Evidence is required to guide some key areas of physiotherapy management. The role of exercise selleck kinase inhibitor in managing hip osteoarthritis should be clarified including comparisons of the effects of different exercise modalities (land-based, aquatic) and dosages. Manual therapy requires further investigation given the seemingly different results when it is delivered in isolation versus in combination with exercise. Randomised controlled trials are also needed to evaluate other interventions such as gait aids, heel wedges, and self-management programs. In parallel with this, investigation into the biomechanical, neuromuscular, and psychological mechanisms underpinning treatment effects will help to better understand outcomes and refine treatments.

In addition to assessing clinical effectiveness, economic evaluations should be included to establish the cost-effectiveness of treatments. This is important in today’s health care landscape to assist health policy makers in their decision-making regarding funding. A recent systematic review found few studies documenting cost-effectiveness for conservative non-drug interventions in hip or knee osteoarthritis (Pinto et al 2012b). Given the heterogeneity in clinical presentation, it would also be useful to identify prognostic factors that predict which people with hip osteoarthritis are likely to demonstrate a favourable Perifosine response

to which physiotherapy intervention. In a recent study, five baseline variables were found to predict treatment responders to a physiotherapy program for hip osteoarthritis (Wright et al 2011) – unilateral hip pain, age ≤ 58 years, pain ≥ 6/10 on a numeric pain rating scale, 40 m self-paced walk test time of ≤ 26 sec, and duration of symptoms

of ≤ 1 year. Having three or more of the five predictor variables increased the post-test probability of success to 99% or higher. While the results need to be validated in replication studies, they suggest that early referral for physiotherapy is preferable. Development of clinical prediction rules will assist clinicians in ascertaining the likelihood that their intervention will be effective for a particular patient. There have been considerable advances at the knee in understanding the role of biomechanical factors in influencing knee osteoarthritis disease progression as well as investigating biomechanical interventions to reduce knee load first such as footwear, bracing and gait retraining. This area could be extended to hip osteoarthritis to develop and evaluate potential disease-modifying treatments. In order to do this, better knowledge of the biomechanical and neuromuscular contributors to disease progression is also needed. Kim Bennell is partly supported by an Australian Research Council Future Fellowship. The contribution of A/Professor Haxby Abbott and Dr Fiona Dobson in assisting with the exercise study data extraction is gratefully appreciated. “
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