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Personalised hip therapy : development of a non-operative protocol to treat femoroacetabular impingement syndrome in the FASHIoN randomised controlled trial

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Wall, Peter D. H., Dickenson, Edward J., Robinson, David, Hughes, Ivor, Realpe, Alba, Hobson, Rachel, Griffin, Damian R. and Foster, Nadine E. (2016) Personalised hip therapy : development of a non-operative protocol to treat femoroacetabular impingement syndrome in the FASHIoN randomised controlled trial. British Journal of Sports Medicine, 50 (19). pp. 1217-1223. doi:10.1136/bjsports-2016-096368 ISSN 0306-3674.

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Official URL: http://dx.doi.org/10.1136/bjsports-2016-096368

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Abstract

Introduction

Femoroacetabular impingement (FAI) syndrome is increasingly recognised as a cause of hip pain. As part of the design of a randomised controlled trial (RCT) of arthroscopic surgery for FAI syndrome, we developed a protocol for non-operative care and evaluated its feasibility.

Methods

In phase one, we developed a protocol for non-operative care for FAI in the UK National Health Service (NHS), through a process of systematic review and consensus gathering. In phase two, the protocol was tested in an internal pilot RCT for protocol adherence and adverse events.

Results

The final protocol, called Personalised Hip Therapy (PHT), consists of four core components led by physiotherapists: detailed patient assessment, education and advice, help with pain relief and an exercise-based programme that is individualised, supervised and progressed over time. PHT is delivered over 12–26 weeks in 6–10 physiotherapist-patient contacts, supplemented by a home exercise programme. In the pilot RCT, 42 patients were recruited and 21 randomised to PHT. Review of treatment case report forms, completed by physiotherapists, showed that 13 patients (62%) received treatment that had closely followed the PHT protocol. 13 patients reported some muscle soreness at 6 weeks, but there were no serious adverse events.

Conclusion

PHT provides a structure for the non-operative care of FAI and offers guidance to clinicians and researchers in an evolving area with limited evidence. PHT was deliverable within the National Health Service, is safe, and now forms the comparator to arthroscopic surgery in the UK FASHIoN trial (ISRCTN64081839).

Item Type: Journal Article
Subjects: Q Science > QM Human anatomy
R Medicine > RD Surgery
Divisions: Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH): Hip joint -- Diseases -- Treatment -- Great Britain, Femur -- Abnormalities, Acetabulum (Anatomy) -- Abnormalities, Pelvic bones, Arthroscopy, Joints -- Examination, Physical therapy, Clinical trials
Journal or Publication Title: British Journal of Sports Medicine
Publisher: B M J Group
ISSN: 0306-3674
Official Date: October 2016
Dates:
DateEvent
October 2016Published
9 August 2016Accepted
Volume: 50
Number: 19
Page Range: pp. 1217-1223
DOI: 10.1136/bjsports-2016-096368
Status: Peer Reviewed
Publication Status: Published
Access rights to Published version: Open Access (Creative Commons)
Date of first compliant deposit: 15 September 2016
Date of first compliant Open Access: 15 September 2016
RIOXX Funder/Project Grant:
Project/Grant IDRIOXX Funder NameFunder ID
HTA10/41/02[NIHR] National Institute for Health Researchhttp://dx.doi.org/10.13039/501100000272
RP-011-015[NIHR] National Institute for Health Researchhttp://dx.doi.org/10.13039/501100000272

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