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      Effectiveness and current recommendation of manual therapy on hip osteoarthritis. An overview Translated title: Efectividad y recomendación de la terapia manual sobre la artrosis de cadera. Revisión panorámica

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          Abstract

          ABSTRACT Introduction: Osteoarthritis (OA) is the most common joint disease, increases with age and it is estimated that in those over 60 years of age more than 80 % have OA in at least one joint. Currently, the evidence regarding manual therapy (MT) in hip OA has had unclear results. Therefore, the main objective of this study is to determine the effectiveness and recommendation of MT in the hip OA. And secondary objectives, (I) review the existing literature on the intervention of MT in hip OA, (II) calculate the effectiveness of MT techniques in hip OA and (III) determine if there are benefits after the MT intervention in hip OA. Methods: A systematic search was carried out in electronic databases, in order to compile the available literature between the years 2000 and 2019, taking as reference the PRISMA statement for systematic reviews. Letters to the editor, bibliographic reviews and gray literature were excluded. Results: After reviewing 30 articles, we included 7 RS and 14 RCTs. 7 RCTs measured pain intensity of OA in response to MT vs. a control group. 4 RCTs measuring pain intensity in hip OA using MT + exercises Seven RCTs measured function in subjects with hip OA in response to MT vs. CG. Two RCTs evaluated the effects of MT + Ex on function. Discussion: Although the results were in favor of manual therapy, compared to the control group, these were not statistically significant, so we propose to carry out new primary studies to eliminate some biases in program execution and improve intervention in both groups.

          Translated abstract

          RESUMEN Introducción: La osteoartritis (OA) es la enfermedad articular más frecuente, aumenta con la edad y se estima que en los mayores de 60 años más del 80 % tienen OA en, al menos, una articulación. Actualmente, la evidencia respecto a la terapia manual (TM) en la OA de cadera ha tenido resultados poco claros, por lo que el objetivo principal de este estudio es determinar la efectividad y recomendación de TM en la OA cadera. Los objetivos secundarios son: a) revisar la literatura existente sobre la intervención de TM en OA de cadera; b) calcular la efectividad de las técnicas de TM en OA de cadera, y c) determinar si hay beneficios después de la intervención de TM en OA cadera. Métodos: Se realizó una búsqueda sistemática en bases de datos electrónicas, con el fin de recopilar la literatura disponible entre los años 2000 y 2019, tomando como referencia la declaración PRISMA para revisiones sistemáticas. Se excluyeron las cartas al editor, revisiones bibliográficas y literatura gris. Resultados: Después de revisar 30 artículos, incluimos 7 RS y 14 ECA. 7 ECA midieron la intensidad del dolor de la OA en respuesta a TM vs. un grupo de control. 4 ECA que midieron la intensidad del dolor en la OA de cadera que usaban TM + ejercicios Siete ECA midieron la función en sujetos con OA de cadera en respuesta a TM vs. CG. Dos ECA evaluaron los efectos de TM + Ex en la función. Discusión: Si bien los resultados estuvieron a favor de la terapia manual, en comparación con el grupo control estos no fueron estadísticamente significativos, por lo cual proponemos realizar nuevos estudios primarios para eliminar algunos sesgos en la ejecución del programa y mejorar la intervención en ambos grupos.

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          Most cited references49

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          OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines.

          To develop concise, patient-focussed, up to date, evidence-based, expert consensus recommendations for the management of hip and knee osteoarthritis (OA), which are adaptable and designed to assist physicians and allied health care professionals in general and specialist practise throughout the world. Sixteen experts from four medical disciplines (primary care, rheumatology, orthopaedics and evidence-based medicine), two continents and six countries (USA, UK, France, Netherlands, Sweden and Canada) formed the guidelines development team. A systematic review of existing guidelines for the management of hip and knee OA published between 1945 and January 2006 was undertaken using the validated appraisal of guidelines research and evaluation (AGREE) instrument. A core set of management modalities was generated based on the agreement between guidelines. Evidence before 2002 was based on a systematic review conducted by European League Against Rheumatism and evidence after 2002 was updated using MEDLINE, EMBASE, CINAHL, AMED, the Cochrane Library and HTA reports. The quality of evidence was evaluated, and where possible, effect size (ES), number needed to treat, relative risk or odds ratio and cost per quality-adjusted life years gained were estimated. Consensus recommendations were produced following a Delphi exercise and the strength of recommendation (SOR) for propositions relating to each modality was determined using a visual analogue scale. Twenty-three treatment guidelines for the management of hip and knee OA were identified from the literature search, including six opinion-based, five evidence-based and 12 based on both expert opinion and research evidence. Twenty out of 51 treatment modalities addressed by these guidelines were universally recommended. ES for pain relief varied from treatment to treatment. Overall there was no statistically significant difference between non-pharmacological therapies [0.25, 95% confidence interval (CI) 0.16, 0.34] and pharmacological therapies (ES=0.39, 95% CI 0.31, 0.47). Following feedback from Osteoarthritis Research International members on the draft guidelines and six Delphi rounds consensus was reached on 25 carefully worded recommendations. Optimal management of patients with OA hip or knee requires a combination of non-pharmacological and pharmacological modalities of therapy. Recommendations cover the use of 12 non-pharmacological modalities: education and self-management, regular telephone contact, referral to a physical therapist, aerobic, muscle strengthening and water-based exercises, weight reduction, walking aids, knee braces, footwear and insoles, thermal modalities, transcutaneous electrical nerve stimulation and acupuncture. Eight recommendations cover pharmacological modalities of treatment including acetaminophen, cyclooxygenase-2 (COX-2) non-selective and selective oral non-steroidal anti-inflammatory drugs (NSAIDs), topical NSAIDs and capsaicin, intra-articular injections of corticosteroids and hyaluronates, glucosamine and/or chondroitin sulphate for symptom relief; glucosamine sulphate, chondroitin sulphate and diacerein for possible structure-modifying effects and the use of opioid analgesics for the treatment of refractory pain. There are recommendations covering five surgical modalities: total joint replacements, unicompartmental knee replacement, osteotomy and joint preserving surgical procedures; joint lavage and arthroscopic debridement in knee OA, and joint fusion as a salvage procedure when joint replacement had failed. Strengths of recommendation and 95% CIs are provided. Twenty-five carefully worded recommendations have been generated based on a critical appraisal of existing guidelines, a systematic review of research evidence and the consensus opinions of an international, multidisciplinary group of experts. The recommendations may be adapted for use in different countries or regions according to the availability of treatment modalities and SOR for each modality of therapy. These recommendations will be revised regularly following systematic review of new research evidence as this becomes available.
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            Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation.

