Article

Physical therapy for hip osteoarthritis (OA) has shown short-term
effects but limited long-term benefit. There has been limited research, with
inconsistent results, in identifying prognostic factors associated with a positive response to physical therapy.
The purpose of this study was
to identify potential predictors of response to physical therapy (exercise
therapy [ET] with or without adjunctive manual therapy [MT]) for hip OA based on
baseline patient-specific and clinical characteristics. DESIGN: A prognostic
study was conducted. METHODS: Secondary analysis of data from a multicenter
randomized controlled trial (RCT) (N=131) that evaluated the effectiveness of ET
and ET+MT for hip OA was undertaken. Treatment response was defined using
OMERACT/OARSI responder criteria. Ten baseline measures were used as predictor
variables. Regression analyses were undertaken to identify predictors of outcome.
Discriminative ability (sensitivity, specificity, and likelihood ratios) of
significant variables was calculated. RESULTS: The RCT results showed no
significant difference in most outcomes between ET and ET+MT at 9 and 18 weeks
posttreatment. Forty-six patients were classified as responders at 9 weeks, and
36 patients were classified as responders at 18 weeks. Four baseline variables
were predictive of a positive outcome at 9 weeks: male sex, pain with activity
(<6/10), Western Ontario and McMaster Universities Osteoarthritis Index physical
function subscale score (<34/68), and psychological health (Hospital Anxiety and
Depression Scale score <9/42). No predictor variables were identified at the
18-week follow-up. Prognostic accuracy was fair for all 4 variables
(sensitivity=0.5-0.58, specificity=0.57-0.72, likelihood ratios=1.25-1.77),
indicating fair discriminative ability at predicting treatment response.
LIMITATIONS: The short-term follow-up limits the interpretation of results, and
the low number of identified responders may have resulted in possible overfitting
of the predictor model. CONCLUSIONS: The authors were unable to identify baseline
variables in patients with hip OA that indicate those most likely to respond to
treatment due to low discriminative ability. Further validation studies are
needed to definitively define the best predictors of response to physical therapy
in people with hip OA.

Langue : ANGLAIS