This study evaluated the outcomes of a 3-week multidisciplinary residential rehabilitation program for 40 young UK military personnel with prearthritic hip pain. The rehabilitation program improved hip range of motion, as measured by increased flexion and internal rotation, and improved performance on a functional Y-balance test. However, scores on a hip disability questionnaire, pain levels, and a shuttle run test did not significantly improve. The study suggests the rehabilitation program provided short-term benefits for physical function, but not pain or self-reported hip function.
This case study examines the outcomes of a 9-year-old male who received applied functional science movement based therapy following a 12-week arm cast for a distal radius/ulna fracture. The patient received 6 weeks of therapy focused on restoring range of motion, strength, and function through a progressive 3-phase protocol. Evaluation measures showed significant improvements in range of motion, grip strength, muscle strength, and disability scores. While grip strength improved substantially, it did not fully return to normal levels. The functional movement based approach effectively reduced impairments and disability from immobilization.
This study compared the incidence of neurobehavioral side effects of levetiracetam versus phenytoin in patients with traumatic brain injury (TBI). In a prospective observational study of 100 TBI patients treated with either levetiracetam or phenytoin, researchers found:
1. Levetiracetam was associated with significantly fewer neurobehavioral side effects than phenytoin, including less irritability, aggression, and confusion.
2. Phenytoin treatment resulted in nearly double the incidence of neurobehavioral side effects compared to levetiracetam.
3. Levetiracetam appears to be a better-tolerated antiepileptic drug for
Study of functional outcome following arthroscopic anatomical ACL reconstruct...Dr.Avinash Rao Gundavarapu
This document summarizes a study examining the functional outcomes of 40 patients who underwent arthroscopic anatomical ACL reconstruction using autologous hamstring grafts. The study found significant improvements in stability scores (measured by IKDC, Lachman, anterior drawer, and pivot shift tests) at 6-month follow-up compared to pre-operation scores. Complications were minor, with 7.5% having superficial infections and 7.5% difficulty regaining full range of motion. The study concludes that anatomical ACL reconstruction is an excellent technique for restoring stability, especially in active patients.
Does a standard outpatient physiotherapy regime improve the range of knee mot...FUAD HAZIME
This study investigated whether a standard outpatient physiotherapy regime improved range of knee motion after primary total knee arthroplasty (TKA). 150 patients were randomly assigned to either receive 6 weeks of outpatient physiotherapy after TKA (Group A) or no outpatient physiotherapy (Group B). Range of motion measurements found that while Group A achieved greater flexion than Group B, the difference was not statistically significant. The study concluded that outpatient physiotherapy does not improve range of knee motion after primary TKA.
This study compared the effectiveness of two rehabilitation programs for acute hamstring strains. Twenty-four athletes with hamstring strains were randomly assigned to either a static stretching, isolated strengthening, and icing program (STST group) or a progressive agility, trunk stabilization, and icing program (PATS group). The PATS group had a significantly shorter average time to return to sports (22.2 days vs 37.4 days) and lower reinjury rates both within 2 weeks of returning (0% vs 54.5%) and within 1 year (7.7% vs 70%) compared to the STST group. A rehabilitation program including progressive agility and trunk stabilization exercises was found to be more effective for returning athletes to
Hip fractures are common and debilitating injuries among the elderly that can result in loss of independence and mortality. This study compared functional recovery outcomes between elderly patients treated surgically with either a dynamic hip screw (DHS) or proximal femoral nail (PFN) for intertrochanteric hip fractures. The study found that while functional recovery scores were similar between the DHS and PFN groups at 1-year post-surgery, patients treated with a DHS had significantly reduced function at 3 and 6 months compared to their pre-operative levels, whereas PFN patients did not experience this loss of function in the early months of recovery.
This document contains summaries of several research articles on various topics related to physiotherapy and physical therapy. The articles discuss the effects of home exercise programs for older adults, interval bicycling interventions for Parkinson's disease, exergaming and treadmill training for Parkinson's disease, predictors of walking speed after stroke, reliability of chest x-ray interpretation by physiotherapy students, effects of home rehabilitation on activities of daily living and gait for older adults with heart failure, a model for teaching ethical reflection in service learning, and several other topics related to physiotherapy treatments and interventions.
Effectiveness of cpm and conventional physical therapy after total knee arthr...FUAD HAZIME
This randomized clinical trial compared the effectiveness of 3 in-hospital rehabilitation programs following primary total knee arthroplasty (TKA): 1) conventional physical therapy alone, 2) conventional physical therapy with 35 minutes of continuous passive motion (CPM) daily, and 3) conventional physical therapy with 2 hours of CPM daily. Outcome measures included range of motion, functional ability, and length of stay. The results showed no significant differences between the groups for any outcomes, suggesting that adding CPM to conventional physical therapy provided no additional benefits after primary TKA.
This case study examines the outcomes of a 9-year-old male who received applied functional science movement based therapy following a 12-week arm cast for a distal radius/ulna fracture. The patient received 6 weeks of therapy focused on restoring range of motion, strength, and function through a progressive 3-phase protocol. Evaluation measures showed significant improvements in range of motion, grip strength, muscle strength, and disability scores. While grip strength improved substantially, it did not fully return to normal levels. The functional movement based approach effectively reduced impairments and disability from immobilization.
This study compared the incidence of neurobehavioral side effects of levetiracetam versus phenytoin in patients with traumatic brain injury (TBI). In a prospective observational study of 100 TBI patients treated with either levetiracetam or phenytoin, researchers found:
1. Levetiracetam was associated with significantly fewer neurobehavioral side effects than phenytoin, including less irritability, aggression, and confusion.
2. Phenytoin treatment resulted in nearly double the incidence of neurobehavioral side effects compared to levetiracetam.
3. Levetiracetam appears to be a better-tolerated antiepileptic drug for
Study of functional outcome following arthroscopic anatomical ACL reconstruct...Dr.Avinash Rao Gundavarapu
This document summarizes a study examining the functional outcomes of 40 patients who underwent arthroscopic anatomical ACL reconstruction using autologous hamstring grafts. The study found significant improvements in stability scores (measured by IKDC, Lachman, anterior drawer, and pivot shift tests) at 6-month follow-up compared to pre-operation scores. Complications were minor, with 7.5% having superficial infections and 7.5% difficulty regaining full range of motion. The study concludes that anatomical ACL reconstruction is an excellent technique for restoring stability, especially in active patients.
Does a standard outpatient physiotherapy regime improve the range of knee mot...FUAD HAZIME
This study investigated whether a standard outpatient physiotherapy regime improved range of knee motion after primary total knee arthroplasty (TKA). 150 patients were randomly assigned to either receive 6 weeks of outpatient physiotherapy after TKA (Group A) or no outpatient physiotherapy (Group B). Range of motion measurements found that while Group A achieved greater flexion than Group B, the difference was not statistically significant. The study concluded that outpatient physiotherapy does not improve range of knee motion after primary TKA.
This study compared the effectiveness of two rehabilitation programs for acute hamstring strains. Twenty-four athletes with hamstring strains were randomly assigned to either a static stretching, isolated strengthening, and icing program (STST group) or a progressive agility, trunk stabilization, and icing program (PATS group). The PATS group had a significantly shorter average time to return to sports (22.2 days vs 37.4 days) and lower reinjury rates both within 2 weeks of returning (0% vs 54.5%) and within 1 year (7.7% vs 70%) compared to the STST group. A rehabilitation program including progressive agility and trunk stabilization exercises was found to be more effective for returning athletes to
Hip fractures are common and debilitating injuries among the elderly that can result in loss of independence and mortality. This study compared functional recovery outcomes between elderly patients treated surgically with either a dynamic hip screw (DHS) or proximal femoral nail (PFN) for intertrochanteric hip fractures. The study found that while functional recovery scores were similar between the DHS and PFN groups at 1-year post-surgery, patients treated with a DHS had significantly reduced function at 3 and 6 months compared to their pre-operative levels, whereas PFN patients did not experience this loss of function in the early months of recovery.
