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1. In this randomized controlled trial, progressive resistance training (PRT) was not superior to neuromuscular exercise (NEMEX) in improving functional performance in patients with hip osteoarthritis (OA).

2. PRT was not superior to NEMEX in improving patients’ hip pain or hip-related quality of life.

Evidence Rating Level: 1 (Excellent)

Study Rundown: OA is a degenerative joint disease characterized by the breakdown of cartilage between bones, which results in pain, decreased range of motion, and impaired quality of life. Hip OA is one of the most common forms of OA, and its prevalence is expected to increase due to aging demographics. While exercise is recommended as the first-line treatment for hip OA, evidence for the optimal type and exercise regimen is currently lacking. NEMEX, which focuses on functional stability and postural control, has been implemented in several countries to treat patients with hip OA. However, there has been increasing evidence for the efficacy of PRT, whose role in increasing muscle mass, strength, and power may improve functional impairments exhibited by these patients. Thus, this study aimed to investigate whether a 12-week regimen of PRT was more effective than that of NEMEX in improving functional performance in those with hip OA. Secondary outcomes were also explored, including pain and hip-related quality of life. Overall, the trial demonstrated that PRT was not superior to NEMEX in improving function in patients with hip OA. It also showed that PRT was not superior to NEMEX in improving patients’ hip pain or hip-related quality of life. Both patients and physiotherapists were unable to be blinded to treatment allocation, subjecting the study to potential performance bias.

Click to read the study in AIM

In-Depth [randomized controlled trial]: This cluster-randomized, controlled trial aimed to compare the efficacy of PRT to NEMEX in improving the functional performance of patients with hip OA. Patients were eligible if they were 45 or older, had OA of one or both hips, and had hip pain during activity within the previous two weeks. Enrolled participants were randomly assigned via cluster randomization to undergo a 12-week regimen of two 60-minute sessions each week of PRT or NEMEX. PRT sessions consisted of 5 generic exercises targeting the muscles of the knee and hip joints. NEMEX sessions encompassed 10 exercises whose progression was based on varying the movements’ number, direction, and velocity. The primary outcome was a change in the 30-second chair stand test (30s-CST) from baseline to the 12-week follow-up. Key secondary outcomes included changes in the pain and hip-related quality of life subscales of the Hip Disability and Osteoarthritis Outcome Score (HOOS) at 12 weeks. Of 339 screened patients, 160 were randomly assigned to PRT (82) or NEMEX (78). The mean change in the 30s-CST scores was 1.5 chair stands (95% confidence interval [CI], 0.9 to 2.1) for the PRT group and 1.5 chair stands (95% CI, 0.9 to 2.1) for the NEMEX group, for a mean between-group difference of 0.0 chair stands (95% CI, -0.8 to 0.8). The mean change in the HOOS pain subscale was 8.6 points (95% CI, 5.3 to 11.8) with PRT and 9.3 points (95% CI, 5.9 to 12.6) with NEMEX (mean difference, -0.7 points; 95% CI, -5.3 to 4.0). Moreover, the mean change in the HOOS quality of life subscale was 8.0 points (95% CI, 4.3 to 11.7) with PRT and 5.7 points (95% CI, 1.9 to 9.5) with NEMEX (mean difference, 2.3 points; 95% CI, -3.0 to 7.6). In summary, this study demonstrated that PRT was not superior to NEMEX in improving functional performance, hip pain, or hip-related quality of life in patients with hip OA.

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