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bibliography*The PainScience Bibliography contains plain language summaries of thousands of scientific papers and others sources, like a specialized blog. This page is about a single scientific paper in the bibliography, Busato 2016.

Fascial Manipulation Associated With Standard Care Compared to Only Standard Postsurgical Care for Total Hip Arthroplasty: A Randomized Controlled Trial


Tags: treatment, fascia, controversy, debunkery, etiology, pro, massage, manual therapy

PainSci summary of Busato 2016?This page is one of thousands in the bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided at the bottom of the page, as often as possible. ★☆☆☆☆?1-star ratings are for negative examples, fatally flawed papers, junk science, suspected fraud. Ratings are a highly subjective opinion, and subject to revision at any time. If you think this paper has been incorrectly rated, please let me know.

This is a teensy study with several problems that would get it excluded from any self-respecting meta-analysis, or at least classified as poor quality evidence. I see many concerns…

Risk of bias is clearly high, which the authors reveal immediately by assuming the efficacy of manual therapy in general. The control group received no manual therapy, potentially causing a frustrebo effect (exaggerating the relative benefit for the experimental group). Despite that, and likely p-hacking, effect sizes are modest, and clinical significance is not mentioned. It’s an under-powered study, rendering statistical significance even more useless a metric than normal; and the marginal significance reported is embarrassingly emphasized as if it’s the meaningful result (experts have been railing against this for years). Even if the results were stronger, confounding factors can easily account for them. “Fascial manipulation” is undefined; whatever it consists of, this experiment definitely did not isolate the manipulation of “fascia” from many confounding factors.

Basically, this is junk.

~ Paul Ingraham

original abstractAbstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

BACKGROUND: Postsurgical physiotherapy programs after total hip arthroplasty (THA) show important differences between types and numbers of treatment sessions. To increase functional recovery in postsurgical patients, manual therapy can be added to traditional physiotherapy programs. «Dubious premise, reveals a strong bias.» Fascial manipulation (FM) has been demonstrated to be effective in decreasing pain and increasing muscular capacity. «No, it has not — on the contrary, there is a conspicuous lack of compelling evidence of that.»

OBJECTIVE: To compare the effectiveness of FM when added to a standard protocol of care.

DESIGN: Randomized controlled trial.

SETTING: Rehabilitation center.

PATIENTS: A total of 51 patients were recruited after total hip arthroplasty. Inclusion criteria were first THA surgery, posterior-lateral access, and onset of pain within a maximum 2 years. Exclusion criteria were previous hip or knee prosthesis, congenital hip dysplasia, elective THA secondary to trauma, real leg-length discrepancy (≥1.5 cm), cognitive impairment, concomitant rheumatic pathology in acute phase, and serious comorbidities such as cardiac, respiratory, and/or neuromuscular pathologies.

METHODS: Patients were randomized into 2 groups; both followed a standard protocol based on 2 daily sessions of active exercises for 45 minutes. In the study group, 2 sessions were replaced by FM. The clinical trial was registered at (NCT02576028).

MAIN OUTCOME MEASURES: Functional outcome measures were collected before and after treatment and at the end of the rehabilitation program. The measures included the Harris Hip Score; Timed Up-and-Go test; articular range of motion in abduction, flexion, extension, and bilateral external rotation with heels together; and verbal numerical scale.

RESULTS: Statistically significant differences were observed in degrees of flexion between the study and control group with 25.4 (±11.3) and 18.7 (±9.5), respectively (P = .04); for abduction with 16.8 (±7.0) and 11.1 (±6.1), respectively (P = .005); for extension with 16.2 (±4.9) and 9.3 (±3.8), respectively (P = .001); for bilateral external rotation with heels together with 8.3 (±4.3) and 5.5 (±4.6), respectively (P = .04); for the Harris Hip Score 23.3 (±8.9) and 14.5 (±8.5), respectively (P = .002); and for verbal numerical scale score 1.1 (±2.1) and 0.5 (±1.1), respectively.

CONCLUSIONS: This study demonstrates that 2 FM sessions are able to significantly «conflation of statistical and clinical significance» improve several functional outcomes in patients compared to usual treatment after THA.


This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights: