Exercise and manual physiotherapy arthritis research trial (EMPART): a multicentre randomised controlled trial

Helen P French, Tara Cusack, Aisling Brennan, Breon White, Clare Gilsenan, Martina Fitzpatrick, Paul O'Connell, David Kane, Oliver Fitzgerald, Geraldine M McCarthy, Helen P French, Tara Cusack, Aisling Brennan, Breon White, Clare Gilsenan, Martina Fitzpatrick, Paul O'Connell, David Kane, Oliver Fitzgerald, Geraldine M McCarthy

Abstract

Background: Osteoarthritis (OA) of the hip is a major cause of functional disability and reduced quality of life. Management options aim to reduce pain and improve or maintain physical functioning. Current evidence indicates that therapeutic exercise has a beneficial but short-term effect on pain and disability, with poor long-term benefit. The optimal content, duration and type of exercise are yet to be ascertained. There has been little scientific investigation into the effectiveness of manual therapy in hip OA. Only one randomized controlled trial (RCT) found greater improvements in patient-perceived improvement and physical function with manual therapy, compared to exercise therapy.

Methods and design: An assessor-blind multicentre RCT will be undertaken to compare the effect of a combination of manual therapy and exercise therapy, exercise therapy only, and a waiting-list control on physical function in hip OA. One hundred and fifty people with a diagnosis of hip OA will be recruited and randomly allocated to one of 3 groups: exercise therapy, exercise therapy with manual therapy and a waiting-list control. Subjects in the intervention groups will attend physiotherapy for 6-8 sessions over 8 weeks. Those in the control group will remain on the waiting list until after this time and will then be re-randomised to one of the two intervention groups. Outcome measures will include physical function (WOMAC), pain severity (numerical rating scale), patient perceived change (7-point Likert scale), quality of life (SF-36), mood (hospital anxiety and depression scale), patient satisfaction, physical activity (IPAQ) and physical measures of range of motion, 50-foot walk and repeated sit-to stand tests.

Discussion: This RCT will compare the effectiveness of the addition of manual therapy to exercise therapy to exercise therapy only and a waiting-list control in hip OA. A high quality methodology will be used in keeping with CONSORT guidelines. The results will contribute to the evidence base regarding the clinical efficacy for physiotherapy interventions in hip OA.

Trial registration: ClinicalTrials.gov NCT00709566.

Figures

Figure 1
Figure 1
Flow of participants through the RCT.

References

    1. Keuttner K, Goldberg V. Osteoarthritic Disorders Rosemount. 1995.
    1. Croft P. The epidemiology of osteoarthritis: Manchester and beyond. Rheumatology (Oxford) 2005;44:iv27–iv32. doi: 10.1093/rheumatology/kei058.
    1. Woolf AD, Pfleger B. Burden of major musculoskeletal conditions. Bull World Health Organ. 2003;81:646–656.
    1. Marks R, Allegrante JP. Comorbid disease profiles of adults with end-stage hip osteoarthritis. Med Sci Monit. 2002;8:CR305–309.
    1. Gabriel SE, Crowson CS, O'Fallon WM. Comorbidity in arthritis. J Rheumatol. 1999;26:2475–2479.
    1. Lawrence RC, Helmick CG, Arnett FC, Deyo RA, Felson DT, Giannini EH, Heyse SP, Hirsch R, Hochberg MC, Hunder GG, et al. Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States. Arthritis Rheum. 1998;41:778–799. doi: 10.1002/1529-0131(199805)41:5<778::AID-ART4>;2-V.
    1. Arden N, Nevitt MC. Osteoarthritis: epidemiology. Best Pract Res Clin Rheumatol. 2006;20:3–25. doi: 10.1016/j.berh.2005.09.007.
    1. Picavet HS, Hoeymans N. Health related quality of life in multiple musculoskeletal diseases: SF-36 and EQ-5D in the DMC3 study. Ann Rheum Dis. 2004;63:723–729. doi: 10.1136/ard.2003.010769.
