Exercise and manual physiotherapy arthritis research trial (EMPART): a multicentre randomised controlled trial

BACKGROUND: Osteoarthritis (OA) of the hip is a major cause of functional disability and reduced quality of life. Management options aim to reduce pain and improve or maintain physical functioning. Current evidence indicates that therapeutic exercise has a beneficial but short-term effect on pain and disability, with poor long-term benefit. The optimal content, duration and type of exercise are yet to be ascertained. There has been little scientific investigation into the effectiveness of manual therapy in hip OA. Only one randomized controlled trial (RCT) found greater improvements in patient-perceived improvement and physical function with manual therapy, compared to exercise therapy. METHODS AND DESIGN: An assessor-blind multicentre RCT will be undertaken to compare the effect of a combination of manual therapy and exercise therapy, exercise therapy only, and a waiting-list control on physical function in hip OA. One hundred and fifty people with a diagnosis of hip OA will be recruited and randomly allocated to one of 3 groups: exercise therapy, exercise therapy with manual therapy and a waiting-list control. Subjects in the intervention groups will attend physiotherapy for 6-8 sessions over 8 weeks. Those in the control group will remain on the waiting list until after this time and will then be re-randomised to one of the two intervention groups. Outcome measures will include physical function (WOMAC), pain severity (numerical rating scale), patient perceived change (7-point Likert scale), quality of life (SF-36), mood (hospital anxiety and depression scale), patient satisfaction, physical activity (IPAQ) and physical measures of range of motion, 50-foot walk and repeated sit-to stand tests. DISCUSSION: This RCT will compare the effectiveness of the addition of manual therapy to exercise therapy to exercise therapy only and a waiting-list control in hip OA. A high quality methodology will be used in keeping with CONSORT guidelines. The results will contribute to the evidence base regarding the clinical efficacy for physiotherapy interventions in hip OA

Ingesting breakfast meals of different glycaemic load does not alter cognition and satiety in children

Background/Objectives: The effect of Glycaemic Index (GI) and Load (GL) of breakfasts on satiety and aspects of cognitive function in children is inconclusive. We aimed to assess if isocaloric breakfasts differing in GL (by replacing high-GI carbohydrate foods with dairy protein foods) acutely alter cognitive function and satiety in 10- to 12-year-old children.Subjects/Methods: A total of 39 children, aged 11.6±0.7 years with body mass index 18.9±3.0 kg/m 2 (Mean±s.e.) participated in a randomised crossover trial of three isocaloric breakfasts (1.3 MJ): high GL (HGL: 7 g protein, 9 g fat, 50 g carbohydrate, GL 33); medium GL (MGL: 14 g protein, 9 g fat, 45 g carbohydrate, GL 24) and low GL (LGL: 18 g protein, 10 g fat, 38 g carbohydrate, GL 18). Blood glucose was recorded using a continuous glucose monitor. Subjective hunger and cognitive performance were measured before and hourly after consuming the test breakfast via a computer-delivered battery. Ad libitum intake at a buffet lunch meal was measured at 3 h at the end of testing.Results: Incremental area under the glucose curve (iAUC) was significantly different with HGL>MGL>LGL (P0.001). Glucose concentrations fell below baseline after 83±6 min for HGL, 63±5 min (MGL) and 67±5 min (LGL)(P0.009). Breakfast GL did not significantly alter changes in cognitive function or self-reported satiety throughout testing. Energy intake at lunch was not significantly different between treatments (HGL 2943±168 kJ; MGL 2949±166 kJ; LGL 2993±191 kJ).Conclusions: Reducing breakfast GL by replacing carbohydrate with protein does not alter satiety or cognition over 3 h in 10- to 12-year-old children. © 2012 Macmillan Publishers Limited All rights reserved