Dr Joanne Kemp

Recipient: Dr Joanne Kemp
Intended department: La Trobe Sport & Exercise Medicine Research Centre, School of Allied Health, Health and Engineering La Trobe University- Sponsored by Arthritis Tasmania


Reducing the impact of hip pain and disability (physioFIRST study): A randomised, controlled trial


However, since commencement, recruitment has been ahead of schedule, with 37 participants randomised into study, and no losses to follow-up to date. Hip pain is a common in active young and middle-aged people, and has a large impact on their quality of life. Femoroacetabular impingement (FAI) is a leading cause of activity-related hip and groin pain in young and middle-aged people, and increases the risk for end-stage hip osteoarthritis (OA). It is possible that treatments targeted to young adults with FAI, could reduce hip symptom severity, and slow symptomatic disease progression. Interventions like physiotherapy have the potential to reduce the substantive individual and social costs of hip OA. However, there has been an absence of efficacy supporting physiotherapy (i.e. non-surgical) management for FAI. Physiotherapy treatment is used clinically, but no randomised controlled trial (RCT) evidence has evaluated this approach in hip pain. Interventions using exercise-science principals, which resulted in greater improvements in knee
osteoarthritis than “traditional” physiotherapy exercises, have potential to optimise benefits for patients.

We aimed to evaluate the effectiveness of an exercise-based physiotherapy intervention on reducing pain and improving quality of life in young and middle-aged people with hip pain. We planned a full-scale randomised controlled trial evaluating the effectiveness of our exercise-based physiotherapy program on hip pain. We aimed to recruit 80 people who were aged 18 to 50 years with hip and groin pain (FAI) to participate in our trial. In order to be eligible, people needed to have hip pain for at least 6 weeks that was at least 3 out of 10 intensity. They also needed to fulfil some clinical and x-ray-based criteria. Our intervention was six months duration, and participants needed to be able to commit the time needed to this. To date, 40 people have entered our study. We aim to have recruited all people into our study by the end of 2018. We will have full 6-month follow-up on 80 participants by the middle of 2019.Young and middle-aged adults with hip pain (FAI) are up to 10 times more likely to develop advanced hip osteoarthritis and undergo total hip arthroplasty in later life. In addition, they experience significantly reduced function, sports participation and poor quality of life at a time in life when they have peak occupational and family commitments. Non-surgical treatments like physiotherapy have the potential to improve function, sports participation and quality of life in this patient group, as well as slow arthritis progression, however the effectiveness of such interventions had not been tested in a clinical trial. This project aimed to provide unique high-level knowledge regarding the benefit of exercise-based physiotherapy interventions in this important patient group. The findings of this study could provide an effective treatment option for these affected individuals, improving their quality of life, as well as participation in physical activity and work activity. It also could reduce the substantive societal burden of hip arthritis over time. As the project is not yet complete, the results addressing our primary and secondary aims are not yet known. However, a number of achievements have occurred in spite of this. The study protocol was presented at an international conference on hip pain (Warwick Sporting Hip Conference) in July 2018.At this meeting we confirmed that this trial is currently the only trial internationally looking at physiotherapy treatment of hip pain in young and middle-aged adults. As such, we anticipate the results of this study will be published in a very high impact medical journal. We have trained over 10physiotherapists located in 4 physiotherapy clinics in Melbourne and Regional Victoria, to be able to implement the study protocol. During this process, we discovered that physiotherapy knowledge of exercise-based interventions for hip pain is poor, and the results of this study will make a large impact on physiotherapy practice for hip pain. Finally, to date one-third of the community of adults aged 18-50 years with hip pain, who responded to our study advertisements, fulfilled the inclusion criteria. This suggests that FAI is a common cause of hip pain, and affected individuals are seeking effective treatments for their condition .As this study is not yet complete, the findings of the research have not yet benefitted people with musculoskeletal disease. However, once complete, the findings of this study will conclusively show whether an exercise-based physiotherapy treatment is an effective option to reduce pain, improve quality of life and physical activity participation in people aged 18-50 years with hip pain. In addition,
longer-term follow-up (beyond the scope of this grant) is planned, in particular progression of arthritis and progression to hip surgery will be documented. This additional information will provide valuable information about the effectiveness of the exercise-based physiotherapy intervention in slowing disease progression and preventing expensive hip surgery.. We are planning to continue this research. Since receiving funding from Arthritis Australia, our recruitment starting date was delayed by a number of factors. These included a delay in the commencement of the project as Dr Kemp moved from Federation University to La Trobe University There were subsequent delays in the approval of the human research ethics application, in confirmation of engagement of physiotherapy clinicians, and subsequent delay in physiotherapist training. We also extended the treatment period of the study from 3-months to 6-months, based on new evidence demonstrating a possible increase in improvement with a longer intervention, with additional university funding to pay for additional treatment over a longer treatment time. Furthermore, we consulted
additional statisticians for advice regarding the required number of participants for the six-month follow-up, and cost-effectiveness analyses. The additional advice indicated that the required number of participants required to achieve these aims was 164, not 80 as originally planned. Over the next 12months, we will complete recruitment of the revised target number of participants, and then subsequently complete the 6-month follow-up. We have also applied for additional NHMRC project grant funding to include these additional participants