Improving function in people with hip-related pain: a systematic review and meta-analysis of physiotherapist-led interventions for hip-related pain

Kemp, Joanne L; Mosler, Andrea Britt; Hart, Harvi F; Bizzini, Mario; Chang, Steven D.; Scholes, Mark J; Semciw, Adam; Crossley, Kay M

doi:10.1136/bjsports-2019-101690

Cited by 35 publications

(42 citation statements)

References 53 publications

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“…The level of evidence supporting this statement was moderate5 8 12 13 and the median (IQR) score was 8 (1) out of a possible 9 points, indicating small variability within the opinions of the expert group. When undertaking physiotherapist-led treatments in people with hip-related pain, evidence suggests that exercise-based treatments should be prioritised, possibly with hip, trunk and functional strengthening components 8. Strengthening or resistance exercise was included in most studies that demonstrated improvements in pain, function and quality of life; however, strengthening alone may not have caused these reported improvements.…”

Section: Discussionmentioning

confidence: 80%

“…The consensus group considered all consensus recommendations appropriate. The quality of evidence used to inform the consensus voting ranged from moderate to insufficient 8…”

Section: Resultsmentioning

confidence: 99%

“…Six recommendations for clinical practice and five recommendations for research were discussed and voted on. These recommendations combine the best available evidence based from the systematic review8 with expert opinion. Clinicians working with patients with hip-related pain can use the consensus recommendations to guide physiotherapist-led treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Prior to the consensus meeting a systematic literature review was conducted in order to provide the evidence summary from which the consensus recommendations contained in this paper were developed. The systematic review was conducted according to the preferred reporting guidelines for systematic reviews and meta-analysis (PRISMA) guidelines and is published separately 8. The purpose was to synthesise the evidence of the effect of physiotherapist-led treatment for hip-related pain.…”

Section: Methodsmentioning

confidence: 99%

“…Prior to the meeting, a systematic review was undertaken. This formed the evidence summary 8. The evidence summaries were revised on multiple occasions by the working groups, prior to a final draft being confirmed.…”

Section: Methodsmentioning

confidence: 99%

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Physiotherapist-led treatment for young to middle-aged active adults with hip-related pain: consensus recommendations from the International Hip-related Pain Research Network, Zurich 2018

et al. 2019

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The 1st International Hip-related Pain Research Network meeting discussed four prioritised themes concerning hip-related pain in young to middle-aged adults: (1) diagnosis and classification of hip-related pain; (2) patient-reported outcome measures for hip-related pain; (3) measurement of physical capacity for hip-related pain; (4) physiotherapist-led treatment for hip-related pain. Thirty-eight expert researchers and clinicians working in the field of hip-related pain attended the meeting. This manuscript relates to the theme of physiotherapist-led treatments for hip-related pain. A systematic review on the efficacy of physiotherapist-led interventions for hip-related pain (published separately) was conducted and found that strong evidence for physiotherapist-led treatments was lacking. Prior to the meeting, draft consensus recommendations for consideration in the meeting were also developed based on the systematic review. The draft consensus recommendations were presented to all of the meeting participants via email, at least 1 week prior to the meeting. At the meeting, these recommendations were discussed, revised and voted on. Six recommendations for clinical practice and five recommendations for research were included and all gained consensus. Recommendations for clinical practice were that (i) Exercise-based treatments are recommended for people with hip-related pain. (ii) Exercise-based treatment should be at least 3 months duration. (iii) Physiotherapist-led rehabilitation after hip surgery should be undertaken. (iv) Patient-reported outcome measures, measures of physical impairment and measures of psychosocial factors should be used to monitor response to treatment. (v) Physical activity (that may include sport) is recommended for people with hip-related pain. (vi) Clinicians should discuss patient expectations, use shared-decision making and provide education. Recommendations for research were (i) Reporting of exercise programmes: Exercise descriptors such as load magnitude, number of repetitions and sets, duration of whole programme, duration of contractile element of exercise, duration of one repetition, time under tension, rest between repetitions, range of motion through which the exercise is performed, and rest between exercise sessions should be reported. (ii) Research should investigate the optimal frequency, intensity, time, type, volume and progression of exercise therapy. (iii) Research should examine the effect of patient education in people with hip-related pain. (iv) Research should investigate the effect of other treatments used in people with hip-related pain (for example: manual therapy, medications, injections). (v) Research should examine the impact of comorbidities and social determinants on treatment effectiveness in people with hip-related pain. Clinicians and researchers working with young to middle-aged active adults with hip-related pain may use these consensus recommendations to guide, develop, test and implement individualised, evidence-based physiotherapist-led rehabilitation programmes.