    1. Croft P, Lewis M, Wynn Jones C, Coggon D, Cooper C. Health status in patients awaiting hip replacement for osteoarthritis. Rheumatology (Oxford) 2002;41:1001–1007. doi: 10.1093/rheumatology/41.9.1001.
    1. Salaffi F, Carotti M, Stancati A, Grassi W. Health-related quality of life in older adults with symptomatic hip and knee osteoarthritis: a comparison with matched healthy controls. Aging Clin Exp Res. 2005;17:255–263.
    1. Dieppe P, Cushnaghan J, Tucker M, Browning S, Shepstone L. The Bristol 'OA500 study': progression and impact of the disease after 8 years. Osteoarthritis Cartilage. 2000;8:63–68. doi: 10.1053/joca.1999.0272.
    1. Steultjens MP, Dekker J, van Baar ME, Oostendorp RA, Bijlsma JW. Muscle strength, pain and disability in patients with osteoarthritis. Clin Rehabil. 2001;15:331–341. doi: 10.1191/026921501673178408.
    1. Patten SB, Williams JV, Wang J. Mental disorders in a population sample with musculoskeletal disorders. BMC Musculoskelet Disord. 2006;7:37. doi: 10.1186/1471-2474-7-37.
    1. Sarzi-Puttini P, Cimmino MA, Scarpa R, Caporali R, Parazzini F, Zaninelli A, Atzeni F, Canesi B. Osteoarthritis: an overview of the disease and its treatment strategies. Semin Arthritis Rheum. 2005;35:1–10. doi: 10.1016/j.semarthrit.2005.01.013.
    1. Hinton R, Moody RL, Davis AW, Thomas SF. Osteoarthritis: diagnosis and therapeutic considerations. Am Fam Physician. 2002;65:841–848.
    1. Brandt KD. The role of analgesics in the management of osteoarthritis pain. Am J Ther. 2000;7:75–90. doi: 10.1097/00045391-200007020-00005.
    1. Hurley M, Walsh N. Physical, functional and other non-pharmacological interventions for osteoarthritis. Best Pract Res Clin Rheumatol. 2001;15:569–581. doi: 10.1053/berh.2001.0174.
    1. Fransen M. When is physiotherapy appropriate? Best Pract Res Clin Rheumatol. 2004;18:477–489. doi: 10.1016/j.berh.2004.03.006.
    1. French HP. Physiotherapy management of osteoarthritis of the hip: a survey of current practice in acute hospitals and private practice in the Republic of Ireland. Physiotherapy. 2007;93:253–260. doi: 10.1016/j.physio.2006.12.008.
    1. Conaghan PG, Dickson J, Grant RL. Care and management of osteoarthritis in adults: summary of NICE guidance. BMJ. 2008;336:502–503. doi: 10.1136/.
    1. Roddy E, Zhang W, Doherty M, Arden NK, Barlow J, Birrell F, Carr A, Chakravarty K, Dickson J, Hay E, Hosie G, Hurley M, Jordan KM, McCarthy C, McMurdo M, Mockett S, O'Reilly S, Peat G, Pendleton A, Richards S. Evidence-based recommendations for the role of exercise in the management of osteoarthritis of the hip or knee – the MOVE consensus. Rheumatology (Oxford) 2005;44:67–73. doi: 10.1093/rheumatology/keh399.
    1. Zhang W, Doherty M, Arden N, Bannwarth B, Bijlsma J, Gunther KP, Hauselmann HJ, Herrero-Beaumont G, Jordan K, Kaklamanis P, Leeb B, Lequesne M, Lohmander S, Mazieres B, Martin-Mola E, Pavelka K, Pendleton A, Punzi L, Swoboda B, Varatojo R, Verbruggen G, Zimmermann-Gorska I, Dougados M. EULAR evidence based recommendations for the management of hip osteoarthritis: report of a task force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT) Ann Rheum Dis. 2005;64:669–681. doi: 10.1136/ard.2004.028886.