            W Harris (1969)
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              American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee.

              To update the American College of Rheumatology (ACR) 2000 recommendations for hip and knee osteoarthritis (OA) and develop new recommendations for hand OA. A list of pharmacologic and nonpharmacologic modalities commonly used to manage knee, hip, and hand OA as well as clinical scenarios representing patients with symptomatic hand, hip, and knee OA were generated. Systematic evidence-based literature reviews were conducted by a working group at the Institute of Population Health, University of Ottawa, and updated by ACR staff to include additions to bibliographic databases through December 31, 2010. The Grading of Recommendations Assessment, Development and Evaluation approach, a formal process to rate scientific evidence and to develop recommendations that are as evidence based as possible, was used by a Technical Expert Panel comprised of various stakeholders to formulate the recommendations for the use of nonpharmacologic and pharmacologic modalities for OA of the hand, hip, and knee. Both “strong” and “conditional” recommendations were made for OA management. Modalities conditionally recommended for the management of hand OA include instruction in joint protection techniques, provision of assistive devices, use of thermal modalities and trapeziometacarpal joint splints, and use of oral and topical nonsteroidal antiinflammatory drugs (NSAIDs), tramadol, and topical capsaicin. Nonpharmacologic modalities strongly recommended for the management of knee OA were aerobic, aquatic, and/or resistance exercises as well as weight loss for overweight patients. Nonpharmacologic modalities conditionally recommended for knee OA included medial wedge insoles for valgus knee OA, subtalar strapped lateral insoles for varus knee OA, medially directed patellar taping, manual therapy, walking aids, thermal agents, tai chi, self management programs, and psychosocial interventions. Pharmacologic modalities conditionally recommended for the initial management of patients with knee OA included acetaminophen, oral and topical NSAIDs, tramadol, and intraarticular corticosteroid injections; intraarticular hyaluronate injections, duloxetine, and opioids were conditionally recommended in patients who had an inadequate response to initial therapy. Opioid analgesics were strongly recommended in patients who were either not willing to undergo or had contraindications for total joint arthroplasty after having failed medical therapy. Recommendations for hip OA were similar to those for the management of knee OA. These recommendations are based on the consensus judgment of clinical experts from a wide range of disciplines, informed by available evidence, balancing the benefits and harms of both nonpharmacologic and pharmacologic modalities, and incorporating their preferences and values. It is hoped that these recommendations will be utilized by health care providers involved in the management of patients with OA. Copyright © 2012 by the American College of Rheumatology.
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                Author and article information

                Journal
                dolor
                Revista de la Sociedad Española del Dolor
                Rev. Soc. Esp. Dolor
                Inspira Network Group, S.L (Madrid, Madrid, Spain )
                1134-8046
                December 2020
                : 27
                : 6
                : 375-391
                Affiliations
                [2] Santiago Santiago de Chile orgnameUniversidad de Las Américas orgdiv1Facultad de Ciencias de la Salud Chile
                [3] Santiago orgnameUniversidad Andrés Bello orgdiv1Facultad de Medicina orgdiv2Departamento de Morfología Chile
                [1] Santiago orgnameUniversidad San Sebastian orgdiv1Facultad de Medicina y Ciencia orgdiv2Departamento de Ciencias Morfológicas Chile
                [4] Puente Alto Santiago orgnameHospital Sótero del Río orgdiv1Emergencias Chile
                Article
                S1134-80462020000600008 S1134-8046(20)02700600008
                10.20986/resed.2020.3835/2020
                96ec8811-a6c2-4212-8996-6816cf5d8025

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : 11 July 2020
                : 02 December 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 50, Pages: 17
                Product

                SciELO Spain

                Categories
                Reviews

                multicomponent therapies,terapia manual,Hip osteoarthritis,manual therapy,Artrosis de cadera,therapies osteoarthritis,terapia para artrosis,terapia multicomponente

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