This document contains summaries of several research articles on various topics related to physiotherapy and physical therapy. The articles discuss the effects of home exercise programs for older adults, interval bicycling interventions for Parkinson's disease, exergaming and treadmill training for Parkinson's disease, predictors of walking speed after stroke, reliability of chest x-ray interpretation by physiotherapy students, effects of home rehabilitation on activities of daily living and gait for older adults with heart failure, a model for teaching ethical reflection in service learning, and several other topics related to physiotherapy treatments and interventions.
Effectiveness of cpm and conventional physical therapy after total knee arthr...FUAD HAZIME
This randomized clinical trial compared the effectiveness of 3 in-hospital rehabilitation programs following primary total knee arthroplasty (TKA): 1) conventional physical therapy alone, 2) conventional physical therapy with 35 minutes of continuous passive motion (CPM) daily, and 3) conventional physical therapy with 2 hours of CPM daily. Outcome measures included range of motion, functional ability, and length of stay. The results showed no significant differences between the groups for any outcomes, suggesting that adding CPM to conventional physical therapy provided no additional benefits after primary TKA.
This study compared the effects of cruciate retaining (CR) total knee arthroplasty (TKA), posterior stabilized (PS) TKA, and uni-compartmental knee arthroplasty (UKA) on dynamic balance, pain, and functional performance following rehabilitation. The study assessed 45 patients who received either CR TKA, PS TKA, or UKA, as well as a control group of 15 patients who had knee osteoarthritis but did not undergo surgery. All patients underwent assessments of dynamic balance, pain, and functional performance before and after surgery and rehabilitation. The results showed that patients who received UKA had significantly better dynamic balance scores and lower pain and functional performance times compared to those who received CR or PS TKA, indicating that
A prospective comparative study of three treatmentHemant Pippal
This study compared the effectiveness of three treatment modalities for idiopathic adhesive capsulitis of the shoulder: 1) conservative treatment including physical therapy, 2) intra-articular steroid injections plus physical therapy, and 3) arthroscopic capsular release plus physical therapy. The study found that arthroscopic capsular release resulted in significantly better improvement in external shoulder rotation compared to conservative treatment alone. However, overall functional outcomes as measured by a shoulder rating questionnaire were similar across groups. The study concluded that conservative treatment remains an effective first-line option for adhesive capsulitis, though arthroscopic release may provide faster recovery of external rotation.
A randomized controlled trial will compare the effects of a 7-day residential multidisciplinary rehabilitation program to a 6-week individual outpatient physiotherapy program for 100 male UK military personnel aged 18-50 with non-arthritic intra-articular hip pain. Participants will be randomly assigned to receive either the residential multidisciplinary intervention involving group exercise, manual therapy, and education or the individualized outpatient physiotherapy led program involving exercise, manual therapy and education. Outcomes will be measured at baseline, post-treatment, and 3-month follow-up and include pain, physical function, range of motion, strength and quality of life. The study aims to determine if the intensive residential program provides better outcomes than conventional outpatient
The document presents five case reports that required referral from a physical therapist to a physician or specialist due to abnormal screening test results during differential diagnosis of hip versus lumbar spine pathology. Each case resulted in a new diagnosis beyond the scope of physical therapy, such as fracture or osteonecrosis of the hip. Cyriax's concepts of capsular and noncapsular patterns of joint restriction and the "Sign of the Buttock" were useful in differentiating hip from lumbar spine pathology in each patient. The clinical experience suggests these screening tests may effectively identify hip pathology, but further research is needed.
Relationship between extrinsic factors and the acromio humeral distance (1)The Arm Clinic
This study investigated the relationship between various extrinsic factors and acromio-humeral distance (AHD) in male control and elite athlete shoulders. Measurements were taken of scapular rotation, shoulder range of motion, pectoralis minor length, thoracic curve, and AHD in neutral and 60° abduction. Correlations between the factors and AHD were determined, with some significant but weak relationships found. Multiple linear regression showed that combinations of factors accounted for up to 36% of the variance in AHD. The study supports that extrinsic factors influence AHD in a multi-factorial and population-specific manner.
This study examined the active self-correction of spinal curvatures in 249 children (136 females, 113 males aged 10-14 years) in response to the command "straighten your back". Spinal angles were measured in standing and sitting positions both spontaneously and after the command. In standing, the command significantly increased sacral slope and decreased lumbar lordosis, thoracic kyphosis, and lower and upper thoracic kyphosis. In sitting, the command significantly changed sacral slope and lumbar lordosis from kyphotic to lordotic and significantly reduced thoracic kyphosis and flattened lower thoracic kyphosis. There were some gender differences in self-correction of lumbar lordosis and upper thoracic kyphosis
Presentation delivered at 2020 AAOS annual meeting by Dr Adnan Saithna, Professor of Orthopedic Surgery, Overland Park, Kansas. This randomised controlled study demonstrates that combined ACL and anterolateral ligament reconstruction is not associated with an increased risk of adverse events when compared to isolated ACL reconstruction
Goodwin efetividade da fisio supervisionada num período precGustavo Resek Borges
This randomized controlled trial evaluated the effectiveness of supervised physical therapy plus a home program versus a home program alone for 84 patients who underwent arthroscopic partial meniscectomy. Patients were randomly assigned to receive either 6 weeks of supervised physical therapy plus a home program or just a home program. Outcome measures were collected at 5 and 50 days post-surgery and found no differences between the groups, indicating that the supervised physical therapy used in this study provided no additional benefits in the early period after uncomplicated arthroscopic partial meniscectomy compared to a home program alone.
The study compared the effectiveness of electrical stimulation (ES) versus voluntary exercise (VE) for strengthening thigh musculature after anterior cruciate ligament (ACL) reconstructive surgery. Twenty patients were randomly assigned to either an ES or VE group and completed a 3-week training regimen. Results showed that patients in the ES group achieved significantly higher percentages of knee extension and flexion torque compared to patients in the VE group, indicating ES was more effective for strengthening thigh muscles early in postoperative rehabilitation.
Arthroplasty: Present practices by DR. D. P. SWAMI DR. D. P. SWAMI
COMPARISON OF DIFFERENT APPROACHES FOR HIP REPLACEMENT, DIFFERENT ASPECTS OF OVERLAPPING SURGERIES IN TKR AND TEST FOR CONTAMINATION IN OPERATION THEATER
Effectiveness of Posture Correction Girdle as Conservative Treatment for Adol...CrimsonPublishersOPROJ
Effectiveness of Posture Correction Girdle as Conservative Treatment for Adolescent Idiopathic Scoliosis: a Preliminary Study by Joanne Yip in Orthopedic Research Online Journal
Pro disc l replacement vs circumferential arthrodesis of spineQueen Mary Hospital
This study compared results of the ProDisc-L total disc replacement to circumferential spinal fusion for treating two-level lumbar degenerative disc disease. 256 patients were randomized to the two procedures. At 24 months, 143 patients received total disc replacement while 60 received spinal fusion. The total disc replacement group had significantly less operative time, blood loss, and shorter hospital stays. Clinical outcomes including ODI, SF-36, and pain/satisfaction scales were measured at multiple points up to 24 months. Radiographic outcomes were also assessed to analyze device success and fusion rates between the two procedures.
