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The physiotherapy for femoroacetabular impingement rehabilitation study (physioFIRST): a pilot randomized controlled trial [with consumer summary]
Kemp JL, Coburn SL, Jones DM, Crossley KM
The Journal of Orthopaedic and Sports Physical Therapy 2018 Apr;48(4):307-315
clinical trial
6/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: No; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

STUDY DESIGN: A pilot double-blind randomized controlled trial (RCT). BACKGROUND: The effectiveness of physical therapy for femoroacetabular impingement syndrome (FAIS) is unknown. OBJECTIVES: To determine the feasibility of an RCT investigating the effectiveness of a physical therapy intervention for FAIS. METHODS: Participants were 17 women and 7 men (mean +/- SD age 37 +/- 8 years; body mass index 25.4 +/- 3.4 kg/m2) with FAIS who received physical therapy interventions provided over 12 weeks. The FAIS-specific physical therapy group received personalized progressive strengthening and functional retraining. The control group received standardized stretching exercises. In addition, both groups received manual therapy, progressive physical activity, and education. The primary outcome was feasibility, including integrity of the protocol, recruitment and retention, outcome measures, randomization procedure, and sample-size estimate. Secondary outcomes included hip pain and function (international Hip Outcome Tool-33 (iHOT-33)) and hip muscle strength. Poststudy interviews were conducted to determine potential improvements for future studies. RESULTS: Twenty-four (100%) patients with known eligibility agreed to participate. Four patients (17%) were lost to follow-up. All participants and the tester remained blinded, and the control intervention was acceptable to participants. The between-group mean differences in change scores were 16 (95% confidence interval (CI) -9, 38) for the iHOT-33 and 0.24 (95% CI 0.02, 0.47) Nm/kg for hip adduction strength, favoring the FAIS-specific physical therapy group. Using an effect size of 0.61, between-group improvements for the iHOT-33 suggest that 144 participants are required for a full-scale RCT. CONCLUSION: A full-scale RCT of physical therapy for FAIS is feasible. A FAIS-specific physical therapy program has the potential for a moderate to large positive effect on hip pain, function, and hip adductor strength. LEVEL OF EVIDENCE: Therapy, level 2b.

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