Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial

AbstractObjectiveTo compare the effects of a programme of load management education plus exercise, corticosteroid injection use, and no treatment on pain and global improvement in individuals with gluteal tendinopathy.DesignProspective, three arm, single blinded, randomised clinical trial.SettingBri...

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Published in:	BMJ (Online) 2018-05, Vol.361, p.k1662-k1662
Main Authors:	Mellor, Rebecca, Bennell, Kim, Grimaldi, Alison, Nicolson, Philippa, Kasza, Jessica, Hodges, Paul, Wajswelner, Henry, Vicenzino, Bill
Format:	Article
Language:	eng
Subjects:	Adrenal Cortex Hormones - therapeutic use Adult Aged Arthritis Bursitis - therapy Clinical trials Corticosteroids Evidence-based medicine Exercise Exercise Therapy - methods Female Hip Hip Joint Humans Injection Magnetic resonance imaging Male Middle Aged Pain Patient Education as Topic Patients Physical fitness Prospective Studies Quality of life Single-Blind Method Standard deviation Tendinopathy - therapy Tendons Total hip arthroplasty Watchful Waiting Weight-Bearing - physiology
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Summary:	AbstractObjectiveTo compare the effects of a programme of load management education plus exercise, corticosteroid injection use, and no treatment on pain and global improvement in individuals with gluteal tendinopathy.DesignProspective, three arm, single blinded, randomised clinical trial.SettingBrisbane and Melbourne, Australia.ParticipantsIndividuals aged 35-70 years, with lateral hip pain for more than three months, at least 4/10 on the pain numerical rating scale, and gluteal tendinopathy confirmed by clinical diagnosis and magnetic resonance imaging; and with no corticosteroid injection use in previous 12 months, current physiotherapy, total hip replacement, or neurological conditions.InterventionsA physiotherapy led education and exercise programme of 14 sessions over eight weeks (EDX; n=69), one corticosteroid injection (CSI; n=66), and a wait and see approach (WS; n=69).Main outcomesPrimary outcomes were patient reported global rating of change in hip condition (on an 11 point scale, dichotomised to success and non-success) and pain intensity in the past week (0=no pain, 10=worst pain) at eight weeks, with longer term follow-up at 52 weeks.ResultsOf 204 randomised participants (including 167 women; mean age 54.8 years (standard deviation 8.8)), 189 (92.6%) completed 52 week follow-up. Success on the global rating of change was reported at eight weeks by 51/66 EDX, 38/65 CSI, and 20/68 WS participants. EDX and CSI had better global improvement scores than WS (risk difference 49.1% (95% confidence interval 34.6% to 63.5%), number needed to treat 2.0 (95% confidence interval 1.6 to 2.9); 29.2% (13.2% to 45.2%), 3.4 (2.2 to 7.6); respectively). EDX had better global improvement scores than CSI (19.9% (4.7% to 35.0%); 5.0 (2.9 to 21.1)). At eight weeks, reported pain on the numerical rating scale was mean score 1.5 (standard deviation 1.5) for EDX, 2.7 (2.4) for CSI, and 3.8 (2.0) for WS. EDX and CSI participants reported less pain than WS (mean difference −2.2 (95% confidence interval −2.89 to −1.54); −1.2 (−1.85 to −0.50); respectively), and EDX participants reported less pain than CSI (−1.04 (−1.72 to −0.37)). Success on the global rating of change was reported at 52 weeks by 51/65 EDX, 36/63 CSI, and 31/60 WS participants; EDX was better than CSI (20.4% (4.9% to 35.9%); 4.9 (2.8 to 20.6)) and WS (26.8% (11.3% to 42.3%); 3.7 (2.4 to 8.8)). Reported pain at 52 weeks was 2.1 (2.2) for EDX, 2.3 (1.9) for CSI, and 3.2 (2.6) for WS; EDX did not differ fro
ISSN:	0959-8138 1756-1833