Summary

We conducted a full-scale RCT to evaluate the effect of physiotherapist-led targeted strengthening compared to standardised stretching on hip-related quality of life (QoL) and perceived improvement at six-months in people with FAI syndrome. We found no difference between groups for QoL, but the targeted strength group had more improvement in perceived pain and muscle strength.

Abstract

Introduction

There have been no full-scale randomised controlled trials (RCTs) comparing physiotherapist-led interventions for femoroacetabular impingement (FAI) syndrome.

Objectives: Evaluate the effect of physiotherapist-led targeted-strengthening (STRENGTH) compared to physiotherapist-led standardised-stretching (STRETCH) on hip-related quality of life (QOL) and perceived improvement at six-months in people with FAI syndrome.

Study design: Assessor-blind, limited disclosure, parallel, superiority RCT.

Methods

Participants aged 18-50 years, pain ≥3/10 for ≥6 weeks, cam morphology (alpha angle ≥60°), positive flexion–adduction–internal rotation test were included.
Both groups received 6-months of one-on-one treatment with a physiotherapist. STRENGTH undertook a supervised, targeted, individualised exercise therapy and education programme. STRETCH undertook a supervised standardised stretching and education program. Primary outcomes at six-months were change in hip-related QOL (International Hip Outcome Tool-33 (iHOT-33, 0-100 points)); and patient-perceived global improvement (GROC-pain and GROC-function on 7-point Likert scale, measured as a continuous and dichotomised outcome). Secondary outcomes were hip muscle strength, functional task performance, and kinesiophobia. Statistical analyses compared between-group differences by intention-to-treat.

Results

We recruited 154 participants (STRENGTH n=79 (53% women, 35(9) years); STRETCH n=75 (45% women, 36(9) years)). There was no difference between groups for change in hip-related QOL (mean difference (95% confidence interval) 0.2 (-5.9 to 6.3) p=0.95) or patient-perceived global improvement (GROC-pain 0.2 (-0.2 to 0.7), p=0.23; GROC-function 0.3 (-0.1 to 0.6) p=0.18, as a continuous measure) at six-months. When perceived improvement was dichotomised into “improved” or “not improved”, there was a significant difference for GROC-pain (Odds ratio (OR) 2.36 (1.15-4.84), p=0.019) favouring STRENGTH, where 72% of the strength group perceived an improvement in pain at 6 months compared to 52% of STRETCH. Both groups improved in iHOT-33 over six-months (STRETCH 20.8 (17.1 to 24.5), STRENGTH 19.2 (15.7 to 22.8) points). STRENGTH had greater improvements in hip abduction (14.6N (95%CI 2.1 to 27.0) p=0.022), adduction (17.4N (6.1 to 28.7); p=0.002), internal rotation (12.0N (1.4 to 22.7); p= 0.026) and external rotation (10.9N(0.8 to 20.9); p=0.034) strength.

Conclusions

We found no difference between a targeted, individualised strengthening program and a standardised stretching program on hip-related QOL or perceived improvement in function at six-months in people with FAI syndrome. The targeted, individualised strengthening group showed greater improvement in perceived pain and muscle strength. Both groups showed improvements much larger than the minimal clinically important change in hip-related QOL at six-months. Physiotherapist-led treatment could be considered first line of care in people with FAI syndrome.