    1. American College of Rheumatology Subcommittee on Osteoarthritis Recommendations for the medical management of osteoarthritis of the hip and knee: 2000 update. Arthritis Rheum. 2000;43:1905–1915. doi: 10.1002/1529-0131(200009)43:9<1905::AID-ANR1>;2-P.
    1. Zhang W, Moskowitz RW, Nuki G, Abramson S, Altman RD, Arden N, Bierma-Zeinstra S, Brandt KD, Croft P, Doherty M, Dougados M, Hochberg M, Hunter DJ, Kwoh K, Lohmander LS, Tugwell P. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis Cartilage. 2008;16:137–162. doi: 10.1016/j.joca.2007.12.013.
    1. Bijlsma JW, Dekker J. A step forward for exercise in the management of osteoarthritis. Rheumatology (Oxford) 2005;44:5–6. doi: 10.1093/rheumatology/keh432.
    1. Lin SY, Davey RC, Cochrane T. Community rehabilitation for older adults with osteoarthritis of the lower limb: a controlled clinical trial. Clin Rehabil. 2004;18:92–101. doi: 10.1191/0269215504cr706oa.
    1. Sylvester KL. Investigation of the effect of hydrotherapy in the treatment of osteoarthritic hips. Clinical Rehabilitation. 1989;4:223–228. doi: 10.1177/026921559000400307.
    1. Green J, McKenna F, Redfern EJ, Chamberlain MA. Home exercises are as effective as outpatient hydrotherapy for osteoarthritis of the hip. Br J Rheumatol. 1993;32:812–815. doi: 10.1093/rheumatology/32.9.812.
    1. Foley A, Halbert J, Hewitt T, Crotty M. Does hydrotherapy improve strength and physical function in patients with osteoarthritis – a randomised controlled trial comparing a gym based and a hydrotherapy based strengthening programme. Ann Rheum Dis. 2003;62:1162–1167. doi: 10.1136/ard.2002.005272.
    1. Cochrane T, Davey RC, Matthes Edwards SM. Randomised controlled trial of the cost-effectiveness of water-based therapy for lower limb osteoarthritis. Health Technol Assess. 2005;9:iii–iv.
    1. van Baar ME, Dekker J, Oostendorp RA, Bijl D, Voorn TB, Lemmens JA, Bijlsma JW. The effectiveness of exercise therapy in patients with osteoarthritis of the hip or knee: a randomized clinical trial. J Rheumatol. 1998;25:2432–2439.
    1. van Baar ME, Dekker J, Oostendorp RA, Bijl D, Voorn TB, Bijlsma JW. Effectiveness of exercise in patients with osteoarthritis of hip or knee: nine months' follow up. Ann Rheum Dis. 2001;60:1123–1130. doi: 10.1136/ard.60.12.1123.
    1. Hoeksma HL, Dekker J, Ronday HK, Heering A, Lubbe N van der, Vel C, Breedveld FC, Ende CH van den. Comparison of manual therapy and exercise therapy in osteoarthritis of the hip: a randomized clinical trial. Arthritis Rheum. 2004;51:722–729. doi: 10.1002/art.20685.
    1. Tak E, Staats P, Van Hespen A, Hopman-Rock M. The effects of an exercise program for older adults with osteoarthritis of the hip. J Rheumatol. 2005;32:1106–1113.
    1. Haslam R. A comparison of acupuncture with advice and exercises on the symptomatic treatment of osteoarthritis of the hip – a randomised controlled trial. Acupunct Med. 2001;19:19–26.
    1. van Baar ME, Assendelft WJ, Dekker J, Oostendorp RA, Bijlsma JW. Effectiveness of exercise therapy in patients with osteoarthritis of the hip or knee: a systematic review of randomized clinical trials. Arthritis Rheum. 1999;42:1361–1369. doi: 10.1002/1529-0131(199907)42:7<1361::AID-ANR9>;2-9.
