Conservative Treatment for Hip Osteoarthritis (COHART)

• Pain: Numerical pain scale [ Time Frame: Baseline, 6 weeks, 3 months, 1 year ]
• Disability: Patient Specific Hip Disability [ Time Frame: Baseline, 6 weeks, 3 months, 1 year ]

• Hip Disability and Osteoarthritis Outcome Score [ Time Frame: Baseline, 6 weeks, 3 months, 1 year ]
• General improvement experienced by patient - "Global Assessment" [ Time Frame: Baseline, 6 weeks, 3 months, 1 year ]
• Quality of life: EQ-5D [ Time Frame: Baseline, 6 weeks, 3 months, 1 year ]
• Passive hip range of motion [ Time Frame: Baseline, 6 weeks, 3 months, 1 year ]
• Hip surgery up to one year after baseline [ Time Frame: Baseline, 6 weeks, 3 months, 1 year ]
• Use of pain medication [ Time Frame: Baseline, 6 weeks, 3 months, 1 year ]
• Patient Specific Hip Disability [ Time Frame: Baseline, 6 weeks, 3 months, 1 year ]

• Hip Disability and Osteoarthritis Outcome Score [ Time Frame: Baseline, 6 weeks, 3 months, 1 year ]
• General improvement experienced by patient - "Global Assessment" [ Time Frame: Baseline, 6 weeks, 3 months, 1 year ]
• Quality of life: EQ-5D [ Time Frame: Baseline, 6 weeks, 3 months, 1 year ]
• Passive hip range of motion [ Time Frame: Baseline, 6 weeks, 3 months, 1 year ]
• Hip surgery up to one year after baseline [ Time Frame: Baseline, 6 weeks, 3 months, 1 year ]
• Use of pain medication [ Time Frame: Baseline, 6 weeks, 3 months, 1 year ]

Hip osteoarthritis (hip OA) is the second most common arthritis of the larger joints and may result in pain and disability and lead to reduced quality of life (QoL). The prevalence of hip OA, in the adult population, > 35 years, is estimated to 4-11% in the western society. In specific countries hip OA affects up to 25% in adults > 60 years. With a growing elder population, these prevalence rates will increase and the demand for cost-effective and safe interventions will increase as well.

International guidelines, 2008, on the management of hip and knee OA recommend a combination of non-pharmacological and pharmacological treatment. For years the majority of interventional research for hip and knee OA has focused on surgery and drugs. Surgery is an option, when pain and disability have reached severe levels, and an increasing group of patients are today looking for other treatment options than drug treatment (pharmacological). In the last 4-6 years, new randomized controlled trials (RCT) have shown promising results with non-pharmacological treatment, such as exercise, patient education, manual therapy and acupuncture.

The purpose of this RCT is to investigate the effect of combining manual treatment and a patient education programme and compare it to a minimal intervention in form of a home stretching programme. It will further investigate the specific effect of manual treatment.

• Other: Hip School
  The hip school consists of one initial personal interview, three group sessions, and one follow-up personal interview. The hip school is a patient education programme which involves anatomy/physiology, epidemiology, disease progression and pain, advice on self-help and exercises.
• Other: Hip School and Manual Treatment
  Hip school as above. Patients receive manual treatment twice a week for 6 weeks. Manual treatment consists of joint manipulation and muscle energy techniques to the articular and soft-tissue structures of the hip.
• Other: Minimal control intervention
  As control group, an information leaflet is used with instructions to live as usual during the 6 weeks intervention period. The exercise sheet of the hip school is given to the patients with no further instruction.

• Active Comparator: Hip school
  This group will receive hip school during the intervention period of 6 weeks.
  Intervention: Other: Hip School
• Active Comparator: Hip School and Manual Treatment
  This group receives both hip school and manual treatment during the 6 weeks.
  Intervention: Other: Hip School and Manual Treatment
• Active Comparator: Minimal control intervention
  An information leaflet including exercises.
  Intervention: Other: Minimal control intervention

• Poulsen E, Hartvigsen J, Christensen HW, Roos EM, Vach W, Overgaard S. Patient education with or without manual therapy compared to a control group in patients with osteoarthritis of the hip. A proof-of-principle three-arm parallel group randomized clinical trial. Osteoarthritis Cartilage. 2013 Oct;21(10):1494-503. doi: 10.1016/j.joca.2013.06.009. Epub 2013 Jun 21.
• Poulsen E, Christensen HW, Roos EM, Vach W, Overgaard S, Hartvigsen J. Non-surgical treatment of hip osteoarthritis. Hip school, with or without the addition of manual therapy, in comparison to a minimal control intervention: protocol for a three-armed randomized clinical trial. BMC Musculoskelet Disord. 2011 May 4;12:88. doi: 10.1186/1471-2474-12-88.

Inclusion Criteria:

• patients referred from general practitioner, chiropractor or orthopaedic surgeon
• unilateral hip pain of minimum 3 months' duration
• radiology criteria for hip OA: joint space width (JSW) < 2.0 mm or a side difference in JSW of > 10%
• adequate mastering of the Danish language to complete instructions and questionnaires

Exclusion Criteria:

• inflammatory joint disease
• previous hip or knee alloplastic
• secondary arthritis due to hip fracture or infection
• bilateral hip pain
• hip dysplasia with a CE angle > 25 degrees and an AA angle > 10 degrees
• low back pain which dominates over the hip pain
• malignant disease
• patients with paresis or paralysis after neuromuscular, cerebrovascular or polyneuropathic disease
• hip pain resulting from labral tear, bursitis and/or snapping hip syndrome
• polyarthritis
• received manual treatment for the hip within the last year

• University of Southern Denmark
• Odense University Hospital
• Foundation for Chiropractic Research and Post Graduate Education
• Region of Southern Denmark
• The Danish Rheumatism Association