This study compared the outcomes of two rehabilitation protocols for patients with Achilles tendinopathy: an exercise training group that was allowed to continue tendon-loading activities like running and jumping, and an active rest group that was not allowed such activities during the first six weeks. Both groups followed the same progressive strengthening program after the initial period. The study found no significant differences in outcomes between the groups, as both showed significant improvements on patient-reported and functional measures from baseline to 12-month follow-up. The results suggest that continuing tendon-loading activity during rehabilitation, using a pain-monitoring model, does not have negative effects.
This study compared the effectiveness of global postural reeducation (GPR) to segmental exercises (SE) in treating scapular dyskinesis associated with neck pain. 30 patients were randomly assigned to 10 weeks of GPR or SE. Both groups improved in upper extremity and neck function and pain. However, only GPR improved physical and mental quality of life. When comparing groups, GPR was superior in improving pain and physical quality of life. This preliminary study suggests GPR may be more effective than SE for reducing pain and improving well-being in patients with scapular dyskinesis and neck pain.
A comparison of 2 cpm protocols after total knee arthroplastyFUAD HAZIME
1. The study compared outcomes of two continuous passive motion (CPM) protocols (standard vs early flexion) and a no-CPM control group following total knee arthroplasty.
2. The early flexion CPM group had significantly greater range of flexion than the other groups at 5 days post-op but there were no other significant differences between groups.
3. While early flexion CPM resulted in better short-term range of motion, the study found no substantial benefits of either CPM protocol over no CPM for other outcomes like length of stay, wound healing, or function.
Crimson Publishers - Efficacy of Core Strengthening Exercise on a Geriatric S...CrimsonpublishersMedical
Efficacy of Core Strengthening Exercise on a Geriatric Subject with Lumbar Spine Degeneration-Evidence Based Study by Subramanian ss* in Research in Medical & Engineering Sciences
This study examined bone mineral density (BMD) in 54 children and adolescents with juvenile idiopathic arthritis before and after a 12-week exercise program. The participants were randomly assigned to an exercise group or control group. The exercise group performed 100 two-footed jumps with a rope and muscle strength exercises 3 times per week. BMD was measured at the start, after 3 months, and after 6 months using dual-energy x-ray absorptiometry. The results showed that BMD values in the total body increased significantly in the exercise group after the program, while BMD measurements remained stable in the control group and for all participants remained within the normal reference range compared to other children. Thus, a short-
This study examined the intertester reliability of using James Cyriax's system for assessing patients with shoulder pain. Two experienced physical therapists independently evaluated 21 cases of painful shoulders using Cyriax's evaluation method. They classified the cases into specific shoulder lesions or indicated that the case did not fit the Cyriax model. The therapists agreed on the classification for 19 of the 21 cases, showing 90.5% agreement. Statistical analysis found "almost perfect" agreement between the therapists. Both therapists also agreed on the same 4 cases that did not fit the Cyriax model. The results demonstrate that Cyriax's evaluation can be a highly reliable method for assessing patients with shoulder pain.
A Study to compare the effect of Open versus Closed kinetic chain exercises i...IOSR Journals
Abstract: Background And Purpose Of The Study: Patello-femoral arthritis is the most common type of
arthritis especially older people sometimes it is called as degenerative joint disease. Patello- femoral arthritis is
one of the common causes of physical disability in adults. It is the second most common cause of chronic
conditions. 50% of older persons after 55 years are affected. Some of the young people get arthritis from the
joint injuries. Arthritis is the leading cause of disability in our nation more than other systemic diseases like
heart diseases, cancer and diabetes. There are many therapeutic interventions for the treatment of patellofemoral
arthritis. The study is to determine whether closed kinetic chain exercise offer any advantages over
open kinetic chain exercises.
Method: The patients are randomly selected based on inclusion and exclusion criteria and divided into two
groups. Group A and Group B. Group A is trained with closed kinetic chain exercise and Group B is trained
with open kinetic chain exercises for a period of 12 weeks. the pre and post treatment readings of VAS and
KUJALA scale are taken in both groups for statistical analysis.
Results: The results showed reduction in pain and improvement in functional activity in both Group A and
Group B, significant improvement has been noted in Group A after 12 weeks of training.
Conclusion: This study shows that there was significant improvement in functional ability and reduction of pain
as a result of both open and closed kinetic chain exercises program. There are only few significant differences
between closed kinetic chain exercises (GROUP-A) and open kineticchain exercises (GROUP-B). It reviles that
closed kinetic chain exercises are more effective in the treatment of patello-femoral arthritis than the
(GROUP-B) open kinetic chain exercises
Preoperative physical therapy in primary total knee arthroplastyFUAD HAZIME
This study evaluated the effects of preoperative physical therapy in patients undergoing primary total knee arthroplasty. 10 patients completed 6 weeks of physical therapy before surgery while 10 control patients did not receive preoperative therapy. Both groups were tested before and after surgery and compared. The study found that preoperative physical therapy resulted in modest gains in knee flexion strength but no difference in extension strength or other short-term outcomes like function, range of motion, or muscle size. Therefore, the study did not support the routine use of preoperative physical therapy for knee replacement surgery.
This case report summarizes the physical therapy management of a 62-year-old female patient following a right medial unicompartmental knee arthroplasty (UKA). The patient presented with impairments including decreased range of motion, strength, and functional ability. Physical therapy focused on improving range of motion, strength, and dynamic balance through interventions like stretching, strengthening, and balance exercises. Outcomes included clinically meaningful improvements in knee range of motion and function, though some deficits remained at discharge. The report discusses rehabilitation after UKA compared to accelerated protocols for total knee arthroplasty, noting generally faster recovery times but some lingering functional weakness in this case.
This study compared the effects of cruciate retaining (CR) total knee arthroplasty (TKA), posterior stabilized (PS) TKA, and uni-compartmental knee arthroplasty (UKA) on dynamic balance, pain, and functional performance following rehabilitation. The study assessed 45 patients who received either CR TKA, PS TKA, or UKA, as well as a control group of 15 patients who had knee osteoarthritis but did not undergo surgery. All patients underwent assessments of dynamic balance, pain, and functional performance before and after surgery and rehabilitation. The results showed that patients who received UKA had significantly better dynamic balance scores and lower pain and functional performance times compared to those who received CR or PS TKA, indicating that
A prospective comparative study of three treatmentHemant Pippal
This study compared the effectiveness of three treatment modalities for idiopathic adhesive capsulitis of the shoulder: 1) conservative treatment including physical therapy, 2) intra-articular steroid injections plus physical therapy, and 3) arthroscopic capsular release plus physical therapy. The study found that arthroscopic capsular release resulted in significantly better improvement in external shoulder rotation compared to conservative treatment alone. However, overall functional outcomes as measured by a shoulder rating questionnaire were similar across groups. The study concluded that conservative treatment remains an effective first-line option for adhesive capsulitis, though arthroscopic release may provide faster recovery of external rotation.
A randomized controlled trial will compare the effects of a 7-day residential multidisciplinary rehabilitation program to a 6-week individual outpatient physiotherapy program for 100 male UK military personnel aged 18-50 with non-arthritic intra-articular hip pain. Participants will be randomly assigned to receive either the residential multidisciplinary intervention involving group exercise, manual therapy, and education or the individualized outpatient physiotherapy led program involving exercise, manual therapy and education. Outcomes will be measured at baseline, post-treatment, and 3-month follow-up and include pain, physical function, range of motion, strength and quality of life. The study aims to determine if the intensive residential program provides better outcomes than conventional outpatient
The document presents five case reports that required referral from a physical therapist to a physician or specialist due to abnormal screening test results during differential diagnosis of hip versus lumbar spine pathology. Each case resulted in a new diagnosis beyond the scope of physical therapy, such as fracture or osteonecrosis of the hip. Cyriax's concepts of capsular and noncapsular patterns of joint restriction and the "Sign of the Buttock" were useful in differentiating hip from lumbar spine pathology in each patient. The clinical experience suggests these screening tests may effectively identify hip pathology, but further research is needed.
