What is the Rate of Response to Nonoperative Treatment for Hip-Related Pain? A Systematic Review With Meta-analysis

医学 物理疗法 置信区间 荟萃分析 股骨髋臼撞击 随机对照试验 前瞻性队列研究 循证医学 系统回顾 队列研究 分级(工程) 梅德林 外科 内科学 替代医学 土木工程 法学 病理 工程类 政治学
作者
Daniel Probst,Michael F Sookochoff,Marcie Harris‐Hayes,Heidi Prather,Kim Lipsey,Abby L Cheng
出处
期刊:Journal of Orthopaedic & Sports Physical Therapy [American Physical Therapy Association]
卷期号:53 (5): 286-306
标识
DOI:10.2519/jospt.2023.11666
摘要

OBJECTIVE: We aimed to (1) determine the rate of satisfactory response to nonoperative treatment for nonarthritic hip-related pain, and (2) evaluate the specific effect of various elements of physical therapy and nonoperative treatment options aside from physical therapy. DESIGN: Systematic review with meta-analysis. LITERATURE SEARCH: We searched 7 databases and reference lists of eligible studies from their inception to February 2022. STUDY SELECTION CRITERIA: We included randomized controlled trials and prospective cohort studies that compared a nonoperative management protocol to any other treatment for patients with femoroacetabular impingement syndrome, acetabular dysplasia, acetabular labral tear, and/or nonarthritic hip pain not otherwise specified. DATA SYNTHESIS: We used random-effects meta-analyses, as appropriate. Study quality was assessed using an adapted Downs and Black checklist. Certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. RESULTS: Twenty-six studies (1153 patients) were eligible for qualitative synthesis, and 16 were included in the meta-analysis. Moderate certainty evidence suggests that the overall response rate to nonoperative treatment was 54% (95% confidence interval: 32%, 76%). The overall mean improvement after physical therapy treatment was 11.3 points (7.6–14.9) on 100-point patient-reported hip symptom measures (low to moderate certainty) and 22.2 points (4.6–39.9) on 100-point pain severity measures (low certainty). No definitive specific effect was observed regarding therapy duration or approach (ie, flexibility exercise, movement pattern training, and/or mobilization) (very low to low certainty). Very low to low certainty evidence supported viscosupplementation, corticosteroid injection, and a supportive brace. CONCLUSION: Over half of patients with nonarthritic hip-related pain reported satisfactory response to nonoperative treatment. However, the essential elements of comprehensive nonoperative treatment remain unclear. J Orthop Sports Phys Ther 2023;53(5):286–306. Epub 9 March 2023. doi:10.2519/jospt.2023.11666

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