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Section: Discussionmentioning

confidence: 80%

“…The consensus group considered all consensus recommendations appropriate. The quality of evidence used to inform the consensus voting ranged from moderate to insufficient 8…”

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Physiotherapist-led treatment for young to middle-aged active adults with hip-related pain: consensus recommendations from the International Hip-related Pain Research Network, Zurich 2018

et al. 2019

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Clinical reasoning in managing chronic hip pain: One in two Australian and New Zealand physiotherapists diagnosed a case vignette with clinical criteria for hip OA as hip OA. A cross‐sectional survey

Haber

Hinman

Dobson

et al. 2023

Musculoskeletal Care

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ObjectivesUsing a case vignette of an adult (George) presenting with hip pain consistent with hip OA, this study aimed to describe: (a) whether physiotherapists make diagnoses and identify bodily structures using either patient history and/or physical examination findings; (b) which diagnoses and bodily structures physiotherapists attribute to the hip pain; (c) how confident physiotherapists were in their clinical reasoning using patient history and physical examination findings; (d) what treatments physiotherapists would offer to George.MethodsWe conducted a cross‐sectional online survey of physiotherapists in Australia and New Zealand. We used descriptive statistics to analyse closed questions and content analysis for open‐text responses.ResultsTwo hundred and twenty physiotherapists completed the survey (39% response‐rate). After receiving the patient history, 64% diagnosed George's pain and 49% of these as hip OA; 95% attributed George's pain to a bodily structure(s). After receiving the physical examination, 81% diagnosed George's hip pain and 52% of these as hip OA; 96% attributed George's hip pain to a bodily structure(s). Ninety‐six percent of respondents were at least somewhat confident in their diagnosis after the patient history, and 95% were similarly confident after the physical examination. Most respondents offered advice (98%) and exercise (99%), but fewer offered treatments for weight loss (31%), medication (11%), and psychosocial factors (<15%).DiscussionAbout half of the physiotherapists that diagnosed George's hip pain made a diagnosis of hip OA, despite the case vignette including clinical criteria for a diagnosis of OA. Physiotherapists offered exercise and education, but many physiotherapists did not offer other clinically indicated and recommended treatments, such as weight loss and sleep advice.

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Clinical anatomy of the musculoskeletal system in the hip region

2021

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Although the hip joint is regarded as inherently stable, hip pain and injuries caused by traumatic/non-traumatic hip instability are relatively common in active individuals. A comprehensive understanding of hip anatomy may provide better insight into the relationships between hip stability and clinical problems. In this review, we present our recent findings on the hip morphological characteristics, especially focusing on the intramuscular tendon of the gluteus medius tendon and its insertion sites, hip capsular attachment on the anterosuperior region of the acetabular margin, and composition of the iliofemoral ligament. We further discussed the hip stabilization mechanism based on these findings. The characteristics of the gluteus medius tendon suggest that even a single muscle has multiple functional subunits within the muscle. In addition, the characteristics of the hip capsular attachment suggest that the width of the capsular attachment is wider than previously reported, and its wide area shows adaptive morphology to mechanical stress, such as bony impression and distribution of the fibrocartilage. The composition of the iliofemoral ligament and its relation to periarticular structures suggest that some ligaments should be defined based on the pericapsular structures, such as the joint capsule, tendon, and aponeurosis, and also have the ability to dynamically coordinate joint stability. These anatomical perspectives provide a better understanding of the hip stabilization mechanism, and a biomechanical study or an in vivo imaging study, considering these perspectives, is expected in the future.

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Improving function in people with hip-related pain: a systematic review and meta-analysis of physiotherapist-led interventions for hip-related pain

Cited by 35 publications

References 53 publications

Physiotherapist-led treatment for young to middle-aged active adults with hip-related pain: consensus recommendations from the International Hip-related Pain Research Network, Zurich 2018

Physiotherapist-led treatment for young to middle-aged active adults with hip-related pain: consensus recommendations from the International Hip-related Pain Research Network, Zurich 2018

Clinical reasoning in managing chronic hip pain: One in two Australian and New Zealand physiotherapists diagnosed a case vignette with clinical criteria for hip OA as hip OA. A cross‐sectional survey

Clinical anatomy of the musculoskeletal system in the hip region

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