Fulfillment of Expectations for Patients With FAI Syndrome
|ClinicalTrials.gov Identifier: NCT03278353|
Recruitment Status : Terminated (Lack of enrollment)
First Posted : September 11, 2017
Last Update Posted : June 20, 2019
A total of 63 participants will be recruited through 3 local surgeons in Durham, North Carolina after distinctive differential diagnostic methods, all with extensive expertise in intra-articular hip pathology and arthroscopy. The surgeons will offer the opportunity to participate in the trial by providing information to the recipient. Potential participants that do not contact project team members will be contacted by phone if they do not respond to the initial invitation. Potential participants will be initially screened by telephone interview, followed by a clinical examination to confirm study eligibility. The blinded researchers will obtain informed consent and will perform outcome assessments
Purpose of the Study: 1) measure the mediating effect of baseline patient expectations on fulfillment of expectations (for both conservative care and surgery, measured at 6 weeks and at 1 year respectively) in a cohort of patients with a diagnosis of FAI Syndrome who receive six weeks of conservative physical therapy intervention and 2) measure the effect of baseline expectations on patient reported outcomes (e.g., HAGOS, pain, global rating of change) at six weeks.
|Condition or disease||Intervention/treatment||Phase|
|Femoroacetabular Impingement||Other: Exercise Other: Manual Therapy||Not Applicable|
FAI Syndrome is a morphological hip condition that can cause hip/groin pain and impaired performance.1 FAI Syndrome is caused by abnormal morphology of the femoral head (referred to as cam FAI Syndrome), excessive acetabular coverage of the femoral head (referred to as pincer FAI Syndrome) or a combination of the two (mixed FAI Syndrome).2 Not only can FAI Syndrome give rise to symptoms and impair function, the repetitive bony contact can also lead to a cascade of structural damage including tearing at the chondrolabral junction, full thickness cartilage delamination, and potentially hip osteoarthritis.
Presently, there is uncertainty involving the best treatment approach for symptomatic FAI Syndrome.2 The principal two management options are 1) physical therapy management of impairments and function and/or 2) surgery. Although presently, both modalities have been shown to improve symptoms in the short term,2 surgery is by far the most commonly incorporated approach.1, The incidence of the surgery has notably increased in recent years. There has been an 18-fold increase in surgical procedures for FAI Syndrome between 1999 and 2009, varying by geographic region in the USA.3
As an elective procedure, surgery for correction of FAI Syndrome is likely influenced by patients' perspectives and expectations of outcome.4 The extent to which these expectations influence specific treatment choices, as well as subsequent outcomes is currently unclear, although recent findings suggest that across various pathologies both patients5 and clinicians6 rarely have accurate expectations of treatment benefits or harms.
Non-operative, conservative treatments may have a role in managing FAI Syndrome to alleviate symptoms, potentially resulting in postponement or avoidance of surgery. Bony morphological changes can be present without symptoms, and nearly all participants with symptomatic FAI Syndrome undergo a variable asymptomatic period in the presence of structural FAI Syndrome. Recent studies have been hampered by retrospective and case cohort design, very small sample sizes, short-term follow up, and self-report measures only.4 A recent systematic review stated "although the available literature with experimental data is limited, there is a suggestion that physical therapy and activity modification confer some benefit to patients. Non-operative treatment regimens, particularly physical therapy, need to be evaluated more extensively and rigorously".6 Further, it is well known that patient expectations can mediate outcomes. Those who have high expectations about the potential benefit of the conservative approach are more likely to experience improvements. Conversely, those who have low expectations are more likely to fail to see improvement.
4. Design & Procedures: Reporting of the study will conform to STROBE guidelines for observational studies. The proposed study is a prospective case series:
1) Patients will receive:
- A prescription of progressive rehabilitation exercises designed to strengthen weakened muscle groups and stretch joint movements that demonstrate range of motion limitations. Treatment is based on clinical presentation and identification of impairments by the treating clinician.
