In a randomized trial, improvement with two different approaches was similar — but modest.

A 2019 American College of Rheumatology guideline recommends exercise for patients with hip osteoarthritis (OA) but acknowledges that recommendations for any particular form of exercise over another are “based largely on expert opinion.” Indeed, in one well-constructed trial, a multimodal physical therapy program was not superior to a sham intervention (NEJM JW Gen Med Jun 15 2014 and JAMA 2014; 311:1987).

To further address this uncertainty, researchers randomized 160 patients with mostly unilateral hip OA to receive either neuromuscular exercise (NEMEX; focusing on postural and functional stability) or progressive resistance training (PRT; focusing on muscle strength). Both groups had two 60-minute sessions weekly for 12 weeks, delivered by trained physical therapists.

The primary outcome was the “chair stand test,” in which patients go from sitting to standing as many times as possible within 30 seconds. At 12 weeks, this outcome did not differ between the NEMEX and PRT groups; mean improvement in both groups was 1.5 repetitions (from a baseline of ≈11.5 repetitions). Moreover, no significant differences between groups were noted on various secondary outcomes that addressed pain and function.

COMMENT
When we refer patients to physical therapy, most of us probably don’t pay much attention to the therapist’s chosen protocol. This study suggests that, for hip OA, the choice might not matter. In fact, the 1.5-point change with either intervention did not meet the researchers’ prespecified criteria for clinically meaningful improvement, and no untreated control group was included for comparison. Physical therapy has little downside when therapists are flexible and patient-centered, but we shouldn’t expect dramatic improvement for most patients with hip OA. — Allan S. Brett, MD

Dr. Brett is Clinical Professor of Medicine at the University of Colorado School of Medicine, Aurora.

Kjeldsen T et al. Progressive resistance training or neuromuscular exercise for hip osteoarthritis: A multicenter cluster randomized controlled trial. Ann Intern Med 2024 Apr 9; [e-pub]. (https://doi.org/10.7326/M23-3225)

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