Bennell 2014

Methods	Randomised, placebo‐controlled, participant‐ and assessor‐blinded trial.
Participants	Inclusion criteria: aged ≥ 50 years, hip OA fulfilling ACR classification criteria, pain in groin/hip for > 3 months, mean pain intensity in past week of ≥ 40 on 100 mm VAS, at least moderate difficulty with daily activities. Exclusion criteria: hip or knee joint replacements or both; planned lower limb surgery, physical therapy, chiropractic treatment or prescribed exercises for hip, lumbar spine or both in the past 6 months; walking continuously > 30 minutes daily; regular structured exercise more than once weekly. Sample size: 102; 96 completed intervention, 83 completed follow‐up. IG (n = 49): mean age 64.5 years; CG (n = 53): mean age 62.7 years. Country: Australia.
Interventions	Providers: 8 physical therapists with ≥ 5 years of clinical experience and postgraduate qualifications. Training: yes. Setting: private clinic. Content: semi‐standardised exercises with core components and exercises depending on assessment. Participants given manual therapy techniques and 4‐6 home exercises to perform 4 times a week including strengthening, flexibility and balance exercises. Length/intensity: 10 individual treatment sessions over 12 weeks: 2 sessions in week 1, then once weekly for 6 weeks, then approximately once per fortnight. First 2 sessions were 45‐60 minutes, subsequent sessions were 30 minutes. Control: sham intervention of inactive ultrasound and inert gel applied to hip. No exercise or manual therapy instructions. During follow‐up phases, participants asked to apply gel for 5 minutes 3 times a week.
Outcomes	Musculoskeletal impairments and functional performance tests at baseline and week 13: hip range of motion; maximum isometric strength of hip and thigh muscles; stair climb test; 30‐second sit‐to‐stand test; fast‐paced walking velocity (m/s) over 20 m; dynamic standing balance assessed by step test and 4‐square step test. Outcomes at 13 and 36 weeks: Primary: mean hip pain over past week (100‐mm VAS); physical function (WOMAC physical function subscale). Secondary: mean hip pain intensity while walking in past week (VAS); Hip Osteoarthritis Outcome Scale; Assessment of Quality of Life instrument version 2; participant global rating of overall change, change in pain, and change in physical function using a 7‐point ordinal scale (1 indicated much worse; 7 much better); Arthritis Self Efficacy Scale; Pain Catastrophizing Scale; Physical Activity Scale for the Elderly; number of daily steps using a pedometer (HJ‐005, Omron Healthcare).
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Computer‐generated random numbers table, results placed in sealed envelopes by independent person.
Allocation concealment (selection bias)	Low risk	Opened by another independent person 1 by 1, shortly before the next participant attended, and allocation result emailed to non‐blinded therapist.
Blinding of participants and personnel (performance bias) All outcomes	High risk	IG delivered by non‐blinded therapist: authors acknowledged non‐blinding of therapists was a weakness. Blinding of participants was low risk: checked with James test. Participants informed that the comparison was between physical intervention and sham physical therapy intervention but not what either consisted of.
Blinding of outcome assessment (detection bias) All outcomes	Low risk	Outcome assessor and biostatistician blinded.
Incomplete outcome data (attrition bias) All outcomes	Low risk	Attrition: 6 (5.9%) completed did not complete the intervention in both groups and 19 (18.6%) did not complete follow‐up.
Selective reporting (reporting bias)	Low risk	Results reported for all measures.
Other bias	Low risk