EFFECTS OF CHIROPRACTIC CARE ON PAIN AND FUNCTION IN PATIENTS WITH HIP OSTEOARTHRITIS WAITING FOR ARTHROPLASTY: A CLINICAL PILOT TRIAL

Objective: The purpose of this study was to explore the short-term effects of chiropractic care on pain and function in patients with hip osteoarthritis. Methods: A convenience sample of 14 patients waiting to undergo unilateral hip arthroplasty at a large university hospital received either chiropractic care (n = 7) or no additional treatment (n = 7) during a 3-week period. The main outcome was the change in self-rated hip pain on a 100 mm Visual Analogue Scale (VAS, 0-100). Secondary outcomes were the change in the five Hip disability and Osteoarthritis Outcome Subscales (HOOS, 0-100), which include pain, other symptoms, function in daily living, function in sport and recreation and hip related quality of life. Nonparametric statistics were used to explore outcome changes from baseline to follow-up after three weeks within and between the groups. Results: Patients receiving chiropractic care, on average 4.4 (SD +/- 1.0) treatments over 3 weeks, showed a clinically and statistically significant improvement in self-rated hip pain, VAS - 26.0 (SD +/- 28.4), P = .043. The chiropractic patients also had clinically important, but not statistically significant, improvement scores in HOOS function in daily living 18.6 (SD +/- 18.5), pain 15.4 (SD +/- 17.2), and hip-related quality of life 12.4 (SD +/- 19.6). The waiting list controls had no statistically significant improvements in any outcome measured, but a clinically relevant improvement in HOOS Pain 12.2 (SD +/- 18.2), P = .051 was observed. There were no statistically significant differences between the groups due to the small sample size. Approximately 25 patients per arm would be required to adequately power a full scale randomized controlled trial with VAS for hip pain as the main outcome measure. Conclusions: Chiropractic care may provide a short-term benefit in decreasing hip pain for patients with hip osteoarthritis waiting for hip arthroplasty. The pilot findings warrant larger scale randomized controlled trials with longer-term follow-ups. (J Manipulative Physiol Ther 2010;33:438-444)