Comparison of Movement Pattern Training and Manual Therapy for Prearthritic Hip Disorders

The Washington University

Status: Completed

Conditions: Dysplasia Mild; Femoroacetabular Impingement; Hip-related Groin Pain; Prearthritic Hip Disorder

Treatments: Other: Manual Therapy; Other: Movement Pattern Training

Study type: Interventional

Funder types: Other; Industry

Identifiers

NCT03959319

201901005

Details and patient eligibility

About

Significance: Intra-articular, prearthritic hip disorders (PAHD) result in substantial dysfunction in young adults and are proposed precursors to hip osteoarthritis (OA). Our long term goal is to develop effective treatment strategies for people with PAHD that will improve function, decrease pain and prevent or delay the onset of OA. The purpose of this study is to compare movement pattern training (MoveTrain) and manual therapy (ManTher) in their effect on post-treatment, patient-reported outcomes and targeted impairments thought to contribute to PAHD.

This pilot study will collect sufficient data to power a future study that will determine the efficacy of MoveTrain compared to ManTher for people with PAHD. Participants with PAHD will be randomized into one of two treatment groups, MoveTrain or ManTher. The Hip disability and Osteoarthritis Outcome Score (HOOS) will be the primary outcome measure. A measure of hip adduction motion during functional tasks and quantitative sensory assessment (pain pressure threshold and temporal summation) will be the secondary measures used to assess the effect of respective treatment on the impairments thought to contribute to PAHD, thus addressing the mechanisms of pain. Upon completion of this study, we will be positioned to implement a large RCT (randomized clinical trial) to definitively assess the efficacy of MoveTrain and ManTher to improve PAHD.

Specific Aims: To obtain preliminary estimates of effect sizes for planning the future definitive randomized clinical trial,

Aim 1 (Function): we will compare post-treatment improvements in hip-specific, patient-reported outcomes among the two treatment groups. After treatment completion:

Aim 2 (Mechanism): we will compare pre- and post-treatment measures in lower extremity movement patterns during functional tasks (MoveTrain) and quantitative sensory testing (ManTher). After treatment completion:

Aim 3 (Prognosis): we will determine the association among personal factors at baseline (demographic and psychosocial) and treatment prognosis (improvement in HOOS).

Impact: Our line of research will improve our understanding of each proposed treatment and its effect on patient function and each treatment's targeted impairment. This improved understanding will lead to the development of treatment strategies that will ultimately result in comparative effectiveness studies of surgical and non-surgical treatment.

Enrollment: 33 patients

Sex: All

Ages: 18 to 40 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Age 18-40 years

  • Must be scheduled before their 40th birthday

• Have frequent hip joint symptoms, defined as pain, aching or stiffness within the hip joint for at least 3 months during the past 12 months

• Hip joint pain confirmed upon physical exam

• Report pain >= 3/10

• Reports functional limitation as demonstrated by modified Harris Hip Score <90

• Has protective sensation in the feet

Exclusion criteria

• Previous hip surgery, fracture, pelvic/hip infection or cancer

• Pain due to high impact trauma

• Inflammatory disease, e.g. rheumatoid arthritis, gout

• Acute pain in another joint that limits functional activities

• Perthes disease or slipped capital femoral epiphysis

• Hip pain referred from another source, e.g. lumbar spine

• Neurological involvement affecting balance or coordination

• Use of assistive gait device for more than 50% of time walking

• Pain, numbness or tingling in the lower extremity

• Pregnancy or given birth in previous 12 weeks

• Unwilling to refrain from taking NSAIDs 1-2 days prior to testing session

• Unable to attend regular physical therapy sessions

• Unable to complete 12 month follow up session

  • Avascular Necrosis
  • Ehler's Danlos Syndrome

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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33 participants in 2 patient groups

Movement Pattern Training

Experimental group

Description:

Focus will be on task-specific training to improve lower extremity movement patterns during basic daily tasks, such as sit to stand and stairs, and reported patient-specific tasks. Patient education will include instruction in abnormal movement patterns and methods to optimize movement patterns during each task. Tasks will be prioritized based on patient-report of activity limitations during the baseline examination. For example, during the first visit, the treating physical therapist will begin with the daily and patient-specific tasks that the patient reported as being most bothersome. Exercises will include repeated practice of functional tasks using optimized movement patterns. Based on the participant's performance, the difficulty of the task-specific activities will be progressed by varying the repetitions performed, increasing the load or changing the support surface. The home program will consist of repeated practice of tasks performed during the supervised sessions.

Treatment:

Other: Movement Pattern Training

Manual Therapy (Joint Mobilization)

Active Comparator group

Description:

Focus will be on reducing pain and improving pain-free range of motion using manual techniques provided by the physical therapist and exercise performed in the home program. Patient education will include instruction to the benefits of manual therapy and the proposed effects on pain and joint mobility. Joint mobilizations to be used with each patient will be prioritized based on the restrictions, defined as stiffness or pain that is limiting joint range of motion, noted on the patient's baseline examination. For example, during the first visit, the treating physical therapist will begin with the two most restricted motions noted in the baseline exam and perform a standard assessment to determine treatment parameters. The home program will include joint range of motion and stretching exercises to complement techniques performed during the supervised sessions.

Treatment:

Other: Manual Therapy