Self-reported function, hip range of motion (HROM), and patient-perceived improvement occurred after an 8-week program of exercise therapy (ET) for patients with hip osteoarthritis (OA), say authors of an article published in Archives of Physical Medicine and Rehabilitation. Manual therapy (MT) as an adjunct provided no further benefit, except for achieving higher patient satisfaction, they add.

For this investigation, 131 patients with hip OA recruited from general practitioners, rheumatologists, orthopedic surgeons, and other hospital consultants in Dublin, Ireland, were randomized to 1 of 3 groups: ET (n=45), ET+MT (n=43), and wait-list control (n=43).

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

The primary outcome was the WOMAC physical function (PF) subscale. Secondary outcomes included physical performance, pain, HROM, anxiety/depression, quality of life, medication usage, patient-perceived change, and patient satisfaction.

There was no significant difference in WOMAC PF between ET (n=66) and ET+MT (n=65) groups at 9 weeks (mean difference 0.09) or at 18 weeks (mean difference 0.42), or other outcomes, except "patient satisfaction with outcome," which was higher in the ET+MT group. Improvements in WOMAC, HROM, and patient-perceived change occurred in both treatment groups compared with the control group.

Physical therapists (PTs) should consider a number of details before contracting with payers, whether private or public. View APTA's new Managed Care Contracting Toolkit today to learn valuable information about joining a managed care plan, and securing and tracking contracts. A chapter on "doing the math" can help you decide which fee schedules, patient populations, and payment methodologies are best suited to your practice. The toolkit also breaks down the pros and cons of common methodologies that third-party payers use to pay for physical therapy services and offers information on negotiating contracts.   

APTA's Payment and Practice Management Department created the member-only toolkit to help PTs make informed decisions about joining a provider network.

An analysis of clinical practice guidelines archived on the National Guideline Clearinghouse (NGC) website as of June 2011 demonstrated poor compliance with Institute of Medicine (IOM) standards, with little if any improvement over the past 2 decades, say authors of an article published this month in Archives of Medicine. 

For the study, 2 reviewers independently screened 130 guidelines selected at random from NGC's website for compliance with 18 of 25 IOM standards.

The overall median number of IOM standards satisfied (out of 18) was 8 (44.4%). Fewer than half of the guidelines surveyed met more than 50% of IOM standards. Barely a third of the guidelines produced by subspecialty societies satisfied more than 50% of the IOM standards surveyed.

Information on conflicts of interest was given in fewer than half of the guidelines surveyed. Non-English literature, unpublished data, and/or abstracts were rarely considered in developing guidelines. Differences of opinion among committee members generally were not aired in guidelines. Benefits of recommendations were enumerated more often than potential harms. Guidelines published from 2006 through 2011 varied little with regard to average number of IOM standards satisfied.

"Everybody everywhere is developing guidelines and there is no real quality control," lead author Philip A. Mackowiak, MD, told Reuters News. "There is no good oversight of who actually develops the guidelines or what criteria need to be met in order for them to be published."

IOM's standards were not published until 2011. Mackowiak acknowledges that the experts who developed the guidelines reviewed by his team would not have been able to use IOM's standards.  However, he added that similar standards have been published before and that they were basic enough that they should have been followed, says Reuters.

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