PHYS THER
Vol. 87, No. 10, October 2007, pp. 1407-1408
DOI: 10.2522/ptj.2007.87.10.1407.2
Author Response
We appreciate the response by Pua and Lim to our recently published article.1 Although their interpretation that subjects in our study had concomitant hip OA is tenable, especially given the fact that up to 40% of subjects with knee OA have concomitant OA of the hip,2 it is not the only explanation for our results. All 8 subjects in our study who had pain or paresthesia in the hip or groin on the same side as their knee pain had a successful response to hip mobilizations. In addition, 13 of 14 subjects who had passive hip medial rotation less than or equal to 17 degrees had a successful response to hip mobilizations. Three subjects (5%) had both pain or paresthesia in their hip or groin and hip medial rotation less than 17 degrees. However, only 2 of these 3 subjects met the criteria of Altman and colleagues3 for a clinical diagnosis of hip OA with either test cluster 1 (hip pain, hip medial rotation less than 15°, and hip fl exion less than 115°) or test cluster 2 (painful hip medial rotation, greater than 50 years of age, and morning hip stiffness less than 60 minutes).
Although imaging abnormalities were present in all but one of our subjects in this study, many were considered mild. Although radiographic changes alone are not sufficient to establish the diagnosis of symptomatic hip OA, the involvement of surrounding soft tissues in these subjects may, in fact, be responsive to hip mobilization intervention. Many subjects who had a successful response to hip mobilizations did not meet any of the criteria or CPR variables correlated with clinical hip OA, yet they still responded successfully to the mobilizations. Indeed, 41 of the 60 subjects in our study had a successful response to hip mobilizations. This suggests that many subjects who do not meet Altman and colleagues’ clinical criteria for hip OA also respond to hip mobilizations.
In our opinion, the most important finding of our study is that hip mobilizations appear to effectively relieve pain or improve patient status in a subgroup of patients with primary reports of knee OA. The precise pathoanatomic explanation at this time is unclear. Because hip symptoms are neither present nor pronounced in these patients, clinicians may overlook applying an intervention from which these patients may benefit. In summary, Pua and Lim's alternative interpretation explains only a subset of patients who responded successfully to the mobilizations. Patients who meet the other CPR variables cannot be discounted.
Linda L Currier and
Robert S Wainner
References
- Currier LL, Froehlich PJ, Carow SD, et al. Development of a clinical prediction rule to identify patients with knee pain and clinical evidence of knee osteoarthritis who respond favorably to short-term hip mobilizations.
Phys Ther. 2007;87:1106–1119.[Abstract/Free Full Text]
- Aigner T, Dudhia J. Genomics of osteoarthritis.
Curr Opin Rheumatol. 2003;15:634–640.[CrossRef][Web of Science][Medline]
- Altman R, Alarcon G, Appelrouth D, et al. The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hip.
Arthritis Rheum. 1991;34:505–514.[Web of Science][Medline]
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Copyright © 2007 by the American Physical Therapy Association.
