Movement pattern training compared with standard strengthening and flexibility among patients with hip-related groin pain: results of a pilot multicentre randomised clinical trial

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.

Keywords: biomechanics; hip; rehabilitation; strength isometric isokinetic.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1

Study flow diagram. CONSORT flow diagram adapted. CONSORT, Consolidated Standards of Reporting Trials; WU, Washington University; UP, University of Pittsburgh. *inclusion criteria categories are not mutually exclusive.

Figure 2

(A) Initial position. Line A is drawn between the anterior superior iliac spine (ASIS) markers and is the initial position of the pelvis. Line B is drawn from the sternal marker to the midpoint of line A and is the initial position of the trunk. (B) Final depth of squat. Line C is drawn between the ASIS markers and is the final position of the pelvis. Line D is drawn from the sternal marker to the midpoint of line C and is the final position of the trunk. Line E is drawn from the ASIS marker to the femur marker on the weight-bearing leg and is the final position of the femur. (C) Angle measurement. Hip adduction angle is defined by lines C and E. Positive values indicate hip adduction; pelvic excursion is defined by lines A and C. Negative values indicate a pelvic tilt in which the non-weight-bearing side is lowering; trunk excursion is defined by lines B and D. Positive values indicate the trunk is leaning towards the weightbearing limb.