title: Physical therapy aimed at self-management versus usual care physical therapy after hip arthroscopy for femoroacetabular impingement: study protocol for a randomized controlled trial.
abstract: BACKGROUND
  Femoroacetabular impingement has been recognized as a common cause of hip pain and dysfunction, especially in athletes. Femoroacetabular impingement can now be better treated by hip arthroscopy but it is unclear what postoperative rehabilitation of hip arthroscopy should look like. Several rehabilitation protocols have been described, but none presented clinical outcome data. These protocols also differ in frequency, duration and level of supervision. We developed a rehabilitation protocol with supervised physical therapy which showed good clinical results and is considered usual care in our treatment center. However, it is unknown whether, due to the relatively young age and low complication rate of hip arthroscopy patients, rehabilitation based on self-management might lead to similar results. The aims of this pilot study are (1) to determine feasibility and acceptability of the self-management intervention, (2) to obtain a preliminary estimate of the difference in effect between physical therapy aimed at self-management versus usual care physical therapy in patients who undergo hip arthroscopy for femoroacetabular impingement.
  
  
  METHODS
  Thirty participants (aged 18-50 years) scheduled for hip arthroscopy will be included and randomized (after surgery) to either self-management or usual care physical therapy in this assessor-blinded randomized controlled trial. After surgery, the self-management group will perform a home-based exercise program three times a week and will receive physical therapy treatment once every 2 weeks for 14 weeks. The usual care group will receive physical therapy treatment twice a week for 14 weeks and will perform an additional home-based exercise program once a week. Assessment will occur preoperatively and at 6, 14, 26 and 52 weeks after surgery. Primary outcomes are feasibility, acceptability and preliminary effectiveness. Feasibility and acceptability will be determined by the willingness to enroll, recruitment rate, adherence to treatment, patient satisfaction, drop-out rate and adverse events. Preliminary effectiveness will be determined using the following outcomes: the International Hip Outcome Tool 33 and hip functional performance as measured with the Single Leg Squat Test 14 weeks after surgery.
  
  
  CONCLUSIONS
  The results of this study will be used to help decide on the need, feasibility and acceptability of a large-scale randomized controlled trial.
  
  
  BACKGROUND
  This protocol was registered with the Dutch Trial Registry (NTR5168) on 8 May 2015.
authors.affiliation: Sports Medical Center Papendal, Scientific Institute for Health Sciences, IQ Healthcare, Papendallaan 7, 6816 VD, Arnhem, The Netherlands. m.tijssen@smcp.nl.
authors.forename: M
authors.initials: M
authors.lastname: Tijssen
authors.affiliation: Radboud University Medical Center, Scientific Institute for Health Sciences, IQ Healthcare, PO Box 9101, 114 IQ, 6500 HB, Nijmegen, The Netherlands. r.vancingel@smcp.nl.
authors.forename: R E H
authors.initials: RE
authors.lastname: van Cingel
authors.affiliation: HAN University of Applied Sciences, Research Group Musculoskeletal Rehabiliation, PO Box 6960, 6503 GL, Nijmegen, The Netherlands. bart.staal@radboudumc.nl.
authors.forename: J B
authors.initials: JB
authors.lastname: Staal
authors.affiliation: Department for Health Evidence, Radboud Institute for Health Sciences, Section Biostatistics, Radboud University Medical Center, PO Box 9101, 133 HEV, 6500 HB, Nijmegen, The Netherlands. Steven.Teerenstra@radboudumc.nl.
authors.forename: S
authors.initials: S
authors.lastname: Teerenstra
authors.affiliation: Rijnstate Hospital Arnhem, Wagnerlaan 55, 6815 AD, Arnhem, The Netherlands. edevisser@rijnstate.nl.
authors.forename: E
authors.initials: E
authors.lastname: de Visser
authors.affiliation: Scientific Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, PO Box 9101, 114 IQ, 6500 HB, Nijmegen, The Netherlands. Ria.Nijhuis-vanderSanden@radboudumc.nl.
authors.forename: M W G
authors.initials: MW
authors.lastname: Nijhuis-van der Sanden
mesh_terms: D000293:Adolescent; D000328:Adult; D001182:Arthroscopy; D002985:Clinical Protocols; D003627:Data Interpretation, Statistical; D057925:Femoracetabular Impingement / Q000601:surgery*; D006621:Hip Joint / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D010353:Patient Education as Topic; D063868:Patient Outcome Assessment; D017060:Patient Satisfaction; D026741:Physical Therapy Modalities; D012648:Self Care