Exercise and Manual Physiotherapy Arthritis Research Trial (EMPART) for Osteoarthritis of the Hip: A Multicenter Randomized Controlled Trial

Published:October 19, 2012DOI:https://doi.org/10.1016/j.apmr.2012.09.030



      To determine the effectiveness of exercise therapy (ET) compared with ET with adjunctive manual therapy (MT) for people with hip osteoarthritis (OA); and to identify if immediate commencement of treatment (ET or ET+MT) was more beneficial than a 9-week waiting period for either intervention.


      Assessor-blind randomized controlled trial with a 9-week and 18-week follow-up.


      Four academic teaching hospitals in Dublin, Ireland.


      Patients (N=131) with hip OA recruited from general practitioners, rheumatologists, orthopedic surgeons, and other hospital consultants were randomized to 1 of 3 groups: ET (n=45), ET+MT (n=43), and waitlist controls (n=43).


      Participants in both the ET and ET+MT groups received up to 8 treatments over 8 weeks. Control group participants were rerandomized into either ET or ET+MT groups after 9 week follow-up. Their data were pooled with original treatment group data: ET (n=66) and ET+MT (n=65).

      Main Outcome Measures

      The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) physical function (PF) subscale. Secondary outcomes included physical performance, pain severity, hip range of motion (ROM), anxiety/depression, quality of life, medication usage, patient-perceived change, and patient satisfaction.


      There was no significant difference in WOMAC PF between the ET (n=66) and ET+MT (n=65) groups at 9 weeks (mean difference, .09; 95% confidence interval [CI] −2.93 to 3.11) or 18 weeks (mean difference, .42; 95% CI, −4.41 to 5.25), or between other outcomes, except patient satisfaction with outcomes, which was higher in the ET+MT group ( P=.02). Improvements in WOMAC, hip ROM, and patient-perceived change occurred in both treatment groups compared with the control group.


      Self-reported function, hip ROM, and patient-perceived improvement occurred after an 8-week program of ET for patients with OA of the hip. MT as an adjunct to exercise provided no further benefit, except for higher patient satisfaction with outcome.


      List of abbreviations:

      EMPART ( Exercise and Manual Physiotherapy Arthritis Research Trial), ET ( exercise therapy), HADS ( Hospital Anxiety and Depression Scale), HEP ( home exercise program), MCID ( minimal clinically important difference), MT ( manual therapy), OA ( osteoarthritis), PF ( physical function), PGA ( Patient Global Assessment), RCT ( randomized controlled trial), ROM ( range of motion), SF-36 ( Medical Outcomes Study 36-Item Short-Form Health Survey), WOMAC ( Western Ontario and McMaster Universities Osteoarthritis Index)


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      • Correction
        Archives of Physical Medicine and RehabilitationVol. 94Issue 3
        • In Brief
          In the article French HP, Cusack T, Brennan A, et al, Exercise and Manual Physiotherapy Arthritis Research Trial (EMPART) for osteoarthritis of the hip: a multicenter randomized controlled trial, Arch Phys Med Rehabil 2013;94:302-14, an author was inadvertently omitted from the final manuscript.
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