- Education on progression of exercise based on scientific exercise progression principle. Participants will be seen for 3 visits over 6 weeks (with weekly contact with the patient via email or phone call) and a final visit 1 year post-surgery for those electing to undergo surgery.
|Study Type :||Interventional (Clinical Trial)|
|Actual Enrollment :||6 participants|
|Intervention Model:||Single Group Assignment|
|Intervention Model Description:||Prospective cases series|
|Masking:||None (Open Label)|
|Official Title:||The Mediating Effect of Baseline Expectations of Conservative Care and Surgery Outcomes on Fulfillment of Expectations for Patients With Femoroacetabular Impingement Syndrome|
|Actual Study Start Date :||November 7, 2017|
|Actual Primary Completion Date :||July 31, 2018|
|Actual Study Completion Date :||July 31, 2018|
Experimental: Conservative care
Exercise and manual therapy
A prescription of progressive rehabilitation exercises designed to strengthen weakened muscle groups and stretch joint movements that demonstrate range of motion limitations will be provided as a home program. Treatment is based on clinical presentation and identification of impairments by the treating clinician. Participants will be seen for 3 visits over 6 weeks and a final visit 1 year post-surgery for those electing to undergo surgery.
The interventions will consist of progressive exercise (PE) in two phases with general instruction guidelines. The assigned program will be tailored per each participant's clinical presentation and progressed based on response to exercise load. The researcher will instruct, review and supervise each program initially and, at follow-up visits; as well as monitor progress, re-enforce treatment strategies and modify the respective program accordingly. Each participant will receive a home program manual as well as a program log.
Other: Manual Therapy
Hip joint and spine manual therapy techniques applied toward the impairments of the subject.
- Fulfillment of expectations with conservative care [ Time Frame: 6 weeks post study initiation ]fulfillment of expectations after conservative care implemented as by outcome questionnaire 'Fulfillment of expectations'
- Fulfillment of expectations with surgery [ Time Frame: 1 year post-surgery ]fulfillment of expectations after surgical care implemented as measured by 'Fulfillment of expectations' questionnaire
- Change in Musculoskeletal Outcomes Data Evaluation and Management System (MODEMS) [ Time Frame: baseline, 6 weeks and 1 year post-surgery ]patient expectations of care
- Expectations of conservative care [ Time Frame: baseline ]Expectations of conservative care as measured by expectation survey
- Change in Expectations of surgery as measured by expectation survey [ Time Frame: baseline and 6 weeks ]
- Change in Reasons for surgery [ Time Frame: baseline and 6 weeks ]patient reasons on why choosing surgery
- Change in Patient Acceptable Symptom State (PASS) [ Time Frame: 6 weeks and 1 year post-surgery ]PASS
- Change in Numeric pain rating scale (NPRS) [ Time Frame: baseline, 2 weeks, 6 weeks and 1 year ]
- Change in Global Rating of Change Score (GRoC) [ Time Frame: 2 weeks, 6 weeks and 1 year post-surgery ]GRoC
- Change in Hip and Groin Outcome Score (HAGOS) [ Time Frame: baseline, 6 weeks and 1 year post-surgery ]Patient reported outcome measure relative to hip and groin pain
- Change in Single Leg Squat (Maximum ROM until onset of pain) [ Time Frame: baseline, 6 weeks and 1 year post-surgery ]single leg squat performance
- Change in Bilateral Squat (Maximum ROM until onset of pain) [ Time Frame: baseline, 6 weeks and 1 year post-surgery ]bilateral leg squat performance
- Change in Tegner Activity Scale [ Time Frame: baseline, 6 weeks and 1 year post-surgery ]Tegner Activity Scale
- Change in Adverse events [ Time Frame: baseline, 2 weeks, 6 weeks and 1 year post-surgery ]any adverse events encountered
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03278353
|United States, North Carolina|
|Duke Orthopaedic Clinic Page Road|
|Durham, North Carolina, United States, 27703|
|Duke Sports Science Institute|
|Durham, North Carolina, United States, 27705|
|Duke Orthopaedic Clinic|
|Durham, North Carolina, United States, 27710|
|Principal Investigator:||Michael Reiman, DPT||Duke University|