    1. Fransen M, McConnell S, Bell M. Therapeutic exercise for people with osteoarthritis of the hip or knee. A systematic review. Journal of Rheumatology. 2002;29:1737–1745.
    1. Pisters MF, Veenhof C, van Meeteren NL, Ostelo RW, de Bakker DH, Schellevis FG, Dekker J. Long-Term effectiveness of exercise therapy in patients with osteoarthritis of the hip or knee: a systematic review. Arthritis Rheum. 2007;57:1245–1253. doi: 10.1002/art.23009.
    1. Walsh NE, Mitchell HL, Reeves BC, Hurley MV. Integrated Exercise and Self-Management Programmes in Osteoarthritis of the Hip and Knee: A Systematic Review of Effectiveness. Physical Therapy Reviews. 2006;11:289–297. doi: 10.1179/108331906X163432.
    1. Hernández-Molina G, Reichenbach , Zhang B, Lavalley M, Felson DT. Effect of therapeutic exercise for hip osteoarthritis pain: Results of a meta-analysis. Arthritis Care Res. 2008;59:1221–1228. doi: 10.1002/art.24010.
    1. Hopman-Rock M, Westhoff MH. The effects of a health educational and exercise program for older adults with osteoarthritis for the hip or knee. J Rheumatol. 2000;27:1947–1954.
    1. Hughes SL, Seymour RB, Campbell RT, Huber G, Pollak N, Sharma L, Desai P. Long-term impact of Fit and Strong! on older adults with osteoarthritis. Gerontologist. 2006;46:801.
    1. Boutron I, Tubach F, Giraudeau B, Ravaud P. Blinding was judged more difficult to achieve and maintain in nonpharmacologic than pharmacologic trials. J Clin Epidemiol. 2004;57:543–550. doi: 10.1016/j.jclinepi.2003.12.010.
    1. Deyle GD, Henderson NE, Matekel RL, Ryder MG, Garber MB, Allison SC. Effectiveness of manual physical therapy and exercise in osteoarthritis of the knee. A randomized, controlled trial. Ann Intern Med. 2000;132:173–181.
    1. Moss P, Sluka K, Wright A. The initial effects of knee joint mobilization on osteoarthritic hyperalgesia. Man Ther. 2006
    1. Mulligan B. Manual Therapy, NAGs, SNAGs, MWMs etc. 3. New Zealand: Plane View Services; 2003.
    1. Maitland G, Hengveld E, Banks K, English K. Maitland's Vertebral Manipulation. Edinburgh: Elsevier Butterworth Heinemann; 2005.
    1. Grimmer K, Bialocerkowski A, Kumar S, Milanese S. Implementing evidence in clinical practice: the ['therapies'] dilemma. Physiotherapy. 2004;90:189. doi: 10.1016/j.physio.2004.06.007.
    1. Hoeksma HL, Dekker J, Ronday HK, Breedveld FC, Ende CH Van den. Manual therapy in osteoarthritis of the hip: outcome in subgroups of patients. Rheumatology (Oxford) 2005;44:461–464. doi: 10.1093/rheumatology/keh482.
    1. Weigl M, Angst F, Aeschlimann A, Lehmann S, Stucki G. Predictors for response to rehabilitation in patients with hip or knee osteoarthritis: a comparison of logistic regression models with three different definitions of responder. Osteoarthritis Cartilage. 2006;14:641–651. doi: 10.1016/j.joca.2006.01.001.
    1. Moher D, Schulz KF, Altman DG. The CONSORT statement: revised recommendations for improving the quality of reports of parallel group randomized trials. BMC Med Res Methodol. 2001;1:2. doi: 10.1186/1471-2288-1-2.
    1. Boutron I, Moher D, Altman DG, Schulz KF, Ravaud P. Extending the CONSORT statement to randomized trials of nonpharmacologic treatment: explanation and elaboration. Ann Intern Med. 2008;148:295–309.