Relationship between extrinsic factors and the acromio humeral distance (1)The Arm Clinic
This study investigated the relationship between various extrinsic factors and acromio-humeral distance (AHD) in male control and elite athlete shoulders. Measurements were taken of scapular rotation, shoulder range of motion, pectoralis minor length, thoracic curve, and AHD in neutral and 60° abduction. Correlations between the factors and AHD were determined, with some significant but weak relationships found. Multiple linear regression showed that combinations of factors accounted for up to 36% of the variance in AHD. The study supports that extrinsic factors influence AHD in a multi-factorial and population-specific manner.
This study examined the active self-correction of spinal curvatures in 249 children (136 females, 113 males aged 10-14 years) in response to the command "straighten your back". Spinal angles were measured in standing and sitting positions both spontaneously and after the command. In standing, the command significantly increased sacral slope and decreased lumbar lordosis, thoracic kyphosis, and lower and upper thoracic kyphosis. In sitting, the command significantly changed sacral slope and lumbar lordosis from kyphotic to lordotic and significantly reduced thoracic kyphosis and flattened lower thoracic kyphosis. There were some gender differences in self-correction of lumbar lordosis and upper thoracic kyphosis
Presentation delivered at 2020 AAOS annual meeting by Dr Adnan Saithna, Professor of Orthopedic Surgery, Overland Park, Kansas. This randomised controlled study demonstrates that combined ACL and anterolateral ligament reconstruction is not associated with an increased risk of adverse events when compared to isolated ACL reconstruction
Goodwin efetividade da fisio supervisionada num período precGustavo Resek Borges
This randomized controlled trial evaluated the effectiveness of supervised physical therapy plus a home program versus a home program alone for 84 patients who underwent arthroscopic partial meniscectomy. Patients were randomly assigned to receive either 6 weeks of supervised physical therapy plus a home program or just a home program. Outcome measures were collected at 5 and 50 days post-surgery and found no differences between the groups, indicating that the supervised physical therapy used in this study provided no additional benefits in the early period after uncomplicated arthroscopic partial meniscectomy compared to a home program alone.
The study compared the effectiveness of electrical stimulation (ES) versus voluntary exercise (VE) for strengthening thigh musculature after anterior cruciate ligament (ACL) reconstructive surgery. Twenty patients were randomly assigned to either an ES or VE group and completed a 3-week training regimen. Results showed that patients in the ES group achieved significantly higher percentages of knee extension and flexion torque compared to patients in the VE group, indicating ES was more effective for strengthening thigh muscles early in postoperative rehabilitation.
Arthroplasty: Present practices by DR. D. P. SWAMI DR. D. P. SWAMI
COMPARISON OF DIFFERENT APPROACHES FOR HIP REPLACEMENT, DIFFERENT ASPECTS OF OVERLAPPING SURGERIES IN TKR AND TEST FOR CONTAMINATION IN OPERATION THEATER
Effectiveness of Posture Correction Girdle as Conservative Treatment for Adol...CrimsonPublishersOPROJ
Effectiveness of Posture Correction Girdle as Conservative Treatment for Adolescent Idiopathic Scoliosis: a Preliminary Study by Joanne Yip in Orthopedic Research Online Journal
Pro disc l replacement vs circumferential arthrodesis of spineQueen Mary Hospital
This study compared results of the ProDisc-L total disc replacement to circumferential spinal fusion for treating two-level lumbar degenerative disc disease. 256 patients were randomized to the two procedures. At 24 months, 143 patients received total disc replacement while 60 received spinal fusion. The total disc replacement group had significantly less operative time, blood loss, and shorter hospital stays. Clinical outcomes including ODI, SF-36, and pain/satisfaction scales were measured at multiple points up to 24 months. Radiographic outcomes were also assessed to analyze device success and fusion rates between the two procedures.
This study compared the outcomes of two rehabilitation protocols for patients with Achilles tendinopathy: an exercise training group that was allowed to continue tendon-loading activities like running and jumping, and an active rest group that was not allowed such activities during the first six weeks. Both groups followed the same progressive strengthening program after the initial period. The study found no significant differences in outcomes between the groups, as both showed significant improvements on patient-reported and functional measures from baseline to 12-month follow-up. The results suggest that continuing tendon-loading activity during rehabilitation, using a pain-monitoring model, does not have negative effects.
This study compared the effectiveness of global postural reeducation (GPR) to segmental exercises (SE) in treating scapular dyskinesis associated with neck pain. 30 patients were randomly assigned to 10 weeks of GPR or SE. Both groups improved in upper extremity and neck function and pain. However, only GPR improved physical and mental quality of life. When comparing groups, GPR was superior in improving pain and physical quality of life. This preliminary study suggests GPR may be more effective than SE for reducing pain and improving well-being in patients with scapular dyskinesis and neck pain.
A comparison of 2 cpm protocols after total knee arthroplastyFUAD HAZIME
1. The study compared outcomes of two continuous passive motion (CPM) protocols (standard vs early flexion) and a no-CPM control group following total knee arthroplasty.
2. The early flexion CPM group had significantly greater range of flexion than the other groups at 5 days post-op but there were no other significant differences between groups.
3. While early flexion CPM resulted in better short-term range of motion, the study found no substantial benefits of either CPM protocol over no CPM for other outcomes like length of stay, wound healing, or function.
Crimson Publishers - Efficacy of Core Strengthening Exercise on a Geriatric S...CrimsonpublishersMedical
Efficacy of Core Strengthening Exercise on a Geriatric Subject with Lumbar Spine Degeneration-Evidence Based Study by Subramanian ss* in Research in Medical & Engineering Sciences
This study examined bone mineral density (BMD) in 54 children and adolescents with juvenile idiopathic arthritis before and after a 12-week exercise program. The participants were randomly assigned to an exercise group or control group. The exercise group performed 100 two-footed jumps with a rope and muscle strength exercises 3 times per week. BMD was measured at the start, after 3 months, and after 6 months using dual-energy x-ray absorptiometry. The results showed that BMD values in the total body increased significantly in the exercise group after the program, while BMD measurements remained stable in the control group and for all participants remained within the normal reference range compared to other children. Thus, a short-
This study examined the intertester reliability of using James Cyriax's system for assessing patients with shoulder pain. Two experienced physical therapists independently evaluated 21 cases of painful shoulders using Cyriax's evaluation method. They classified the cases into specific shoulder lesions or indicated that the case did not fit the Cyriax model. The therapists agreed on the classification for 19 of the 21 cases, showing 90.5% agreement. Statistical analysis found "almost perfect" agreement between the therapists. Both therapists also agreed on the same 4 cases that did not fit the Cyriax model. The results demonstrate that Cyriax's evaluation can be a highly reliable method for assessing patients with shoulder pain.
A Study to compare the effect of Open versus Closed kinetic chain exercises i...IOSR Journals
Abstract: Background And Purpose Of The Study: Patello-femoral arthritis is the most common type of
arthritis especially older people sometimes it is called as degenerative joint disease. Patello- femoral arthritis is
one of the common causes of physical disability in adults. It is the second most common cause of chronic
conditions. 50% of older persons after 55 years are affected. Some of the young people get arthritis from the
joint injuries. Arthritis is the leading cause of disability in our nation more than other systemic diseases like
heart diseases, cancer and diabetes. There are many therapeutic interventions for the treatment of patellofemoral
arthritis. The study is to determine whether closed kinetic chain exercise offer any advantages over
open kinetic chain exercises.
