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Consensus statement
Physiotherapist-led treatment for young to middle-aged active adults with hip-related pain: consensus recommendations from the International Hip-related Pain Research Network, Zurich 2018
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  1. Joanne L Kemp1,
  2. May Arna Risberg2,3,
  3. Andrea Mosler1,
  4. Marcie Harris-Hayes4,5,
  5. Andreas Serner6,
  6. Håvard Moksnes7,
  7. Nancy Bloom4,5,
  8. Kay M Crossley1,
  9. Boris Gojanovic8,9,
  10. Michael A Hunt10,
  11. Lasse Ishøi11,
  12. Nicolas Mathieu12,
  13. Sue Mayes1,13,
  14. Mark J Scholes1,
  15. Mo Gimpel14,
  16. Daniel Friedman15,
  17. Eva Ageberg16,
  18. Rintje Agricola17,
  19. Nicola C Casartelli18,19,
  20. Laura E Diamond20,
  21. H Paul Dijkstra21,22,
  22. Stephanie Di Stasi23,
  23. Michael Drew24,
  24. Matthew Freke25,
  25. Damian Griffin26,
  26. Joshua Heerey1,
  27. Per Hölmich11,
  28. Franco M Impellizzeri27,
  29. Denise M Jones1,
  30. Ara Kassarjian28,29,
  31. Karim M Khan30,
  32. Matthew G King1,
  33. Peter R Lawrenson31,
  34. Michael Leunig32,
  35. Cara L Lewis33,
  36. Kristian Marstrand Warholm34,
  37. Michael P Reiman35,
  38. Adam Semciw1,
  39. Kristian Thorborg11,
  40. Pim van Klij17,
  41. Tobias Wörner36,
  42. Mario Bizzini37
  1. 1 La Trobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
  2. 2 Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo, Norway
  3. 3 Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway
  4. 4 Physical Therapy, Washington University School of Medicine in Saint Louis, Saint Louis, Missouri, USA
  5. 5 Orthopaedic Surgery, Washington University School of Medicine in Saint Louis, Saint Louis, Missouri, USA
  6. 6 Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
  7. 7 Oslo Sports Trauma Research Center, Oslo, Norway
  8. 8 Swiss Olympic Medical Center, Hopital de la Tour, Meyrin, Geneva, Switzerland
  9. 9 SportAdo consultation, University Hospital of Lausanne (CHUV) Multidisciplinary Unit of Adolescent Health, Lausanne, Switzerland
  10. 10 Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
  11. 11 Sports Orthopaedic Research Center-Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
  12. 12 Physiotherapy, HES-SO Valais, University of Applied Sciences Western Switzerland, Leukerbad, Valais, Switzerland
  13. 13 The Australian Ballet, Southbank, Victoria, Australia
  14. 14 Performance Science, Southampton Football Club, Southampton, Hampshire, UK
  15. 15 Monash School of Medicine, Monash University, Melbourne, Victoria, Australia
  16. 16 Department of Health Sciences, Lund University, Lund, Sweden
  17. 17 Department of Orthopaedic Surgery, University Medical Centre Rotterdam, Rotterdam, The Netherlands
  18. 18 Human Performance Lab, Schulthess Clinic, Zurich, Switzerland
  19. 19 Laboratory of Exercise and Health, ETH Zurich, Schwerzenbach, Switzerland
  20. 20 Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE, Menzies Health Institute Queensland Griffith University, School of Allied Health Sciences, Gold Coast, Queensland, Australia
  21. 21 Department for Continuing Education, University of Oxford, Oxford, Oxfordshire, UK
  22. 22 Aspetar Sports Medicine Hospital, Doha, Qatar
  23. 23 Division of Physical Therapy, The Ohio State Univesity, Columbus, Ohio, USA
  24. 24 University of Canberra Research into Sport and Exercise (UCRISE), University of Canberra, Canberra, Australian Capital Territory, Australia
  25. 25 School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
  26. 26 Warwick Orthopaedics, University of Warwick, Coventry, Warwick, UK
  27. 27 Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
  28. 28 Musculoskeletal Radiology, Corades, LLC, Brookline, Massachusetts, USA
  29. 29 Musculoskeletal Radiology, Elite Sports Imaging, SL, Madrid, Spain
  30. 30 Family Practice & Kinesiology, The University of British Columbia, Vancouver, British Columbia, Canada
  31. 31 School of Health & Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
  32. 32 Department of Orthopaedics, Schulthess Klinik, Zurich, Switzerland
  33. 33 Physical Therapy & Athletic Training, Boston University, Boston, Massachusetts, USA
  34. 34 Divisionof Ortopeadic Surgery, Oslo University Hospital, Oslo, Norway
  35. 35 Orthopedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
  36. 36 Department of Health Sciences, Lunds University, Lund, Sweden
  37. 37 Schulthess Clinic Human Performance Lab, Zurich, Switzerland
  1. Correspondence to Dr Joanne L Kemp, La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Vic, Australia; j.kemp{at}latrobe.edu.au

