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

Abstract

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.

Physiotherapist-led treatment for femoroacetabular impingement syndrome (the PhysioFIRST study): a protocol for a participant and assessor-blinded randomised controlled trial

“…Treatment options for FAI syndrome can be surgical or non-surgical. 11 Non-surgical approaches are recommended as the first line options for other musculoskeletal pain conditions (evident from clinical guidelines for osteoarthritis, 12 low back pain 13 and chronic whiplash associated disorders, 14 ) due to the higher costs and risks associated with surgery. Recently published randomised controlled trials (RCTs) comparing hip arthroscopic surgery to physiotherapist-led interventions for FAI syndrome found small 15 16 to moderate 17 between-group differences favouring hip arthroscopy, with a greater cost and risk of adverse events associated with surgery.…”

“…A recent consensus meeting recommended individualised, exercise-based interventions as the first-line treatment for young adults with hip-related pain, however, no recommendation was made regarding one type of exercise over another. 11 Such a recommendation could not be provided because of the absence of a full-scale RCT comparing the head-to-head effectiveness of different exercise-based, physiotherapist-led interventions for FAI syndrome. [18][19][20] Thus, a physiotherapist-led intervention that compares exercise interventions needs to be developed and tested.…”

Special international consensus and systematic review issue: hips, tendons, shoulders, knees, backs, Ramadan and coffee!

“…You can find the three other papers from that meeting here. [1][2][3] Thirty representatives of the international clinical tendon science community met for the fifth time in Groningen (Netherlands). 4 The authors guide us on terminology, 5 how to report tendon studies (see page 627) as well as steps to developing a new patient-reported outcome measure in the field.…”

“…figure1 Cam lesion as described in the femoroacetabular impingement-one element of the femoroacetabular (FAI) syndrome.…”

Infographic. Consensus recommendations on the classification, definition and diagnostic criteria of hip-related pain in young and middle-aged active adults from the International Hip-related Pain Research Network, Zurich 2018

“…Downloaded from Infographic measures, 6 (2) standardised measurement of physical capacity 7 and (3) physiotherapist-led treatment. 8 For this paper, the working group used a scoping review framework to search the literature for systematic reviews, intervention and observational studies (prospective or retrospective) with a study population of at least 10 young and middle-aged active adults and published in English language, peer-reviewed journals. Evidence summaries and consensus recommendations were then presented to and discussed by the whole group of IHiPRN participants.…”