Comparison of Joint Mobilization and Movement Pattern Training for Patients With Hip-Related Groin Pain: A Pilot Randomized Clinical Trial

Abstract

Objective: The objective of this study was to assess the feasibility of completing a randomized clinical trial (RCT) and examine the preliminary effects of 2 interventions for hip-related groin pain (HRGP).

Methods: In this pilot RCT, patients with HRGP, who were 18 to 40 years old, were randomized (1:1 ratio) to a joint mobilization (JtMob) group or a movement pattern training (MoveTrain) group. Both treatments included 10 supervised sessions and a home exercise program. The goal of JtMob was to reduce pain and improve mobility through peripherally and centrally mediated pain mechanisms. The key element was physical therapist-provided JtMob. The goal of MoveTrain was to reduce hip joint stresses by optimizing the biomechanics of patient-specific tasks. The key element was task-specific instruction to correct abnormal movement patterns displayed during tasks. Primary outcomes were related to future trial feasibility. The primary effectiveness outcome was the Hip Disability and Osteoarthritis Outcome Score. Examiners were blinded to group; patients and treatment providers were not. Data collected at baseline and immediately after treatment were analyzed with analysis of covariance using a generalized linear model in which change was the dependent variable and baseline was the covariate. The study was modified due to the coronavirus disease 2019 (COVID-19) pandemic.

Results: The COVID-19 pandemic affected participation; 127 patients were screened, 33 were randomized (18 to the JtMob group and 15 to the MoveTrain group), and 29 (88%) provided posttreatment data. Treatment session adherence was 85%, and home exercise program component adherence ranged from 71 to 86%. Both groups demonstrated significant mean within-group improvements of ≥5 points on Hip Disability and Osteoarthritis Outcome Score scales. There were no between-group differences in effectiveness outcomes.

Conclusions: A large RCT to assess the effects of JtMob and MoveTrain for patients with HRGP may be feasible. Preliminary findings suggested that JtMob or MoveTrain may result in improvements in patient-reported pain and activity limitations.

Impact: The COVID-19 pandemic interfered with participation, but a randomized controlled trial may be feasible. Modification may be needed if the trial is completed during future pandemics.

Keywords: Femoroacetabular Impingement; Hip Dysplasia; Joint Mobilization; Kinematics; Movement System; Musculoskeletal; Physical Therapy; Physiotherapy; Rehabilitation.

Figure

Consolidated Standards of Reporting Trials (CONSORT) flow diagram adapted from Eldridge et al *The most frequent reasons for ineligibility included pain/numbness/tingling that radiated (n = 15), age (n = 8), high-impact trauma (n = 8), pain in another joint that limited use of stairs/squats (n = 8), and modified Harris Hip score (n = 8). An individual might be ineligible for more than 1 reason. Not all eligibility criteria were assessed for all individuals. ^†Reasons for refusal included inability to contact patient to schedule eligibility assessment (n = 7), patient was too busy (n = 5), patient wanted their own physical therapist (n = 2), patient did not want to get a physician’s prescription for physical therapy (n = 2), patient was considering surgery (n = 1), and patient lived too far away (n = 1). ^‡Reasons for ineligibility included failure of reproduction of groin/hip joint pain in at least 1 hip during the eligibility assessment (n = 6) and reproduction of hip joint pain with spine test during the eligibility assessment (n = 11). ^§Of the 15 patients allocated to the joint mobilization (JtMob) group with follow-up ascertained, 2 did not complete the allocated intervention (1 patient completed 7 treatment visits and 1 patient completed 9 treatment visits due to restrictions put in place for patient safety during the COVID-19 pandemic). Of the 14 patients allocated to the movement pattern training (MoveTrain) group with follow-up ascertained, 2 did not complete the allocated intervention (1 patient completed 7 treatment visits and 1 patient completed 9 treatment visits due to restrictions put in place for patient safety during the COVID-19 pandemic).