One‐year outcomes following physical therapist‐led intervention for chronic hip‐related groin pain: Ancillary analysis of a pilot multicenter randomized clinical trial

Abstract

Evidence related to physical therapist-led intervention for patients with chronic hiprelated groin pain (HRGP) is limited. The purpose was to assess sustainability of treatment effects for people with HRGP undergoing two physical therapist-led interventions. We completed an ancillary analysis of a pilot multicenter, randomized clinical trial. Forty-six patients with chronic HRGP, 15-40 years, were enrolled. Patients were randomized to participate in 10 sessions over 12 weeks of either movement pattern training (MoveTrain) or traditional strength/flexibility (Standard). Participants completed self-report questionnaires before treatment and 6 and 12 months after treatment completion. Outcome measures included Hip disability and Osteoarthritis and Outcome Score (HOOS), Patient Specific Functional Scale and Numeric Pain Rating Scale for average and worst pain. Continuous data were analyzed with mixed model repeated measures analysis of variance (RM-ANOVA) within each group. Numeric pain rating scale (NPRS) was analyzed using multinomial generalized estimating equations (GEE) with a cumulative logit.Reported p values are from statistical contrasts within the RM-ANOVAs and GEEs testing a priori hypotheses regarding change from pretest to month 6, and pretest to month 12. A total of 43/46 (93.5%) participants completed treatment, 40 (87.0%) completed 6 and 38 (82.6%) completed 12 month questionnaires. At 6 and 12 months, both groups demonstrated clinically significant improvements, compared to pretest, in all subscales of HOOS (p < 0.01), Patient Specific Functional Scale (p < 0.001), and NPRS (p < 0.0001). Among patients with chronic HRGP, both MoveTrain and Standard resulted in improved outcomes that were sustained 12 months after treatment. Further investigation in a larger sample is needed to confirm our findings.

Clinical Measures of Pelvic Tilt in Physical Therapy

“…38 Improving hip flexor flexibility has also been proposed as a target, although limited research suggests that addressing hip flexor flexibility in isolation does not lead to carryover in functional tasks. 58 Training specific movements with improved pelvic motor control may be of benefit, 23,59,60 however generalized strength and flexibility interventions may produce similarly beneficial patient-reported outcomes 60 and more research is needed in this area. While there are several potential targets, it is not established if pelvic tilt can be changed because of a specific or generalized rehabilitation plan, or if specifically tracking the change in pelvic tilt might be a useful prognostic factor for a successful outcome.…”

Femoroacetabular impingement syndrome and labral injuries: grading the evidence on diagnosis and non-operative treatment—a statement paper commissioned by the Danish Society of Sports Physical Therapy (DSSF)

“…Standard postoperative care +in-patient physiotherapy for gait aid +written education material +requested to not undertake formal rehabilitation programme. 80 Wright et al 72 (n=18) showed a large but non-significant between-group difference on HOS-Sport at 6-week follow-up in favour of hip exercises performed at home versus manual therapy and supervised physiotherapy for FAI syndrome (mean difference: 21.1 points, 95% CI −9.1 to 51.3, Hedges g=1.27) (very low quality of evidence).…”

“…22 However, 12-month follow-up suggests that within-group improvements are retained, indicating a potential long-term effect of nonoperative treatment outcome. 80 Due to the heterogeneity of physiotherapy interventions between these studies, it seems difficult to recommend a specific non-operative treatment approach (eg, movement pattern training vs hip strengthening) beyond exercise-based treatment. 12 The mechanisms of improvements following exercise-based treatment are yet to be elucidated, but may be related to improvements in hip muscle strength 14 and altered hip joint kinematics (ie, reduced hip adduction angle during single leg squatting) 111 potentially reflecting better load-bearing capacity of the hip joint.…”