    1. Altman R, Alarcon G, Appelrouth D, Bloch D, Borenstein D, Brandt K, Brown C, Cooke TD, Daniel W, Feldman D, Greenwald R, Hochberg M, Howell D, Ike R, Kapila P, Kaplan D, Koopman W, Marino C, McDonald E, McShane DJ, Medsger T, Michel B, Murphy WA, Osial T, Ramsey-Goldman R, Rothschild B, Wolfe F. The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hip. Arthritis Rheum. 1991;34:505–514. doi: 10.1002/art.1780340502.
    1. Sims K. Assessment and treatment of hip osteoarthritis. Man Ther. 1999;4:136–144. doi: 10.1054/math.1999.0192.
    1. Vogels E, Hendriks H, van Baar M, Dekker J, Hopman-Rock M, RAB Oostendorp RAB, Hullegie WAMM, Bloo H, Hilberdink WKHA, Munneke M, Verhoe J. Clinical Practice Guidelines for Physical Therapy in Patients with osteoarthritis of the hip or knee
    1. Long WT, Dorr LD, Healy B, Perry J. Functional recovery of noncemented total hip arthroplasty. Clin Orthop Relat Res. 1993:73–77.
    1. Grimaldi AR, C A, Donnelly W, Durbridge G. Specific changes within the gluteus maximus muscle but no change in tensor fascia lata in patients with osteoarthritis of the hip. Musculoskeletal Physiotherapy Australia 14th Biennial Conference: 2005; Brisbane, Australia e-Aust J Physiother. 2005;51
    1. Sirca A, Susec-Michieli M. Selective type II fibre muscular atrophy in patients with osteoarthritis of the hip. J Neurol Sci. 1980;44:149–159. doi: 10.1016/0022-510X(80)90123-9.
    1. AGS Exercise Prescription for Older Adults with Osteoarthritis Pain: Consensus Practice Recommendations. Journal of the American Geriatrics Society. 2001;49:808–823. doi: 10.1046/j.1532-5415.2001.00496.x.
    1. Cyriax J. Textbook of Orthopaedic Medicine 1: Diagnosis of soft tissue lesions. 8. London: Balliere Tindall; 1982.
    1. Chaitow L. Muscle Energy Techniques. 3. Edinburgh: Churchill Livingstone/Elsevier; 2006.
    1. Adler S, Beckers D, Buck M. PNF in practice: An illustrated guide. 2. Springer; 2003.
    1. Bellamy N, Kirwan J, Boers M, Brooks P, Strand V, Tugwell P, Altman R, Brandt K, Dougados M, Lequesne M. Recommendations for a core set of outcome measures for future phase III clinical trials in knee, hip, and hand osteoarthritis. Consensus development at OMERACT III. J Rheumatol. 1997;24:799–802.
    1. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988;15:1833–1840.
    1. Theiler R, Sangha O, Schaeren S, Michel BA, Tyndall A, Dick W, Stucki G. Superior responsiveness of the pain and function sections of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) as compared to the Lequesne-Algofunctional Index in patients with osteoarthritis of the lower extremities. Osteoarthritis Cartilage. 1999;7:515–519. doi: 10.1053/joca.1999.0262.
    1. Ehrich EW, Davies GM, Watson DJ, Bolognese JA, Seidenberg BC, Bellamy N. Minimal perceptible clinical improvement with the Western Ontario and McMaster Universities osteoarthritis index questionnaire and global assessments in patients with osteoarthritis. J Rheumatol. 2000;27:2635–2641.
    1. Guyatt GH, Norman GR, Juniper EF, Griffith LE. A critical look at transition ratings. J Clin Epidemiol. 2002;55:900–908. doi: 10.1016/S0895-4356(02)00435-3.
    1. Juniper EF, Guyatt GH, Willan A, Griffith LE. Determining a minimal important change in a disease-specific Quality of Life Questionnaire. J Clin Epidemiol. 1994;47:81–87. doi: 10.1016/0895-4356(94)90036-1.
