Paper #78 - ISHA Annual Scientific Meeting 2016

Efficacy of Adding a Physiotherapy Rehabilitation Program to Arthroscopic Management of Femoroacetabular Impingement: The FAIR Randomised Controlled Trial

Amir Takla, MPT, Melbourne, VIC AUSTRALIA
John M. O'Donnell, MBBS, FRACS, FAOrthA, Hawthorn, VIC AUSTRALIA

The University of Melbourne, Melbourne, Victoria, AUSTRALIA

FDA Status Not Applicable

Summary: A physiotherapist-prescribed rehabilitation program augments improvements in patient-reported outcomes following arthroscopy for FAI .

Abstract:
Efficacy of adding a physiotherapy rehabilitation program to arthroscopic management of femoroacetabular impingement: The FAIR randomised controlled trial

ABSTRACT
Background

It is unknown if rehabilitation improves outcomes after arthroscopic surgery for femoroacetabular impingement (FAI). This study investigated the efficacy of a physiotherapist-prescribed rehabilitation program compared with no physiotherapy on quality-of-life, function, symptoms and activity participation in individuals following arthroscopy for FAI.

Methods

A randomised controlled trial was conducted. People aged =16 years with FAI were recruited from surgical practices in Melbourne, Australia and randomly allocated to physiotherapy (PT) or control. All participants received arthroscopic FAI surgery. The PT group received seven physiotherapy sessions (1 pre-operative and 6 post-operative) incorporating education, manual therapy and a progressive rehabilitation program of home, aquatic and gym exercises while the control group did not undertake physiotherapy rehabilitation. Six physiotherapists from 7 treatment centres participated. Measurements were taken at baseline (2 weeks pre-surgery) and 14- and 24-weeks post-surgery. Neither participants nor therapists were blinded. The primary outcomes were the International Hip Outcome Tool (iHOT-33) and the sport subscale of the Hip Outcome Score (HOS) at week 14.

Results

Due to a slower than expected recruitment rate and funding constraints, recruitment was ceased after 23 months, prior to reaching the sample size. Thirty participants (14 PT, 16 control) were randomised and 28 (14 PT, 14 control; 93%) and 22 (11 PT, 11 control; 73%) completed week 14 and 24 measurements, respectively. For the 14-week primary outcomes, the PT group showed significantly greater improvements on the iHOT-33 (mean difference 14.2 units; 95%CI, 1.2 to 27.2) and sport subscale of the HOS (13.8 units; 95%CI, 0.3 to 27.3). There were no between-group differences at week 24.

Conclusion

A physiotherapist-prescribed rehabilitation program augments improvements in patient-reported outcomes following arthroscopy for FAI at 14 weeks post-surgery, but not at 24 weeks. Given the truncated and small sample size, larger trials are needed to validate the findings.

Trial Registration:
Australian New Zealand Clinical Trials Registry reference: ACTRN12613000282785