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Young J1, Wright A2, Rhon D3
1AT Still University, Mesa, United States, 2High Point University, High Point, United States, 3US Army Office of the Surgeon General, Physical Performance Service Line, Falls Church, United States
Background: Surgery for femoroacetabular impingement (FAI) syndrome has risen significantly in recent years, but little is known about the utilization of physical therapy prior to surgery. A trial of ´adequate conservative management´ is recommended for patients with FAI syndrome prior to surgery. However, the definition of ´adequate conservative management´ is poorly described in the literature. Without a clear definition, it is difficult to differentiate between an individual who has exhausted the opportunity for improvement with an appropriate evidence-based intervention from someone who has not. These courses of conservative management, however poorly defined, often dictate how this requirement is met before decisions for progression to surgery are made. Physical therapy should be considered an integral part of conservative management before surgical decisions are made, but it is currently unknown how often it is utilized. The presence of comorbidities also has the ability to impact the utilization of physical therapy, but it has not been studied in individuals with FAI syndrome.
Purpose: To investigate the use and dosing of physical therapy prior to surgery for FAI syndrome, and evaluate if the presence of comorbidities prior to surgery influenced the use of physical therapy.
Methods: Eligible participants between the ages of 18 and 50 undergoing hip arthroscopy between 2004 and 2013 in the United States Military Health System were included. Patients were categorized based on whether or not they saw a physical therapist for their hip in the year prior to surgery. For physical therapy utilizers, dosing variables were identified, including timing, total visits and visits that included an exercise procedure code.
Results: Of 1870 participants, 1106 (59.1%) did not receive any hip-related physical therapy prior to surgery. In those receiving physical therapy, 79 (10.3%) had no additional visits beyond the initial evaluation, 217 (28.4%) had one or two, and only 184 (24.1%) had six or more. Exercise was included in only 43.0% to 63.0% of the total visits in each course of care (mean=52.3%). Comorbidities present prior to surgery did not influence the use of physical therapy, aside from the presence of cardiovascular disease.
Conclusion(s): In this setting, physical therapy, including exercise, is not commonly used before undergoing arthroscopic hip surgery. Further research is needed to understand the reasons for poor utilization and better define failed conservative management.
Implications: Because the potential benefits of physical therapy outweigh the risk of invasive surgical procedures, physical therapy should be trialled in patients with FAI syndrome prior to surgery.
Keywords: Arthroscopic surgery, conservative treatment, femoroacetabular impingement
Funding acknowledgements: This study was funded by the United States Defense Health Agency.
Purpose: To investigate the use and dosing of physical therapy prior to surgery for FAI syndrome, and evaluate if the presence of comorbidities prior to surgery influenced the use of physical therapy.
Methods: Eligible participants between the ages of 18 and 50 undergoing hip arthroscopy between 2004 and 2013 in the United States Military Health System were included. Patients were categorized based on whether or not they saw a physical therapist for their hip in the year prior to surgery. For physical therapy utilizers, dosing variables were identified, including timing, total visits and visits that included an exercise procedure code.
Results: Of 1870 participants, 1106 (59.1%) did not receive any hip-related physical therapy prior to surgery. In those receiving physical therapy, 79 (10.3%) had no additional visits beyond the initial evaluation, 217 (28.4%) had one or two, and only 184 (24.1%) had six or more. Exercise was included in only 43.0% to 63.0% of the total visits in each course of care (mean=52.3%). Comorbidities present prior to surgery did not influence the use of physical therapy, aside from the presence of cardiovascular disease.
Conclusion(s): In this setting, physical therapy, including exercise, is not commonly used before undergoing arthroscopic hip surgery. Further research is needed to understand the reasons for poor utilization and better define failed conservative management.
Implications: Because the potential benefits of physical therapy outweigh the risk of invasive surgical procedures, physical therapy should be trialled in patients with FAI syndrome prior to surgery.
Keywords: Arthroscopic surgery, conservative treatment, femoroacetabular impingement
Funding acknowledgements: This study was funded by the United States Defense Health Agency.
Topic: Musculoskeletal: lower limb; Musculoskeletal
Ethics approval required: Yes
Institution: Brooke Army Medical Center
Ethics committee: Institutional Review Board
Ethics number: C.2015.061d
All authors, affiliations and abstracts have been published as submitted.
