Author Names
Wright, A., Hegedus, E., Taylor, J., Dischiavi, S., Stubbs, A
Reviewer Name
Margaret Pohl, SPT
Reviewer Affiliations
Duke University School of Medicine, Doctor of Physical Therapy Division
Paper Abstract
Objectives: To determine the efficacy of physical therapy on pain and physical function in patients with femoroacetabular impingement.
Design: Randomized, participant- and assessor blinded controlled trial pilot study.
Methods: This trial was registered at ClinicalTrials.gov (NCT01814124) and reported according to Con- solidated Standards of Reporting Trials (CONSORT) requirements. Patients were randomly assigned to receive either a combination of manual therapy and supervised exercise (MTEX), plus advice and home exercise or advice and home exercise alone (Ad + HEP) over six weeks. Primary outcomes were average pain (Visual Analog Scale) and physical function (Hip Outcome Score) at week seven.
Results: Fifteen patients, mean age 33.7 (SD 9.5, 73% female) satisfied the eligibility criteria and completed week seven measurements. The between group differences for changes in pain or physical function were not significant. Both groups showed statistically significant improvements in pain: the MTEX group improved a mean of 17.6 mm and the Ad + HEP group, 18.0 mm.
Conclusions: The results of this pilot study provide preliminary evidence that symptomatic femoroac- etabular impingement may be amenable to conservative treatment strategies however further full-scale randomized controlled trials are required to demonstrate this. In this small pilot study, supervised man- ual therapy and exercise did not result in greater improvement in pain or function compared to advice and home exercise in patients with symptomatic femoroacetabular impingement.
NIH Risk of Bias Tool
Quality Assessment of Controlled Intervention Studies
- Was the study described as randomized, a randomized trial, a randomized clinical trial, or an RCT
- Yes
- Was the method of randomization adequate (i.e., use of randomly generated assignment)?
- Yes
- Was the treatment allocation concealed (so that assignments could not be predicted)?
- Yes
- Were study participants and providers blinded to treatment group assignment?
- Yes
- Were the people assessing the outcomes blinded to the participants’ group assignments?
- Yes
- Were the groups similar at baseline on important characteristics that could affect outcomes (e.g., demographics, risk factors, co-morbid conditions)?
- Yes
- Was the overall drop-out rate from the study at endpoint 20% or lower of the number allocated to treatment?
- Yes
- Was the differential drop-out rate (between treatment groups) at endpoint 15 percentage points or lower?
- Yes
- Was there high adherence to the intervention protocols for each treatment group?
- Yes
- Were other interventions avoided or similar in the groups (e.g., similar background treatments)?
- Yes
- Were outcomes assessed using valid and reliable measures, implemented consistently across all study participants?
- Yes
- Did the authors report that the sample size was sufficiently large to be able to detect a difference in the main outcome between groups with at least 80% power?
- No
- Were outcomes reported or subgroups analyzed prespecified (i.e., identified before analyses were conducted)?
- Yes
- Were all randomized participants analyzed in the group to which they were originally assigned, i.e., did they use an intention-to-treat analysis?
- Yes
Key Finding #1
No significant between-group differences were observed in primary or secondary outcomes at week 7.
Key Finding #2
Advice and Home-Exercise (ad + HEP) group showed statistically significant improvements in the HOS (hip outcome scale) ADL and Sport sub-scales.
Key Finding #3
Both groups, manual therapy with exercises and advice with HEP, showed statistically significant improvements in pain as well as hip flexion range of motion.
Please provide your summary of the paper
This study looked to compare physical therapy treatment approaches for patients with femoacetabular impingement (FAI). The study originally had 18 participants satisfying the eligibility and completing the baseline examination with 15 of the original 18 patients completing the 7-week follow-up. Of the 15, 8 were randomly placed in the Advice and Home-Exercise (ad + HEP) group and 7 were placed in the Manual Therapy and Exercise group. Both groups used the same primary outcome measures of average pain, measured by the Visual Analog Scale, and physical function measured by the Hip Outcome Scale, 7 weeks after the beginning of the study. Overall, both groups showed statistically significant improvements in pain as well as significant hip flexion range of motion. There was no statistical difference between the two groups in pain or physical function improvements. Overall, the study shows that, over a 6-week treatment time period, both physical therapy interventions of manual therapy and home exercise programs provided the patients with clinical improvements in both functional abilities and pain levels.
Please provide your clinical interpretation of this paper. Include how this study may impact clinical practice and how the results can be implemented.
I think that this study is very important to the future of treatment approaches for FAI. As this is the first study to look at the combination of manual therapy with supervised exercise in patients with FAI, and had a very small sample size, more information would be gained from a larger study with more participants and therefore more data. As the intervention of manual therapy and exercise in comparison to the advice and HEP both showed improvement to the patient’s function and pain levels, this study supports the need for more research of the intervention. Clinically, as there is no statistical difference between the two treatment groups, patient preference and response should be taken into consideration when determining individual treatment courses.