Method: The patients are randomly selected based on inclusion and exclusion criteria and divided into two
groups. Group A and Group B. Group A is trained with closed kinetic chain exercise and Group B is trained
with open kinetic chain exercises for a period of 12 weeks. the pre and post treatment readings of VAS and
KUJALA scale are taken in both groups for statistical analysis.
Results: The results showed reduction in pain and improvement in functional activity in both Group A and
Group B, significant improvement has been noted in Group A after 12 weeks of training.
Conclusion: This study shows that there was significant improvement in functional ability and reduction of pain
as a result of both open and closed kinetic chain exercises program. There are only few significant differences
between closed kinetic chain exercises (GROUP-A) and open kineticchain exercises (GROUP-B). It reviles that
closed kinetic chain exercises are more effective in the treatment of patello-femoral arthritis than the
(GROUP-B) open kinetic chain exercises
Preoperative physical therapy in primary total knee arthroplastyFUAD HAZIME
This study evaluated the effects of preoperative physical therapy in patients undergoing primary total knee arthroplasty. 10 patients completed 6 weeks of physical therapy before surgery while 10 control patients did not receive preoperative therapy. Both groups were tested before and after surgery and compared. The study found that preoperative physical therapy resulted in modest gains in knee flexion strength but no difference in extension strength or other short-term outcomes like function, range of motion, or muscle size. Therefore, the study did not support the routine use of preoperative physical therapy for knee replacement surgery.
This case report summarizes the physical therapy management of a 62-year-old female patient following a right medial unicompartmental knee arthroplasty (UKA). The patient presented with impairments including decreased range of motion, strength, and functional ability. Physical therapy focused on improving range of motion, strength, and dynamic balance through interventions like stretching, strengthening, and balance exercises. Outcomes included clinically meaningful improvements in knee range of motion and function, though some deficits remained at discharge. The report discusses rehabilitation after UKA compared to accelerated protocols for total knee arthroplasty, noting generally faster recovery times but some lingering functional weakness in this case.
This document summarizes the pulmonary management of a 19-year-old male patient with a complete thoracic spinal cord injury and internal injuries from a gunshot wound. After two weeks of daily inspiratory muscle training (IMT) using a resistance device, the patient showed improvements in measures of chest excursion, incentive spirometry, breath support, and timed mobility tests. While IMT appeared beneficial for this patient, further research is needed to determine its efficacy for individuals with paraplegia using larger sample sizes and controlling for confounding variables. Pulmonary management can help improve respiratory status and function for those with spinal cord injuries.
The document discusses a client named Glenn who underwent pre-screening that revealed high risk during exercise due to medical conditions. An exercise program was implemented based on GP recommendations to help manage his conditions and reduce disease risks. Pre-screening methods are discussed as an effective way to reduce adverse events during exercise.
This document contains abstracts from multiple conference presentations on various chiropractic case studies and research:
- The first case study found that implementing functional medicine protocols as part of chiropractic care resulted in improved health outcomes for a patient with various chronic conditions over 15 years.
- The second case study found that a 9-week-old infant with retrocollis saw resolution of their posture issues with 6 chiropractic adjustments to the upper cervical spine.
- A third case study presented a successful total ankle replacement in a 51-year-old patient with end-stage ankle osteoarthritis.
- Multiple additional abstracts summarized chiropractic case studies and research on various topics.
Long-Term Effect of Exercise Therapyand Patient Education on.docxwkyra78
Long-Term Effect of Exercise Therapy
and Patient Education on Impairments
and Activity Limitations in People
With Hip Osteoarthritis: Secondary
Outcome Analysis of a Randomized
Clinical Trial
Ida Svege, Linda Fernandes, Lars Nordsletten, Inger Holm, May Arna Risberg
Background. The effect of exercise on specific impairments and activity limitations in
people with hip osteoarthritis (OA) is limited.
Objective. The study objective was to evaluate the long-term effect of exercise therapy and
patient education on range of motion (ROM), muscle strength, physical fitness, walking
capacity, and pain during walking in people with hip OA.
Design. This was a secondary outcome analysis of a randomized clinical trial.
Setting. The setting was a university hospital.
Participants. One hundred nine people with clinically and radiographically evident hip
OA were randomly allocated to receive both exercise therapy and patient education (exercise
group) or patient education only (control group).
Intervention. All participants attended a patient education program consisting of 3 group
meetings led by 2 physical therapists. Two other physical therapists were responsible for
providing the exercise therapy program, consisting of 2 or 3 weekly sessions of strengthening,
functional, and stretching exercises over 12 weeks. Both interventions were conducted at a
sports medicine clinic.
Measurements. Outcome measures included ROM, isokinetic muscle strength, predicted
maximal oxygen consumption determined with the Astrand bicycle ergometer test, and
distance and pain during the Six-Minute Walk Test (6MWT). Follow-up assessments were
conducted 4, 10, and 29 months after enrollment by 5 physical therapists who were unaware
of group allocations.
Results. No significant group differences were found for ROM, muscle strength, predicted
maximal oxygen consumption, or distance during the 6MWT over the follow-up period, but
the exercise group had less pain during the 6MWT than the control group at 10 months (mean
difference��8.5 mm; 95% confidence interval��16.1, �0.9) and 29 months (mean differ-
ence��9.3 mm; 95% confidence interval��18.1, �0.6).
Limitations. Limitations of the study were reduced statistical power and 53% rate of
adherence to the exercise therapy program.
Conclusions. The previously described effect of exercise on self-reported function was
not reflected by beneficial results for ROM, muscle strength, physical fitness, and walking
capacity, but exercise in addition to patient education resulted in less pain during walking in
the long term.
I. Svege, PT, PhD, Norwegian
Research Center for Active Reha-
bilitation, Department of Ortho-
paedics, Oslo University Hospital,
Kirkeveien 166, 0450 Oslo, Nor-
way. Address all correspondence
to Dr Svege at: [email protected]
ous-hf.no.
L. Fernandes, PT, PhD, Norwegian
Research Center for Active Reha-
bilitation, Department of Ortho-
paedics, Oslo University Hospital,
and Department of Orthopaedic
Surgery and T.
Long-Term Effect of Exercise Therapyand Patient Education on.docxcroysierkathey
Long-Term Effect of Exercise Therapy
and Patient Education on Impairments
and Activity Limitations in People
With Hip Osteoarthritis: Secondary
Outcome Analysis of a Randomized
Clinical Trial
Ida Svege, Linda Fernandes, Lars Nordsletten, Inger Holm, May Arna Risberg
Background. The effect of exercise on specific impairments and activity limitations in
people with hip osteoarthritis (OA) is limited.
Objective. The study objective was to evaluate the long-term effect of exercise therapy and
patient education on range of motion (ROM), muscle strength, physical fitness, walking
capacity, and pain during walking in people with hip OA.
Design. This was a secondary outcome analysis of a randomized clinical trial.
Setting. The setting was a university hospital.
Participants. One hundred nine people with clinically and radiographically evident hip
OA were randomly allocated to receive both exercise therapy and patient education (exercise
group) or patient education only (control group).
Intervention. All participants attended a patient education program consisting of 3 group
meetings led by 2 physical therapists. Two other physical therapists were responsible for
providing the exercise therapy program, consisting of 2 or 3 weekly sessions of strengthening,
functional, and stretching exercises over 12 weeks. Both interventions were conducted at a
sports medicine clinic.
Measurements. Outcome measures included ROM, isokinetic muscle strength, predicted
maximal oxygen consumption determined with the Astrand bicycle ergometer test, and
distance and pain during the Six-Minute Walk Test (6MWT). Follow-up assessments were
conducted 4, 10, and 29 months after enrollment by 5 physical therapists who were unaware
of group allocations.
