Alison Smeatham1, Roy Powell2, Sarah Moore3, Rohan Chauhan2, Matthew Wilson4. 1. Royal Devon & Exeter NHS Foundation Trust (RDEFT), Barrack Road, Exeter EX2 5DW, Devon, United Kingdom; Princess Elizabeth Orthopaedic Centre, Barrack Road, Exeter EX2 5DW, Devon, United Kingdom. Electronic address: Alisonsmeatham@nhs.net. 2. Royal Devon & Exeter NHS Foundation Trust (RDEFT), Barrack Road, Exeter EX2 5DW, Devon, United Kingdom; University of Exeter Medical School, St. Lukes Campus, Heavitree Road, Exeter EX1 2LU, United Kingdom. 3. Royal Devon & Exeter NHS Foundation Trust (RDEFT), Barrack Road, Exeter EX2 5DW, Devon, United Kingdom. 4. Princess Elizabeth Orthopaedic Centre, Barrack Road, Exeter EX2 5DW, Devon, United Kingdom.
Abstract
AIM: Femoroacetabular impingement (FAI) is recognised as a source of hip pain but the effect of conservative treatment remains untested. This pilot study aimed to inform and evaluate the methods required to conduct a substantive trial comparing the effect of treatment by a physiotherapist versus routine care on the symptoms of FAI. DESIGN: A parallel group, pilot randomised controlled trial (RCT). SETTING: A single NHS acute hospital trust, Devon, England. PARTICIPANTS: 30 adults with symptomatic FAI were recruited. 23 (77%) completed the study. INTERVENTIONS: Intervention was 3 months of treatment by a specialist physiotherapist. The control group received routine care. MAIN OUTCOMES: Change in pain and function was measured using a Visual Analogue Scale, Non Arthritic Hip Score (NAHS), Lower Extremity Functional Score (LEFS) and Hip Outcome Score. RESULTS: Participants in the intervention arm undertook a personalised exercise programme to improve pelvic and femoral control plus advice on posture, activity pacing and pain relief. The mean change in NAHS for the intervention group was 12.7 (95% CI 4.7 to 20.7) and 1.8 (95% CI -5.3 to 9.0) in the control group; Median change in LEFS was 11.5 (95% CI 5.0 to 26.0) versus -1.0 (95% CI -7.0 to 4.0). This improvement in LEFS was beyond minimal clinically important difference in the intervention group. Pain scores improved marginally in both groups. CONCLUSIONS: Methodological strengths and weaknesses were successfully identified for a substantive study. Further research is needed to evaluate the relative influence of structural and neuromuscular features on symptoms of FAI and the role of conservative treatment.
RCT Entities:
AIM: Femoroacetabular impingement (FAI) is recognised as a source of hip pain but the effect of conservative treatment remains untested. This pilot study aimed to inform and evaluate the methods required to conduct a substantive trial comparing the effect of treatment by a physiotherapist versus routine care on the symptoms of FAI. DESIGN: A parallel group, pilot randomised controlled trial (RCT). SETTING: A single NHS acute hospital trust, Devon, England. PARTICIPANTS: 30 adults with symptomatic FAI were recruited. 23 (77%) completed the study. INTERVENTIONS: Intervention was 3 months of treatment by a specialist physiotherapist. The control group received routine care. MAIN OUTCOMES: Change in pain and function was measured using a Visual Analogue Scale, Non Arthritic Hip Score (NAHS), Lower Extremity Functional Score (LEFS) and Hip Outcome Score. RESULTS:Participants in the intervention arm undertook a personalised exercise programme to improve pelvic and femoral control plus advice on posture, activity pacing and pain relief. The mean change in NAHS for the intervention group was 12.7 (95% CI 4.7 to 20.7) and 1.8 (95% CI -5.3 to 9.0) in the control group; Median change in LEFS was 11.5 (95% CI 5.0 to 26.0) versus -1.0 (95% CI -7.0 to 4.0). This improvement in LEFS was beyond minimal clinically important difference in the intervention group. Pain scores improved marginally in both groups. CONCLUSIONS: Methodological strengths and weaknesses were successfully identified for a substantive study. Further research is needed to evaluate the relative influence of structural and neuromuscular features on symptoms of FAI and the role of conservative treatment.
Authors: Joanne L Kemp; Andrea B Mosler; Harvi Hart; Mario Bizzini; Steven Chang; Mark J Scholes; Adam I Semciw; Kay M Crossley Journal: Br J Sports Med Date: 2020-05-06 Impact factor: 13.800