title: Personalised Hip Therapy: development of a non-operative protocol to treat femoroacetabular impingement syndrome in the FASHIoN randomised controlled trial.
abstract: BACKGROUND
  Femoroacetabular impingement (FAI) syndrome is increasingly recognised as a cause of hip pain. As part of the design of a randomised controlled trial (RCT) of arthroscopic surgery for FAI syndrome, we developed a protocol for non-operative care and evaluated its feasibility.
  
  
  METHODS
  In phase one, we developed a protocol for non-operative care for FAI in the UK National Health Service (NHS), through a process of systematic review and consensus gathering. In phase two, the protocol was tested in an internal pilot RCT for protocol adherence and adverse events.
  
  
  RESULTS
  The final protocol, called Personalised Hip Therapy (PHT), consists of four core components led by physiotherapists: detailed patient assessment, education and advice, help with pain relief and an exercise-based programme that is individualised, supervised and progressed over time. PHT is delivered over 12-26 weeks in 6-10 physiotherapist-patient contacts, supplemented by a home exercise programme. In the pilot RCT, 42 patients were recruited and 21 randomised to PHT. Review of treatment case report forms, completed by physiotherapists, showed that 13 patients (62%) received treatment that had closely followed the PHT protocol. 13 patients reported some muscle soreness at 6 weeks, but there were no serious adverse events.
  
  
  CONCLUSIONS
  PHT provides a structure for the non-operative care of FAI and offers guidance to clinicians and researchers in an evolving area with limited evidence. PHT was deliverable within the National Health Service, is safe, and now forms the comparator to arthroscopic surgery in the UK FASHIoN trial (ISRCTN64081839).
  
  
  BACKGROUND
  ISRCTN 09754699.
authors.affiliation: Warwick Medical School, University of Warwick, Coventry, UK.
authors.forename: Peter Dh
authors.initials: PD
authors.lastname: Wall
authors.affiliation: Warwick Medical School, University of Warwick, Coventry, UK.
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Dickenson
authors.affiliation: Southbank Hospital Worcester, Spire Healthcare, Worcester, UK.
authors.forename: David
authors.initials: D
authors.lastname: Robinson
authors.affiliation: University Hospitals Coventry and Warwickshire, Coventry, UK.
authors.forename: Ivor
authors.initials: I
authors.lastname: Hughes
authors.affiliation: Warwick Medical School, University of Warwick, Coventry, UK.
authors.forename: Alba
authors.initials: A
authors.lastname: Realpe
authors.affiliation: Warwick Medical School, University of Warwick, Coventry, UK.
authors.forename: Rachel
authors.initials: R
authors.lastname: Hobson
authors.affiliation: University Hospitals of Coventry and Warwickshire NHS Trust and Warwick Medical School, University of Warwick, Coventry, UK.
authors.forename: Damian R
authors.initials: DR
authors.lastname: Griffin
authors.affiliation: Arthritis Research UK Primary Care Centre, Research Institute of Primary Care and Health Sciences NIHR Professor of Musculoskeletal Health in Primary Care, Keele University, Keele, UK.
authors.forename: Nadine E
authors.initials: NE
authors.lastname: Foster
mesh_terms: D000328:Adult; D002985:Clinical Protocols; D003226:Congresses as Topic; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D057925:Femoracetabular Impingement / Q000628:therapy*; D006621:Hip Joint / Q000503:physiopathology*; D006801:Humans; D008297:Male; D059352:Musculoskeletal Pain / Q000209:etiology / Q000628:therapy
keywords: Exercise rehabilitation; Hip; Orthopaedics; Physiotherapy