Results. No significant group differences were found for ROM, muscle strength, predicted
maximal oxygen consumption, or distance during the 6MWT over the follow-up period, but
the exercise group had less pain during the 6MWT than the control group at 10 months (mean
difference��8.5 mm; 95% confidence interval��16.1, �0.9) and 29 months (mean differ-
ence��9.3 mm; 95% confidence interval��18.1, �0.6).
Limitations. Limitations of the study were reduced statistical power and 53% rate of
adherence to the exercise therapy program.
Conclusions. The previously described effect of exercise on self-reported function was
not reflected by beneficial results for ROM, muscle strength, physical fitness, and walking
capacity, but exercise in addition to patient education resulted in less pain during walking in
the long term.
I. Svege, PT, PhD, Norwegian
Research Center for Active Reha-
bilitation, Department of Ortho-
paedics, Oslo University Hospital,
Kirkeveien 166, 0450 Oslo, Nor-
way. Address all correspondence
to Dr Svege at: [email protected]
ous-hf.no.
L. Fernandes, PT, PhD, Norwegian
Research Center for Active Reha-
bilitation, Department of Ortho-
paedics, Oslo University Hospital,
and Department of Orthopaedic
Surgery and T ...
Concussions are a growing concern, especially in young athletes. Common symptoms include headaches, dizziness, and memory issues. While rest is usually recommended, longer periods of inactivity do not necessarily lead to faster recovery. Physical therapy can help address lingering symptoms through manual therapy, soft tissue work, vestibular rehabilitation, education, and light aerobic exercise. Further research is still needed to better understand and treat concussions.
This document reviews interventions for improving outcomes following total hip or knee arthroplasty. It finds that pre-operative patient education, nutrition management, and pain management can help reduce hospital stays and aid recovery. Specifically, education improves expectations and anxiety, while addressing malnutrition and anemia. Neuromuscular electrical stimulation pre-operatively may also enhance muscle strength and early mobility.
Assessing recovery and establishing prognosis following total knee arthroplastyFUAD HAZIME
This study assessed recovery over 1 year following total knee arthroplasty using the Lower Extremity Functional Scale (LEFS) and Six-Minute Walk Test (6MWT). The greatest improvement occurred in the first 12 weeks, with slower improvement from 12-26 weeks, and little improvement after 26 weeks. The results provide clinicians with information on expected recovery timelines to guide prognosis and rehabilitation planning.
To Determine Preference of Shoulder Pain Management by General Physicians in ...suppubs1pubs1
Rotator cuff muscles are functionally active and provide stability to the shoulder joint and also thereby allow the full Range of Motion (ROM) by moving the head of humerus in the glenoid cavity. Any tear or fragility of the rotator cuff muscles can cause the dislocation or instability and hence damaging other muscles specially the long head of biceps muscle. The diseases related to the supraspinatus tendon are frequently linked with the long head of the biceps tendon. Other cause of chronic shoulder pain is the adhesive capsulitis with large prevalence rates of more than 5.3% in the general target population [3].
Effectiveness of physiotherapy exercise after knee arthroplasty for oa.FUAD HAZIME
This systematic review evaluated the effectiveness of physiotherapy exercise after knee arthroplasty for osteoarthritis. The review included 6 randomized controlled trials that compared physiotherapy exercise interventions to usual care or different exercise interventions after discharge. The review found small to moderate benefits of functional exercise for function, range of motion, and quality of life 3-4 months after surgery. However, benefits were no longer evident at 1 year, suggesting no long term benefit of physiotherapy exercise after knee arthroplasty.
Effectiveness of pt artro systematic review and metanalysisFUAD HAZIME
This systematic review evaluated the effectiveness of physiotherapy exercise after knee arthroplasty for osteoarthritis. The review included 6 randomized controlled trials that compared physiotherapy exercise interventions to usual care or different exercise interventions after discharge. The review found small to moderate benefits of functional exercise for function, range of motion, and quality of life 3-4 months after surgery. However, benefits were no longer evident at 1 year, suggesting no long term benefit of physiotherapy exercise after knee arthroplasty.
Pilot Study of Massage in Veterans with Knee OsteoarthritisMichael Juberg
This pilot study assessed the feasibility and preliminary efficacy of Swedish massage therapy for 25 veterans with knee osteoarthritis. The study found high retention and adherence rates, suggesting massage was feasible and acceptable for veterans. Veterans receiving 8 weekly one-hour massage sessions experienced statistically significant improvements in self-reported knee pain, stiffness, function, and quality of life, as well as trends toward improved range of motion. The results support further study of massage as a treatment approach for knee osteoarthritis in veterans.
This document provides an overview of spasticity, including its pathophysiology, assessment, and treatment options. It defines spasticity as velocity-dependent increased muscle tone caused by hyperactive stretch reflexes. Assessment involves history, physical exam using scales like the Modified Ashworth Scale, and sometimes quantitative testing. Treatment depends on whether spasticity is generalized or localized and includes oral medications, botulinum toxin injections, phenol/alcohol injections, intrathecal baclofen, and occasionally neurosurgeries. The appropriate treatment choice depends on the specific muscles affected and individual patient factors.
The document discusses the frequency of common clinical conditions among clients presented at Habib Physiotherapy Complex in 2010. The most common condition was low back pain (29% of clients). The second most common was osteoarthritis of the knee joint (20% of clients). The third most common was cerebrovascular accidents (18.4% of clients). Other common conditions included cervical pain, frozen shoulder, pelvic inflammation, cerebral palsy, and effects of polio. The study found that musculoskeletal conditions like low back pain, osteoarthritis, and joint pain were among the most frequent issues deteriorating individuals' functioning in the studied society.
Effectiveness of Stretch Interventions for Children With Neuromuscular Disabi...Sarah Craig
This systematic review examined the effectiveness of stretch interventions for children with neuromuscular disabilities. Sixteen studies were included, with sample sizes ranging from 14 to 1110 participants. The studies evaluated casting, orthoses, passive stretching, and supported standing programs. Low-grade evidence suggests casting can temporarily increase ankle range of motion. Orthoses may improve gait parameters while worn. Supported standing programs may improve bone mineral density. However, there is limited evidence stretch interventions benefit body functions and structures. The evidence is also inconclusive regarding whether stretching prevents contractures or impacts activity or participation. Overall, the methodological quality of included studies was poor.
This document contains summaries of 4 research studies:
1. A randomized controlled trial that found suprascapular nerve blocks were no more effective than saline injections for treating subacute adhesive capsulitis.
2. A study that found intra-articular injections of hyaluronic acid plus dextrose for knee osteoarthritis resulted in greater improvements in physical function and pain reduction compared to hyaluronic acid plus saline.
3. A randomized controlled trial that demonstrated alendronate effectively prevented bone loss in the hip in men during the first year after a traumatic spinal cord injury.
4. A study that found patients with acquired brain injuries who had contractures required more intensive rehabilitation therapy, longer
Early Outcome of Discectomy with Interspinous Process Distraction Device a Re...CrimsonPublishersOPROJ
Early Outcome of Discectomy with Interspinous Process Distraction Device a Retrospective Cross-Sectional Study by Gunaseelan Ponnusamy* in Crimson Publishers: Orthopedic Research and Reviews Journal
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BMJ Open Sport Exerc Med-2016-Coppack-[1]
1. Physical and functional outcomes
following multidisciplinary residential
rehabilitation for prearthritic hip pain
among young active UK military
personnel
Russell J Coppack,1,2
James L Bilzon,2
Andrew K Wills,3
Ian M McCurdie,4
Laura K Partridge,4
Alastair M Nicol,4
Alexander N Bennett1,5
To cite: Coppack RJ,
Bilzon JL, Wills AK, et al.
