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Original research
Movement pattern training compared with standard strengthening and flexibility among patients with hip-related groin pain: results of a pilot multicentre randomised clinical trial
  1. Marcie Harris-Hayes1,2,
  2. Karen Steger-May3,
  3. Allyn M Bove4,
  4. Stefanie N Foster5,
  5. Michael J Mueller5,
  6. John C Clohisy6,
  7. G Kelley Fitzgerald4
  1. 1Department of Physical Therapy, Washington University School of Medicine in Saint Louis, Saint Louis, Missouri, USA
  2. 2Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
  3. 3Division of Biostatistics, Washington University in Saint Louis, Saint Louis, Missouri, USA
  4. 4Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  5. 5Department of Physical Therapy, Washington University in Saint Louis, Saint Louis, Missouri, USA
  6. 6Department of Orthopaedic Surgery, Washington University in Saint Louis, Saint Louis, Missouri, USA
  1. Correspondence to Dr Marcie Harris-Hayes; harrisma{at}wustl.edu

Abstract

Study design Pilot, multicentre randomised clinical trial (RCT).

Objectives Assess viability of performing a definitive RCT and compare preliminary effects of movement pattern training (MoveTrain) and strengthening/flexibility (Standard) to improve function in people with chronic hip-related groin pain (HRGP).

Background To determine the best physical therapist-led intervention for patients with HRGP, we must understand treatment effects of different treatment modes.

Methods Forty-six patients (17M:29F; 29±5.3 years; body mass index 25.6±6.3 kg/m2) with HRGP were randomised. MoveTrain included task-specific training to optimise biomechanics during daily tasks. Standard included strengthening/flexibility. Treatment included 10 visits/12 weeks and home exercise programme (HEP). Primary outcomes for feasibility were recruitment, retention, treatment adherence and treatment fidelity. Secondary outcomes were patient-reported function (Hip disability and Osteoarthritis Outcome Score (HOOS)), lower extremity kinematics and hip muscle strength.

Results We achieved target recruitment, and retention was excellent (91%). Patient session attendance was high (93%); however, reported HEP adherence (62%) was lower than expected. Physical therapists’ adherence to treatment protocols was high (90%). Patients demonstrated high treatment receipt; 91% of exercises performed were rated independent. Both groups demonstrated clinically important improvements in function (HOOS) and muscle strength; however, there were no between-group differences (HOOS subscales, p≥0.13, strength, p≥0.34). Compared with Standard, MoveTrain demonstrated greater reductions in hip adduction (p=0.016) and pelvic drop (p=0.026) during a single leg squat. No adverse events were noted.

Conclusion Our experience in completing this RCT confirmed that a larger, multicentre RCT is feasible and highlighted modifications we will implement to optimise the future RCT.

Trial registration number NCT02913222.

  • hip
  • rehabilitation
  • biomechanics
  • strength isometric isokinetic
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjsem-2019-000707

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    Footnotes

    • Twitter @MHarrisHayes

    • Contributors All authors contributed to the study design, data analysis, interpretation and manuscript preparation, including final approval. The corresponding author takes responsibility for the integrity of the work as a whole, from inception to the finished article. MH-H: conception and design of study, data analysis and interpretation; drafting, revising and approving the final manuscript; provision of study materials and patients; obtaining of funding; and collection and assembly of data. KS-M: conception and design of study, data analysis and interpretation; drafting, revising and approving the final manuscript; statistical expertise; administrative, technical or logistic support; and collection and assembly of data. AMB: conception and design of study, data analysis and interpretation; drafting, revising and approving the final manuscript; provision of study materials and patients; administrative, technical or logistic support; and collection and assembly of data. SNF: data analysis and interpretation; drafting, revising and approving the final manuscript; and collection and assembly of data. MJM and JCC: conception and design of study, data analysis and interpretation; drafting, revising and approving the final manuscript; and provision of study materials and patients. GKF: conception and design of study, data analysis and interpretation; drafting, revising and approving the final manuscript; provision of study materials and patients; obtaining of funding; and collection and assembly of data.

    • Funding This work was supported by the following grants: R21HD086644 and NIH T32HD007434 from the National Center for Medical Rehabilitation Research, National Institute of Child Health and Human Development; the Orthopaedic Research Grant from the Foundation for Physical Therapy Research; Washington University Institute of Clinical and Translational Sciences grant UL1TR002345 from the National Center for Advancing Translational Sciences of the National Institutes of Health. Additional support was provided by Program in Physical Therapy at Washington University School of Medicine, Clinical and Translational Science Award.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available on reasonable request. Deidentified participant data related to this study may be made available on reasonable request to the principal investigator, MHH. Email: harrisma@wustl.edu.