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Hip osteoarthritis

Physiotherapy for patients with hip osteoarthritis

A randomized controlled trial to compare short- and long-term effects of hip school alone and hip school combined with Basic Body Awareness Therapy (BBAT)

Musculoskeletal disorders are reported to be the second largest contributor to years lived with disability worldwide, and osteoarthritis (OA) of the hips and knees among the most prevalent. Common findings are loss of articular cartilage, synovitis and capsule shrinkage, accompanied by muscle atrophy. Weight bearing tends to become painful and cause compensatory movements and altered body posture. Even if the hip problems tend to become worse over time, they can be improved by movement therapy, adjusted physical activities and weight reduction (in overweight), which is also recommended as primary treatment by international clinical guidelines. However, a substantial share of patients undergoes surgery as the first treatment option. A challenge is that few randomized controlled trials (RCT) have documented clinical important long-term effects of conservative treatment. We also need more knowledge about the long-term effects of different training/exercise modalities.

A pilot study was carried out in 2014 to explore effects of Hip school combined with weekly group sessions of Basic Body Awareness Therapy (BBAT) over a time period of 3-4 months. Patients were recruited from consultations at the orthopedic department, Haukeland University Hospital. Very promising results were demonstrated, with clinical important decrease of pain and improved functioning in most patients at 6 months follow-up.

To examine the supplementary effects of BBAT, an RCT of 100 patients with hip OA will be conducted. Patients who take part in Hip school (in line with ActiveA by Inger Holm) at Learning and Mastery Centre in Bergen will be asked to participate. Empowerment of the patients is the main aim of the Hip school which is led by physiotherapists, an orthopedic surgeon and a patient representative, starting in October 28th 2015. Hip schools will be offered frequently over the coming years to patients from Hordaland County, referred to the orthopedic department from family doctor/specialist.  

 Read more about the Hip school here:

 http://www.helse-bergen.no/no/Hendelser/Sider/Hofteskole-oktober-2015.aspx

 The aim of the RCT is to compare short- and long-term effects of Hip school alone and Hip school combined with Basic Body Awareness Therapy. The BBAT, a physiotherapy modality, is promising because of its multi-perspective approach to movement and health, and high patient involvement in the learning process. The physiotherapist directs attention to the whole moving person, on movement habits, experiences and reflections, promoting a dynamic interplay between postural balance, breathing, and mental awareness. By BBAT the patient is supported to easily integrate such elements into a broad scope of daily life movements, aiming for lasting effect.

Pain during walking will be the main outcome. Embedded in the main study is a PhD project (PhD candidate Aarid Liland Olsen) exploring: 1) Patients’ experiences with BBAT regarding functional changes in a short- and long-term perspective, 2) Association between patients’ description of movement and physiotherapist’s scores of movement quality by the observational Body Awareness Rating Scale (BARS), and 3) Responsiveness to change of BARS over time in the assessment of movement quality.

 

Project leader: Liv Inger Strand, professor, Dr. Philos.
Liv.Strand@uib.no

Collaborating partners:

Haukeland University Hospital: 
Physiotherapist, Msc Aarid Liland Olsen, orthopedic surgeon, PhD Geir Halland, Physiotherapist, BSc Gyøngyver Molvær, physiotherapist, BSc Marianne Allers, orthopedic surgeon, professor, PhD Ove Furnes, and specialist in physical medicine, PhD Thomas Kadar.

Bergen University College: Associate professor (dosent) Liv Helvik Skjærven, associate professor, PhD Liv Heide Magnussen, assistant professor, MSc Hildegunn Lygren.

 Oslo University Hospital: physiotherapist, professor, PhD Inger Holm   

Norwegian medical institute for sports (NIMI): physiotherapist, professor, PhD May Arna Risberg

Vrije University, Amsterdam: physiotherapist, professor, PhD Raymond Ostelo