Physical and functional
outcomes following
multidisciplinary residential
rehabilitation for prearthritic
hip pain among young active
UK military personnel. BMJ
Open Sport Exerc Med
2016;2:e000107.
doi:10.1136/bmjsem-2015-
000107
▸ Prepublication history for
this paper is available online.
To view these files please
visit the journal online
(http://dx.doi.org/10.1136/
bmjsem-2015-000107).
Accepted 11 March 2016
For numbered affiliations see
end of article.
Correspondence to
Russell J Coppack;
russ.coppack100@mod.uk
ABSTRACT
Background: There are no studies describing the
clinical outcomes of a residential, multidisciplinary
team (MDT) rehabilitation intervention for patients with
prearthritic hip pain. The aim of this cohort study was
to describe the functional and physical outcomes of
multidisciplinary residential rehabilitation for UK
military personnel with prearthritic hip pain.
Methods: Participants (N=40) with a mean age of
33 years referred to a specialist residential rehabilitation
centre completed a comprehensive multidisciplinary
residential intervention. The main outcome measures
were mean pain, physical function (modified shuttle
test (MST) and Y-balance test), hip range of motion
(HROM) and a patient-reported outcome measure (The
Copenhagen Hip and Groin Outcome Score, HAGOS).
All scores for symptomatic hips were taken at baseline
and post-treatment.
Results: There were improvements in the Y-balance
test and HROM following rehabilitation. There were
significant improvements in mean difference (T1-to-T2)
for Y-balance scores (15.8 cm, 95% CI 10.7 to 20.9,
p<0.001), HROM (6.5° increase in hip flexion, 95% CI
4.6 to 9.4, p<0.001) and hip internal rotation (4.6°,
95% CI 2.7 to 6.6, p<0.001). Scores for HAGOS, pain,
MST and functional activity assessment showed no
improvement.
Conclusions: Among UK military personnel with
prearthritic hip pain, MDT residential rehabilitation
resulted in improvements in a functional Y-balance
test, hip flexion and internal rotation. The study
suggests short-term benefits across some outcomes
for the current UK military approach to MDT residential
rehabilitation.
INTRODUCTION
Prearthritic hip disorders are abnormalities
of the articulating surfaces of the acetabulum
and femoral head before the onset of osteo-
arthritis (OA), including intra-articular struc-
tures such as the acetabular labrum and
chondral surfaces.1
Abnormalities of these
structures can lead to biomechanical
changes associated with significant hip pain
and dysfunction in young adults.2 3
Femoroacetabular impingement (FAI) is
recognised as a major cause of prearthritic
hip pain in young active adults.4 5
FAI is
characterised by impingement between the
proximal end of the femur and acetabular
rim caused by either an abnormally shaped
femoral head (cam impingement) and/or
an abnormally shaped acetabulum (pincer
impingement).6 7
Abnormal femoroacetabu-
lar morphology is commonly seen in young
men who make up much of the UK military
population.8
Furthermore, hip pain with
mechanical symptoms, particularly acetabu-
lar labral tears, are common symptoms pre-
senting to the military orthopaedic surgeon.9
Hip arthroscopy and non-surgical interven-
tions such as the treatments offered by phy-
siotherapists, are recommended in the
management of prearthritic FAI.1 10–12
However, while single (unidisciplinary) treat-
ments have been the subject of research,2 10 12
there are no studies evaluating multidiscip-
linary team (MDT) programmes for the
conservative treatment or postsurgical
rehabilitation of prearthritic intra-articular
What are the new findings
▪ We describe the clinical outcomes of multidiscip-
linary team residential rehabilitation on young
active patients with prearthritic hip pain/femoroa-
cetabular impingement.
▪ There was improvement in physical capacity
measured by the Y-balance test and hip range of
motion.
Coppack RJ, et al. BMJ Open Sport Exerc Med 2016;2:e000107. doi:10.1136/bmjsem-2015-000107 1
Open Access Research
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2. hip disorders in young adults. Residential (inpatient)
MDT rehabilitation for patients with musculoskeletal
injuries has a long tradition in the UK military.
Rehabilitation most often takes place in two clinical set-
tings; outpatient primary care rehabilitation facilities
(PCRFs), and inpatient residential centres including
regional rehabilitation units (RRUs) and the UK
Defence Medical Rehabilitation Centre (DMRC),
Headley Court. Rehabilitation at the PCRF is focused
primarily on physical function led by a physiotherapist,
whereas residential centres have access to larger
consultant-led MDTs delivering a broader biopsychoso-
cial approach to treatment.
Despite the popularity and acceptance of residential
MDT rehabilitation in the UK military, evidence support-
ing its effectiveness is lacking, and the extent to which
outcomes differ between residential and outpatient
approaches remains unknown. Therefore, the objective
of our study was to describe the structure and process of
a residential MDT intervention for UK military person-
nel with prearthritic hip pain and describe their asso-
ciated clinical outcomes.
METHODS
Setting
The study was conducted at a specialist UK military
rehabilitation centre.
Study design
We performed a retrospective cohort study. A review of
the computerised clinical records was performed on
military personnel admitted to the UK DMRC hip pain
treatment programme. The intention of the observa-
tional study design was to describe and record the clin-
ical outcomes of residential, multidisciplinary hip
rehabilitation. Ethical approval was granted by the
University of Bath Research Ethics Approval Committee
for Health (REACH reference EP 15/16 87). In accord-
ance with Ministry of Defence (MOD) research ethics
guidelines, this study was exempt from requiring formal
MOD ethical approval as it was categorised as a service
evaluation. Approval for anonymised data extraction was
granted in accordance with the local Caldicott guardian
policy.
Participants
All UK military patients with clinical indicators of prear-
thritic, intra-articular hip pain attending DMRC for their
first admission between October 2014 and May 2015
were included in the study. Clinical diagnoses were con-
firmed on imaging with MRI±MR arthrogram prior to
admission for rehabilitation (figure 1). X-ray was used to
identify typical FAI features including cam and pincer-
type abnormalities. Patients were also included if they
were admitted for treatment following arthroscopy for
the management of acetabular labral tears. Participants
comprised a mix of non-surgical and postsurgical
patients completing concurrent residential treatment
reflecting current UK military rehabilitation practice.
Intervention
All patients completed an intensive, goal-based multidis-
ciplinary residential rehabilitation programme. Patients
received treatment from Monday to Friday for 5 h/day
over a 3-week period (mean (SD) duration 16.2±1.3
treatment days). The MDT consists of a consultant phys-
ician, physiotherapist, exercise rehabilitation instructor
and occupational therapist. On admission, all patients
underwent a comprehensive clinical assessment with
each member of the MDT. The standardised treatment
goals were to improve hip range of motion (HROM),
improve ‘global’ hip strength, improve core and trunk
muscle function, improve strength and neuromotor
control of the deep hip stabiliser muscles, correct gait
and balance deficits, control/reduce pain, improve func-
tion in daily living, and weight management. Active ther-
apies included individually prescribed and group
exercises, manual physiotherapy techniques, hydrother-
apy/swimming, and patient education. Administration of
non-steroidal anti-inflammatory drugs (NSAIDs) and
analgesics were minimised where possible and con-
trolled by the supervising lead consultant. The pro-
gramme was individually tailored to each patient based
on the findings of repeat assessments, weight-bearing
status and response to treatment. All patients received a
home-based exercise programme on discharge. Table 1
summarises the treatment intervention.
