- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03571971
Load Modification Versus Standard Exercise for Greater Trochanteric Pain Syndrome (GLAM)
Load Modification Versus Standard Exercise to Inform Treatment for Individuals With Greater Trochanteric Pain Syndrome
Greater trochanteric pain syndrome (GTPS), or lateral hip pain, is associated with muscle weakness, altered movement patterns and painful daily activities. The disability associated with GTPS is comparable to end stage hip osteoarthritis, primarily affecting young and middle aged women. Few non-operative treatments have demonstrated long-term lasting or satisfactory results. For those who do improve, recurrence rates of pain and disability can be as high as 50%.
Gluteal tendinopathy is the most common condition associated with a GTPS diagnosis. High compressive loads of the gluteal tendons during common activities like walking, stair-climbing, and running are the theorized mechanism for GTPS. These compressive loads are exacerbated with postures and movement patterns that involve the lateral tilting of the pelvis or movement of the thigh across the midline of the body. There is recent evidence that load modification through education and exercise is superior to a corticosteroid injection for reducing pain in these patients. However, it is unknown whether the possible effects of the load modification program were due to exercise alone or the reduction in compressive loads. As current physical therapy interventions for GTPS commonly incorporate high load postures and exercise activities, there is an urgent need to compare outcomes of standard of care physical therapy to load modification.
The goal of this study is to evaluate the short-term effects of load modification education on pain and function in individuals with GTPS. Participants will be randomized to receive either standard exercise education or load modification education. Both groups will complete a series of questionnaires about their pain and function, and undergo a brief 2-dimensional assessment of their posture and movement. Between follow-up sessions, participants will be asked to respond to brief weekly online surveys to document their home program compliance, pain, and function. It is hypothesized that the group of participants receiving load modification will have the highest proportion of individuals with significant improvements in pain and function, and will demonstrate improved posture and movement.
Study Overview
Status
Conditions
Intervention / Treatment
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
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-
Ohio
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Columbus, Ohio, United States, 43202
- Jameson Crane Sports Medicine Institute
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria: Unilateral diagnosis of GTPS, as confirmed by physician using the following criteria:
- Lateral hip pain, worst over greater trochanter, for >/= 3 months
- Pain with palpation over greater trochanter
- Average pain intensity of >/= 4/10 most days of the week
Lateral hip pain reproduced during a 30 second single leg stance, or at least one of the following positive tests:
- >/= 2/10 lateral hip pain reproduce with passive hip flexion, adduction, and external rotation (ie. FADER)
- lateral hip pain reproduced with resisted internal rotation in the passive hip flexion, adduction, and external rotation position (ie. FADER-R)
- lateral hip pain reproduce with overpressure into passive hip adduction in sidelying (ie. ADD)
- lateral hip pain reproduced with resisted hip abduction in the hip hip adducted position (ie. ADD-R)
lateral hip pain reproduced with hip flexion, abduction, external rotation (ie. FABER)
Exclusion Criteria:
Any of the following treatments within the last 3 months:
- corticosteroid injection in the affected hip
- physical therapy or other skilled exercise intervention by a medical or rehabilitation professional
Any of the following concomitant impairments or conditions:
a) Known or observed advanced spine, hip, knee, or ankle joint pathology, including: i. Spinal or lower extremity surgery within the last 6 months ii. Imaging data showing Kellgren Lawrence grade >/=2 in any lower extremity joint with concurrent complaint >/=2/10 most days of the week.
iii. Groin pain as the primary hip pain complaint >/=2/10 most days of the week.
iv. <90 degrees of active hip and knee flexion bilaterally v. <0 degrees of active ankle dorsiflexion
b) Systemic inflammatory diseases, or any systemic disease that affects the nervous or musculoskeletal system or uncontrolled diabetes, or active malignancy c) Individuals who cannot tolerate or should not assume the positions required for the exercises for any reason other than hip discomfort
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Double
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Load modification education
Load modification education includes exercises currently prescribed by physical therapists, like stretching and strengthening activities, but will also include education on common daily postures and movement patterns that may increase load and stress on the muscles and tendons around the hip.
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Load modification education includes exercises currently prescribed by physical therapists, like stretching and strengthening activities, but will also include education on common daily postures and movement patterns that may increase load and stress on the muscles and tendons around the hip.
Other Names:
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Active Comparator: Standard exercise education
Standard exercise education includes exercises currently prescribed by physical therapists, like stretching and strengthening activities.
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Standard exercise education includes exercises currently prescribed by physical therapists, like stretching and strengthening activities.
Other Names:
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Global Rating of Change
Time Frame: 4 weeks after enrollment
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Participant perception of functional change, measured on an 11-point likert scale
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4 weeks after enrollment
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Change in Numeric Pain Rating Scale
Time Frame: at the time of enrollment and 4 weeks after enrollment
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Participant perception of best and worst hip pain in the last week, on an 11 point scale
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at the time of enrollment and 4 weeks after enrollment
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in Pain Self-Efficacy Questionnaire (PSEQ)
Time Frame: at the time of enrollment and 4 weeks after enrollment
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10-question survey about confidence with activities of daily living, using a 7-point likert scale
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at the time of enrollment and 4 weeks after enrollment
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Change in Victorian Institute of Sport Assessment for Greater trochanteric pain syndrome (VISA-G)
Time Frame: at the time of enrollment and 4 weeks after enrollment
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8 questions asking about severity of functional limitation based on the participant's hip pain
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at the time of enrollment and 4 weeks after enrollment
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Change in Patient Reported Outcomes Measurement Information System (PROMIS) Bank v2.0 Physical Function
Time Frame: at the time of enrollment and 4 weeks after enrollment
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Assesses physical function of participants using computerized adaptive testing techniques
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at the time of enrollment and 4 weeks after enrollment
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Change in Tegner Activity Level Scale
Time Frame: at the time of enrollment and 4 weeks after enrollment
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Activity scale with 11 options ranging from complete disability to national elite level sports
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at the time of enrollment and 4 weeks after enrollment
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Patient Acceptable Symptomatic State question
Time Frame: 4 weeks after enrollment
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A single question (yes/no response) asking participants whether or not they are satisfied with their current state, considering all daily activities, their level of pain, and perceived functional impairment
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4 weeks after enrollment
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Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Stephanie Di Stasi, PhD, PT, Ohio State University
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Estimate)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 2017H0450
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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