments over 8 weeks. Control group participants were re-randomised into either ET or ET+MT group after 9 week follow-up. Their data were pooled with original treatment group data: ET (n = 66) and ET+MT (n = 65). MAIN OUTCOME MEASURES: The primary outcome was the WOMAC physical function (PF) subscale. Secondary outcomes included physical performance, pain, hip range of motion (HROM), anxiety/depression, quality of life, medication usage, patient-perceived change and patient satisfaction. RESULTS: There was no significant difference in WOMAC PF between ET (n = 66) and ET+MT (n = 65) groups at 9 weeks (mean diff 0.09 (95% CI -4.41 to 5.25)) or at 18 weeks (mean diff 0.42 (95% CI -3.98 to 6.83)), or other outcomes, except 'patient satisfaction with outcome' which was higher in the ET+MT group (p = 0.02). Improvements in WOMAC, HROM and patient-perceived change occurred in both treatment groups compared with the control group. CONCLUSION: Self-reported function, HROM and patient-perceived improvement occurred after an 8 week programme of ET for patients with hip OA MT as an adjunct provided no further benefit, except for higher patient satisfaction.

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