A comparison of multidisciplinary team residential rehabilitation with conventional outpatient care for the treatment of non-arthritic intra-articular hip pain in UK Military personnel – a protocol for a randomised controlled trial

Abstract

BackgroundNon-arthritic hip disorders are defined as abnormalities of the articulating surfaces of the acetabulum and femur before the onset of osteoarthritis, including intra-articular structures such as the acetabular labrum and chondral surfaces. Abnormal femoroacetabular morphology is commonly seen in young men who constitute much of the UK military population. Residential multidisciplinary team (MDT) rehabilitation for patients with musculoskeletal injuries has a long tradition in the UK military, however, there are no studies presenting empirical data on the efficacy of a residential MDT approach compared with individualised conventional outpatient treatment. With no available data, the sustainability of this care pathway has been questioned. The purpose of this randomised controlled trial is to compare the effects of a residential multidisciplinary intervention, to usual outpatient care, on the clinical outcomes of young active adults undergoing treatment for non-arthritic intra-articular hip pain.Methods/designThe trial will be conducted at the Defence Medical Rehabilitation Centre, Headley Court, UK. One hundred military male participants with clinical indicators of non-arthritic intra-articular hip pain will be randomly allocated to either: (1) 7-day residential multidisciplinary team intervention, n = 50; (2) 6-week physiotherapist-led outpatient intervention (conventional care), n = 50. Measurements will be taken at baseline, post-treatment (1-week MDT group; 6-weeks physiotherapy group), and 12-weeks. The primary outcome measures are the function in daily living sub-scale of the Copenhagen Hip and Groin Outcome Score (HAGOS), the physical function subscale of the Non-arthritic Hip Score (NAHS), and VAS pain scale. Secondary outcomes include objective measures of physical capacity and general health. An intention-to-treat analysis will be performed using linear and mixed models.DiscussionThis study will be the first to assess the efficacy of intensive MDT rehabilitation, versus conventional outpatient care, for the management of non-arthritic hip pain. The results from this study will add to the evidence-base and inform clinical practice for the management of intra-articular non-arthritic hip pain and femoroacetabular impingement in young active adults.Trial registrationISRCTN Reference: ISRCTN 59255714 dated 11-Nov-2015Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-016-1309-z) contains supplementary material, which is available to authorized users.

The Stanford Hall consensus statement for post-COVID-19 rehabilitation

“…The optimal setting for delivery of rehabilitation is an existing and active area of UK military research. 102 Given the large numbers affected by this pandemic so far, capacity and costings may impact on delivery setting. The cost of inpatient rehabilitation at DMRC per day is estimated at £500 (2011 pricing), for example.…”

“…The UK military delivers a proportion of rehabilitation in a residential setting, with those requiring more intensive treatment historically admitted on a rolling inpatient basis at DMRC, punctuated by periods of home-based rehabilitation allowing for psychological recovery and family adjustment. 101 The residential model receives positive patient feedback 102 103 but when applying these recommendations to civilians it is worth noting patients may be less familiar with geographical separation and may prefer treatment delivery in a more local setting. While it is too early to confirm these opinions in a COVID-19 cohort, DMRC will be seeking further patient feedback and will model for optimal care delivery.…”

The effects of low-intensity blood flow restricted exercise compared with conventional resistance training on the clinical outcomes of active UK military personnel following a 3-week in-patient rehabilitation programme: protocol for a randomized controlled feasibility study

“…1 and Table 2 , respectively. This generic treatment approach has been described elsewhere by Coppack et al [ 49 ]. All participants will receive individualised programmes focussing on improving range of motion, balance, aerobic conditioning, manual therapy and education sessions.…”

“…Manual therapy techniques will be used to modify the quality and range of motion of soft tissue structures, and assist with pain relief. The manual therapy intervention will be prescribed individually for each participant on the basis of the physical examination findings, from a list of techniques including, trigger point massage, passive joint mobilisation, distraction and sustained stretches [ 49 ]. These techniques are commonly used in the management of injured military personnel at DMRC and delivered by their respective MSK physiotherapist.…”

“…Educating the patient on factors surrounding their treatment and the importance of regular exercise is a key component of the rehabilitation process at DMRC to optimise patient adherence to home or work-based exercise programmes. Education and advice will be a focus of the intervention and will include information on diagnosis and aetiology of their injury, rationale for treatment, the benefits of exercise, joint protection and activity modification strategies, pain management, coping with acts of daily living (sitting, driving, sleeping, work) and the importance of increasing physical activity levels in everyday life [ 49 ]. Unsupervised home-based prescription of BFR has not been investigated and therefore not recommended in the UK Defence best practice guidelines.…”