    1. Jaeschke R, Singer J, Guyatt GH. Measurement of health status. Ascertaining the minimal clinically important difference. Control Clin Trials. 1989;10:407–415. doi: 10.1016/0197-2456(89)90005-6.
    1. Downie WW, Leatham PA, Rhind VM, Wright V, Branco JA, Anderson JA. Studies with pain rating scales. Ann Rheum Dis. 1978;37:378–381. doi: 10.1136/ard.37.4.378.
    1. Bergh I, Sjostrom B, Oden A, Steen B. An application of pain rating scales in geriatric patients. Aging (Milano) 2000;12:380–387.
    1. Farrar JT, Young JP, Jr, LaMoreaux L, Werth JL, Poole RM. Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain. 2001;94:149–158. doi: 10.1016/S0304-3959(01)00349-9.
    1. Ware JE., Jr SF-36 health survey update. Spine. 2000;25:3130–3139. doi: 10.1097/00007632-200012150-00008.
    1. Veenhof C, Koke AJ, Dekker J, Oostendorp RA, Bijlsma JW, van Tulder MW, Ende CH van den. Effectiveness of behavioral graded activity in patients with osteoarthritis of the hip and/or knee: A randomized clinical trial. Arthritis Rheum. 2006;55:925–934. doi: 10.1002/art.22341.
    1. Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the Hospital Anxiety and Depression Scale. An updated literature review. J Psychosom Res. 2002;52:69–77. doi: 10.1016/S0022-3999(01)00296-3.
    1. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67:361–370. doi: 10.1111/j.1600-0447.1983.tb09716.x.
    1. Rosemann T, Kuehlein T, Laux G, Szecsenyi J. Factors associated with physical activity of patients with osteoarthritis of the lower limb. J Eval Clin Pract. 2008;14:288. doi: 10.1111/j.1365-2753.2007.00852.x.
    1. van Baar ME, Dekker J, Lemmens JA, Oostendorp RA, Bijlsma JW. Pain and disability in patients with osteoarthritis of hip or knee: the relationship with articular, kinesiological, and psychological characteristics. J Rheumatol. 1998;25:125–133.
    1. Craig CL, Marshall AL, Sjostrom M, Bauman AE, Booth ML, Ainsworth BE, Pratt M, Ekelund U, Yngve A, Sallis JF, et al. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003;35:1381–1395. doi: 10.1249/01.MSS.0000078924.61453.FB.
    1. Hills R, Kitchen S. Satisfaction with outpatient physiotherapy: a survey comparing the views of patients with acute and chronic musculoskeletal conditions. Physiother Theory Pract. 2007;23:21–36. doi: 10.1080/09593980601147876.
    1. Harden RN, Weinland SR, Remble TA, Houle TT, Colio S, Steedman S, Kee WG. Medication Quantification Scale Version III: update in medication classes and revised detriment weights by survey of American Pain Society Physicians. J Pain. 2005;6:364–371. doi: 10.1016/j.jpain.2005.01.350.
    1. Paterson C, Britten N. A narrative review shows the unvalidated use of self-report questionnaires for individual medication as outcome measures. J Clin Epidemiol. 2005;58:967–973. doi: 10.1016/j.jclinepi.2005.03.012.
    1. Steultjens MP, Dekker J, van Baar ME, Oostendorp RA, Bijlsma JW. Range of joint motion and disability in patients with osteoarthritis of the knee or hip. Rheumatology (Oxford) 2000;39:955–961. doi: 10.1093/rheumatology/39.9.955.
    1. Holm I, Bolstad B, Lutken T, Ervik A, Rokkum M, Steen H. Reliability of goniometric measurements and visual estimates of hip ROM in patients with osteoarthrosis. Physiother Res Int. 2000;5:241–248. doi: 10.1002/pri.204.
    1. Ross MD, Nordeen MH, Barido M. Test-retest reliability of Patrick's hip range of motion test in healthy college-aged men. J Strength Cond Res. 2003;17:156–161. doi: 10.1519/1533-4287(2003)017<0156:TRROPH>;2.
