Moderators, mediators, and prognostic indicators of treatment with hip arthroscopy or physical therapy for femoroacetabular impingement syndrome: secondary analyses from the Australian FASHIoN trial

Review written by Dr Joanne Kemp info

Key Points

  1. This study explored which factors influenced response to hip arthroscopy or physiotherapist-led treatment in people with femoroacetabular impingement syndrome (FAIS), using data from the Australian FASHION randomized controlled trial.
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BACKGROUND & OBJECTIVE

Hip arthroscopy and physiotherapist-led treatment are commonly used to treat femoroacetabular impingement syndrome (FAIS). In recent years there have been 3 randomized controlled trials (RCT) published that compared hip arthroscopy to physiotherapist-led treatment on pain, function and quality of life in people with FAIS. While these trials showed benefits of both treatments, the surgical groups did better in the short term (up to 12 months) (1).

A fourth study, the Australian FASHION RCT, was recently published, which compared hip arthroscopy to physiotherapist-led treatment for change in the quality of hip cartilage, measured using delayed gadolinium-enhanced magnetic resonance imaging (dGEMRIC) over 12 months (2). It found no significant difference in change in hip cartilage quality between the 2 groups. But it was not clear from this study whether there were certain factors that could determine who might respond best to either treatment.

This study aimed to explore what factors potentially mediated/moderated (influenced) the effectiveness of each treatment on hip quality of life (measured using the iHOT-33 score), and whether it was possible to predict who would respond best to treatment.

Hip arthroscopy and physiotherapist-led treatment are commonly used to treat femoroacetabular impingement syndrome.
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Those in the physiotherapist-led treatment group who did not adhere to the treatment program had worse outcomes, demonstrating the importance of undertaking exercise at an appropriate dose.

METHODS

  • The researchers used data from the Australian FASHION RCT to conduct an exploratory mediation/moderation analysis.
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