Femoroacetabular Impingement Clinical Trial
Official title:
Therapeutic Effectiveness of Manual Therapy Plus Exercise for Femoroacetabular Impingement of the Hip: a Randomized Controlled Clinical Trial Pilot Study
Femoroacetabular impingement (FAI) is recognized as a formal source of hip pain and
disability typically affecting the young adult, active population and has been identified as
a precursor to hip osteoarthritis (OA). Common impairments include sharp, anterior groin
pain in a position of hip flexion limiting patients' ability to tolerate prolonged sitting,
squatting, stair climbing, etc. resulting in both work limitations and decreased social
participation. Manual therapy and exercise is known to be effective in reducing pain and
increasing physical function in the management of hip OA. To the extent that FAI is often a
precursor to developing hip OA, logic would seem to dictate a manual therapy plus exercise
approach to decrease pain and disability and potentially prevent or delay osteoarthritis
related surgery. Currently, surgery is considered the first line of treatment with respect
to FAI. However, there is a lack of evidence to support or refute the use of conservative
treatment interventions in this patient population.
This study is designed to investigate the benefits of physical therapy interventions (manual
therapy and exercise) over usual care for improving pain and physical function in patients
with FAI of the hip. For this study, 52 participants will be recruited from the Department
of Orthopaedic Surgery, Wake Forest Baptist Medical Center, for an outpatient consultation
for consideration of hip arthroscopy surgery. Participants will include those patients who
meet clinical and radiological criteria for formal diagnosis of FAI. Participants will be
randomized into two treatment groups. Participants in one group will receive usual care plus
manual therapy directed at the hip as well as a supervised exercise program and home
exercise program twice weekly for six weeks. Participants in the usual care group will
receive usual care as prescribed by the physician. Changes in pain, physical function and
benefits of the intervention will be assessed over six weeks. Should this research study
demonstrate treatment effectiveness of physical therapy intervention in patients diagnosed
with FAI of the hip, manual therapy plus exercise may have the potential to delay or prevent
surgery in this patient population. Further, to the extent to which FAI has been shown to
lead to later development of hip OA, effective treatment interventions may help to delay or
prevent secondary osteoarthritis related changes as well as total joint replacement surgery
associated with hip OA. This study will provide preliminary data that can be used to prepare
further grant applications designed to determine the safest, most effective treatments for
patients with FAI.
Status | Completed |
Enrollment | 18 |
Est. completion date | May 2015 |
Est. primary completion date | May 2015 |
Accepts healthy volunteers | No |
Gender | Both |
Age group | 18 Years to 55 Years |
Eligibility |
Inclusion Criteria: - The participants will include new and existing patients with a diagnosis of femoroacetabular impingement and are being seen for an outpatient consultation for consideration of hip arthroscopy surgery. - From direct correspondence with Dr. Stubbs, criteria for formal diagnosis of FAI includes a combination of clinical diagnosis supported with radiography. - Clinical examination typically consists of reported hip pain, decreased flexion (<95o), decreased internal rotation (<10o), and - a positive anterior impingement test result (report of deep, anterior groin pain following combination of flexion, internal rotation, and adduction). - Use of an alpha angle is also used as a distinct characteristic with patient's having an alpha angle of > 50-55 degrees at increased risk for FAI. Exclusion Criteria: - previous hip surgery; - any other surgical procedure of the lower limbs in the prior 6 months; - pre-existing disease state of the hip such as rheumatoid arthritis; - fracture; - congenital/developmental hip dysplasia; - initiation of opioid analgesia or cortico-steroid or analgesic injection intervention for hip pain within prior 30 days; - physical impairments unrelated to the hip preventing safe participation in exercise, manual therapy, walking or stationary cycling; - advanced osteoporosis; - body mass index > 38; - significant cardio-pulmonary disease; - cardiac pacemaker; - stated inability to complete the proposed course of intervention and follow-up; - insufficient English language skills to comprehend assessment tools; - resident greater than 90 minutes from Wake Forest Baptist Medical Center. - Individuals with contraindications to treatment with mobilization and manipulation |
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Investigator, Outcomes Assessor), Primary Purpose: Treatment
Country | Name | City | State |
---|---|---|---|
United States | Institute for Human Health and Sports Science Research | High Point | North Carolina |
Lead Sponsor | Collaborator |
---|---|
High Point University |
United States,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Hip Outcome Score | Participants will fill out the Hip Outcome Score (HOS). The HOS is a 29-item instrument. Patient data from the HOS has been reported as reliable, valid, and responsive specific to this patient population and has been identified as the best available questionnaire for assessing younger patients undergoing hip arthroscopy. Test-retest reliability has been reported in the range of ICC = 0.92 - 0.98; internal consistency measures at cronbach's alpha = 0.96, 0.95; and responsiveness characteristics with effect sizes post-surgery ranging from 1.2-1.5. | Change from baseline functional status at 6 weeks | No |
Primary | Numeric Pain Rating Scale | Lower extremity pain will be recorded using the Numeric Pain Rating Scale (NPRS). Participants will be asked to report their pain levels from no pain (0/10) to worse imaginable pain (10/10). This scale has been demonstrated to be a reliable, generalizable, internally consistent measure of clinical and experimental pain sensation intensity. | Change from baseline pain level at 6 weeks | No |
Secondary | Functional Squat | The functional squat test is considered to be a provocative test that also serves as a measure of function. A digital inclinometer will be placed on the tibia just distal to the tibial tuberosity. The participants will be asked to bend the knees and bring their buttocks toward their heels without bending forward or lifting their heels off the floor. The range of motion measurement will be taken at the greatest range of motion at which the participant was able to maintain good form or the first point of reported pain. The functional squat test has good reported reliability (ICC = 0.90 - 0.92) and responsiveness with standard error of measurement of 1.9. | Change from baseline functional status at 6 weeks | No |
Secondary | Global Rating of Change Scale | The Global Rating of Change Scale (GRCS) will be completed by each participant to rate their own perception of improved hip function. The GRCS questionnaire is an instrument that measures overall changes in the quality of life of the subject. The use of a GRCS is a common, feasible, and useful method for assessing outcome, and has been shown to be a valid measurement of change in patient status in patients with knee OA and other pain populations | 6 weeks | No |
Secondary | Lower Extremity Functional Scale | General lower extremity function will be quantified using the LEFS. The LEFS is a 20 item instrument with reported test-retest reliability of ICC = 0.98; internal consistency measures of cronbach's alpha = 0.96; and responsiveness characteristics of area under the curve of 0.77 | Change from baseline general functional status at 6 weeks | No |
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