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This reads to me as a straightforward, practical application of some recent, encouraging evidence regarding therapeutic exercise for hip OA.
I truly appreciate the journals efforts to highlight the relatively recent evidence and give it some flesh via the imagined case report.
What was interesting to me was how the case report in fact went against the Cochrane review as far dosage and duration of therapy. That is, the interventions in the studies included in the review included 6 to 36 physical therapy sessions spread out over 6 to 12 weeks. Although longer term follow up data was collected at upwards of 6 months, it was interesting to see how the case report utilized only 4 therapy sessions spread out over 9 months. I sincerely appreciate the emphasis that the results of exercise may require more protracted periods of time, however I am not sure that an appropriate application of the study is to think that less therapy is required than what was in fact shown to be beneficial.
Otherwise, I appreciate the comprehensive nature of care in the imagined case report – education, referral for weight loss, hydrotherapy, strategies to encourage exercise compliance. We do well to integrate the published evidence (e.g., the Cochrane review) into our practice without losing sight of the comprehensive way we can specifically manage the patient in front of us, even evidence for such components is lacking.
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I wonder how his search strategy would change if he used the narrow and extended search strategy we learned. Granit our search is very manual based and the author’s PICO is TherEx based. I appreciated the Cochrane review as it focused on his PICO question. He also mentions using high quality evidence with a greater reduction in pain at the end of treatment and long-term follow up. Which is interesting why he used a 9 month treatment approach if the high quality studies went to 6 months? Nick brings up a good point that 4 sessions over 9 months, sounds like a very minimal dosage approach. As well, his literature review: the oldest study was published in 1991 otherwise everything else was >2000.
I would like to further look into different adherence strategies applied per patient. I know motivation is thoroughly important. As well, for her subjective information I did not see if she had any help at home? I appreciate how patient centered this review was and it sounds like she made great improvements over a short amount of sessions!
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This is a great application of recent evidence into a comprehensive, patient-centered approach. I appreciate the detailed explanation on their decision making based on both the patient in front of them, their needs/expectations to achieve long term results and on the recent evidence from the systematic review.
Although their PICO question was based on land-based exercise vs. no treatment only, they also incorporated aquatic therapy, weight management strategies, patient education, and using an exercise diary as well to provide a comprehensive approach. They used the evidence to support part of their treatment, but did not let it limit the others.
The authors of this report did a nice job of stating the limitations of the systematic review results such as variability of type, frequency, and intensity of exercise, and they also used the limitations to their advantage. It gave them more room for decision making based on the patient and focused on patient adherence to the exercise routine. I enjoyed this article – transferring stats into reality.
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