Superior effect of forceful compared with standard traction mobilizations in hip disability?

Abstract

THE OBJECTIVE OF THIS STUDY WAS TO COMPARE THE EFFECTIVENESS OF TWO COMPILED PHYSIOTHERAPY PROGRAMS: one including forceful traction mobilizations, the other including traction with unknown force, in patients with hip disability according to ICF (the International Classification of Functioning, Disability and Health, 2001; WHO), using a block randomized, controlled trial with two parallel treatment groups in a regular private outpatient physiotherapy practice. In the experimental group (E; n = 10) and control group (C; n = 9), the mean (+/-SD) age for all participants was 59 +/- 12 years. They were recruited from outpatient physiotherapy clinics, had persistent pain located at the hip joint for >8 weeks and hip hypomobility. Both groups received exercise, information and manual traction mobilization. In E, the traction force was progressed to 800 N, whereas in C it was unknown. Major outcome measure was the median total change score >/=20 points or >/=50% of the disease- and joint-specific Hip disability and Osteoarthritis Outcome Score (HOOS), compiled of Pain, Stiffness, Function and Hip-related quality of life (ranging 0-100). The mean (range) treatments received were 13 (7-16) over 5-12 weeks and 20 (18-24) over 12 weeks for E and C, respectively. The experimental group showed superior clinical post-treatment effect on HOOS (>/=20 points), in six of 10 participants compared with none of nine in the control group (p = 0.011). The effect size was 1.1. The results suggest that a compiled physiotherapy program including forceful traction mobilizations are short-term effective in reducing self-rated hip disability in primary healthcare. The long-term effect is to be documented.

Figure 1

The progress of the participants through the trial phases. Not meeting inclusion criteria due to: lumbar pain (n = 6), pelvic pain (n = 4), enthesopathies without joint pain (n = 7), too small ROM deficits (n = 3). The one dropout was given the median change score for his group, implementing the intention-to-treat analysis, which explains why there was data for nine participants being analyzed in the control group.

Figure 2

Physiotherapist mobilizing in traction on the patient's right hip. The pillow bolsters the pubic and the anterior superior iliac spines. The belt resisting lateral pelvis glide loops the metal under the patients left side of the plinth, and turns around the pelvis in a level directly inferior to the two anterior superior iliac spines to reconnect. Pelvis caudal glide is resisted by a belt looped from under the superior right-hand side of the plinth, turn around the ipsilateral pubic bone to recouple.