    1. Theiler R, Stucki G, Schutz R, Hofer H, Seifert B, Tyndall A, Michel BA. Parametric and non-parametric measures in the assessment of knee and hip osteoarthritis: interobserver reliability and correlation with radiology. Osteoarthritis Cartilage. 1996;4:35–42. doi: 10.1016/S1063-4584(96)80005-7.
    1. Stratford PW, Kennedy DM. Performance measures were necessary to obtain a complete picture of osteoarthritic patients. J Clin Epidemiol. 2006;59:160–167. doi: 10.1016/j.jclinepi.2005.07.012.
    1. Simmonds MJ. Measuring and managing pain and performance. Man Ther. 2006;11:175–179. doi: 10.1016/j.math.2006.03.002.
    1. Simmonds MJ, Olson SL, Jones S, Hussein T, Lee CE, Novy D, Radwan H. Psychometric characteristics and clinical usefulness of physical performance tests in patients with low back pain. Spine. 1998;23:2412–2421. doi: 10.1097/00007632-199811150-00011.
    1. Oldham JA, Howe TE, Petterson T, Smith GP, Tallis RC. Electrotherapeutic rehabilitation of the quadriceps in elderly osteoarthritic patients: a double blind assessment of patterned neuromuscular stimulation. Clin Rehabil. 1995;9:10–20. doi: 10.1177/026921559500900102.
    1. Fransen M, Nairn L, Winstanley J, Lam P, Edmonds J. Physical activity for osteoarthritis management: a randomized controlled clinical trial evaluating hydrotherapy or Tai Chi classes. Arthritis Rheum. 2007;57:407–414. doi: 10.1002/art.22621.
    1. Hurley MV, Scott DL, Rees J, Newham DJ. Sensorimotor changes and functional performance in patients with knee osteoarthritis. Ann Rheum Dis. 1997;56:641–648. doi: 10.1136/ard.56.11.641.
    1. Schilke JM, Johnson GO, Housh TJ, O'Dell JR. Effects of muscle-strength training on the functional status of patients with osteoarthritis of the knee joint. Nurs Res. 1996;45:68–72. doi: 10.1097/00006199-199603000-00002.
    1. Meinhert C. Clinical Trials: design, conduct and analysis. New York: Oxford University Press; 1986.
    1. Iversen MD, Petersson IF. Design issues and priorities in team and nonpharmacological arthritis care research. J Rheumatol. 2006;33:1904–1907.
    1. Fransen M, Crosbie J, Edmonds J. Physical therapy is effective for patients with osteoarthritis of the knee: a randomized controlled clinical trial. J Rheumatol. 2001;28:156–164.
    1. Hicks GE, Fritz JM, Delitto A, McGill SM. Preliminary development of a clinical prediction rule for determining which patients with low back pain will respond to a stabilization exercise program. Arch Phys Med Rehabil. 2005;86:1753–1762. doi: 10.1016/j.apmr.2005.03.033.
    1. Childs JD, Fritz JM, Flynn TW, Irrgang JJ, Johnson KK, Maj GR, Majkowski M, Delitto A. A clinical prediction rule to identify patients with low back pain most likely to benefit from spinal manipulation: a validation study. Ann Intern Med. 2004;141:920–928.
    1. Bisset L, Smidt N, Windt DA Van der, Bouter LM, Jull G, Brooks P, Vicenzino B. Conservative treatments for tennis elbow do subgroups of patients respond differently? Rheumatology. 2007;46:1601–1605. doi: 10.1093/rheumatology/kem192.
    1. Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K, Christy W, Cooke TD, Greenwald R, Hochberg M, Howell D, Kaplan D, Koopman W, Longley S, Mankin H, McShane DJ, Medsger TA, Jr, Meenan R, Mikkelsen W, Moskowitz R, Murphy W, Rothschild B, Segal M, Solokoff L, Wolfe F. Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Arthritis Rheum. 1986;29:1039–1049. doi: 10.1002/art.1780290816.

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