Abstract

The 1st International Hip-related Pain Research Network meeting discussed four prioritised themes concerning hip-related pain in young to middle-aged adults: (1) diagnosis and classification of hip-related pain; (2) patient-reported outcome measures for hip-related pain; (3) measurement of physical capacity for hip-related pain; (4) physiotherapist-led treatment for hip-related pain. Thirty-eight expert researchers and clinicians working in the field of hip-related pain attended the meeting. This manuscript relates to the theme of physiotherapist-led treatments for hip-related pain. A systematic review on the efficacy of physiotherapist-led interventions for hip-related pain (published separately) was conducted and found that strong evidence for physiotherapist-led treatments was lacking. Prior to the meeting, draft consensus recommendations for consideration in the meeting were also developed based on the systematic review. The draft consensus recommendations were presented to all of the meeting participants via email, at least 1 week prior to the meeting. At the meeting, these recommendations were discussed, revised and voted on. Six recommendations for clinical practice and five recommendations for research were included and all gained consensus. Recommendations for clinical practice were that (i) Exercise-based treatments are recommended for people with hip-related pain. (ii) Exercise-based treatment should be at least 3 months duration. (iii) Physiotherapist-led rehabilitation after hip surgery should be undertaken. (iv) Patient-reported outcome measures, measures of physical impairment and measures of psychosocial factors should be used to monitor response to treatment. (v) Physical activity (that may include sport) is recommended for people with hip-related pain. (vi) Clinicians should discuss patient expectations, use shared-decision making and provide education. Recommendations for research were (i) Reporting of exercise programmes: Exercise descriptors such as load magnitude, number of repetitions and sets, duration of whole programme, duration of contractile element of exercise, duration of one repetition, time under tension, rest between repetitions, range of motion through which the exercise is performed, and rest between exercise sessions should be reported. (ii) Research should investigate the optimal frequency, intensity, time, type, volume and progression of exercise therapy. (iii) Research should examine the effect of patient education in people with hip-related pain. (iv) Research should investigate the effect of other treatments used in people with hip-related pain (for example: manual therapy, medications, injections). (v) Research should examine the impact of comorbidities and social determinants on treatment effectiveness in people with hip-related pain. Clinicians and researchers working with young to middle-aged active adults with hip-related pain may use these consensus recommendations to guide, develop, test and implement individualised, evidence-based physiotherapist-led rehabilitation programmes.

  • hip
  • physiotherapy
  • consensus statement
  • exercise

https://doi.org/10.1136/bjsports-2019-101458

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    Footnotes

    • Twitter @JoanneLKemp, @AndreaBMosler, @MHarrisHayes, @aserner, @HMoksnes, @drsportsante, @LasseIshoei, @MarkScholes85, @MoGimpel, @ddfriedman, @EvaAgeberg, @RintjeAgricola, @NicCasartelli, @lauradiamond05, @_mickdrew, @DamianGriffin, @JHeerey, @francoimpell, @akassarjian, @mattgmking1, @ProfCaraLewis, @MikeReiman, @ASemciw, @KThorborg, @Wuninho

    • Correction notice This article has been corrected since it published Online First. The author affiliations have been updated.

    • Contributors The concept was developed by JK, AM, KMC, KMK, CLL and MB. All authors contributed to the material presented and approved the final version of the manuscript.

    • Funding Dr Kemp is supported by an NHMRC (Australia) ECF 1119971.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available on request