Outcome measures
Relevant descriptive, sociodemographic and
disease-related information at the time of admission
were recorded. The primary outcome was the change
from admission (baseline) to discharge (3 weeks) in
mean scores on a series of standardised, validated
outcome measures assessing pain, physical function and
occupational employability. Hip and groin disability was
measured using the Copenhagen Hip and Groin
Outcome Score (HAGOS).13
This self-report question-
naire is a quantitative measure of hip disability contain-
ing 37 questions covering six domains. Each question is
answered on a Likert scale and each subscale is trans-
formed and scored separately on a 100-point scale where
0=extreme problems and 100=no problems. The
HAGOS has good-to-excellent test–retest reliability and
responsiveness to change,14
and is specifically designed
to assess hip disorders in young active adults similar to
the UK military population. Hip pain was scored using a
100 mm horizontal visual analogue scale (VAS) where 0
represents no pain and 100 worst possible pain. A
minimal clinically important difference is 18 mm.15
The
VAS has shown good internal consistency16
and has been
extensively evaluated in clinical trials.16 17
Active HROM was measured for flexion and internal
rotation using a 360° goniometer. This is a standard
assessment widely used in the clinical setting with high
2 Coppack RJ, et al. BMJ Open Sport Exerc Med 2016;2:e000107. doi:10.1136/bmjsem-2015-000107
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group.bmj.comon May 5, 2016 - Published byhttp://bmjopensem.bmj.com/Downloaded from
3. test-retest reliability values reported in participants with
hip OA.18 19
Physical performance was measured using the modi-
fied 20 m shuttle test (MST). The MST20
involves walking
and running at gradually increasing speeds until the
patient is unable to continue. Speed is controlled by a
series of paced-auditory cues accompanied by recorded
verbal instructions. The MST ranges from level 0
(0.66 m/s) to level 28 (5 m/s). Thirty shuttles at level 28
is the highest level attainable before the test is termi-
nated. The MST is preferred by military rehabilitation
practitioners to the 6 min walk test21
because the incre-
mental increase in speed mimics a military marching
task.22
Dynamic balance and postural control was mea-
sured using the modified star excursion balance test,
known as the Y-balance test (figure 2).23
The Y-balance
test was developed to incorporate those directional move-
ments (anterior, posteromedial, posterolateral directions)
with the greatest accuracy in identifying lower extremity
dysfunction.24
The supervising therapist measures the
maximum distance in centimetres the patient can reach
with the free limb while balancing on the contralateral
limb. Scores for all three movements were combined to
provide a single composite measure of dynamic balance.
The test is a highly reliable tool to measure dynamic
balance,25
and is currently used by the UK military.
Figure 1 UK Defence Rehabilitation Hip Pain Care Pathway. AP anteroposterior; DMRC, Defence Medical Rehabilitation
Centre; FAI, femoroacetabular impingement; MDT, multidisciplinary team; PCRF, primary care rehabilitation facility.
Coppack RJ, et al. BMJ Open Sport Exerc Med 2016;2:e000107. doi:10.1136/bmjsem-2015-000107 3
Open Access
group.bmj.comon May 5, 2016 - Published byhttp://bmjopensem.bmj.com/Downloaded from
4. Occupational employability was assessed using the
functional activity assessment (FAA).26
The FAA is a
single-item, five-point ordinal measure developed to
assess occupational outcome in military rehabilitation
(table 2). The validity of the patient-reported FAA has
been tested on our military patient population at DMRC
and reported in the scientific literature.26 27
All outcome
measures were recorded at baseline (pretreatment) and
at 3 weeks (post-treatment) by a trained member of the
MDT.
Statistical analysis
For participants with bilateral hip pain, HROM and
Y-balance scores were summed (eg, right score+left
Table 1 Multidisciplinary team residential hip rehabilitation programme—components of treatment
Treatment
modality Treatment content Treatment goals
Frequency per
week (duration)
Group exercise Strengthening exercises, active range of
motion exercises, functional balance drills,
gait drills, progressive coordination drills,
non-weight-bearing aerobic /endurance
exercise, minor team games
Restore strength of deep hip
stabilisers, improve core strength,
increase joint range of motion, improve
balance and neuromotor control,
improve muscle endurance, promote
group cohesion and social support
12 (30–45 min)
Individual
physiotherapy*
Manual therapy techniques, muscle
activation and timing patterns, active and
passive range of motion exercises, advice
on home exercise, gait re-education training
Improve quality and timing of
movement, improve muscle strength,
reduce pain, increase joint range of
motion, induce relaxation, promote
normal walking gait
5 (30 min)
Hydrotherapy/
swimming
Non-weight-bearing aerobic exercise,
strengthening exercises, active range of
motion exercises, self-paced recreational
swimming, progressive/assisted
weight-bearing exercise and activity
Improve muscle strength, improve
aerobic capacity, increase joint range
of motion, improve confidence in
weight bearing, induce relaxation,
promote enjoyment and variety of
treatment
3 (60 min)
Individual
occupational
therapy†
Relaxation techniques, postural
re-education, cognitive–behavioural therapy
techniques, self-help coping strategies, pain
management
Induce relaxation, promote behavioural
change, control pain, correct/improve
poor posture
3 (60 min)
Patient education Coping with pain, benefits of exercise, joint
protection, anatomy and pathology of hip
pain, nutrition
Activity modification, reduction of pain,
promote behavioural change, weight
management, improve knowledge of
treatment options, improve ability to
relax, improve knowledge of self-help
techniques
2 (60 min)
*Exercise dosage, progression and intensity were governed by the physiotherapist and tailored to the needs of each individual patient.
†Occupational therapy referrals were individually prescribed to selected patients.
Figure 2 Y-balance test. From a single-leg stance the participant reaches the freely moveable limb along a line in the anterior
(A), posterolateral (B) and posteromedial (C) directions.
4 Coppack RJ, et al. BMJ Open Sport Exerc Med 2016;2:e000107. doi:10.1136/bmjsem-2015-000107
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5. score/2) to provide an aggregate score for internal rota-
tion, flexion and dynamic balance pre-to-post treatment.
All continuous variables were assessed using the
Kolmogorov-Smirnov test and an examination of histo-
grams and their skewness and kurtosis28
; none were con-
sidered to deviate from normality. Descriptive statistics
were calculated for the whole sample. Continuous vari-
ables are presented as means and SD, and categorical
variables are presented by frequencies and percentages.
Within group changes over time were analysed using a
paired t test. Ordinal data for the FAA employability
scale were assessed using the Wilcoxon signed rank test.
Statistical calculations were performed using SPSS
(V.21.0.0, SPSS Inc, Chicago, Illinois, USA).
RESULTS
Participant characteristics
The demographic and baseline patient characteristics
are presented in table 3. Forty UK military patients (27
(67.5%) male) with a mean age of 32.8 years (SD 7.1),
range 20–50 years, were included in the study. The distri-
bution of patients by military branch was 26 (65%)
Army, 10 (25%) Royal Air Force (RAF) and 4 (10%)
Royal Marines (RM). The patient distribution by rank
seniority was 23 (57.5%) junior ranks, 10 (25%) senior
ranks and 7 (17.5%) officer rank. Nineteen (47.5%)
patients had undergone arthroscopic repair for a labral
tear, and 29 (72.5%) had completed a previous course
of inpatient treatment at a RRU.
Main outcome measures
The main treatment effects (paired t test) for all
outcome measures are presented in table 4.
Physical and functional outcome measures (Y-balance,
HROM, MST)
The change in Y-balance test score over time was statistic-
ally significant. The mean (SD) pretreatment and post-
treatment scores for Y-balance were 240.5 (26.9) cm and
256.3 (20.8) cm, respectively. The mean improvements of
15.8 cm showed a significant increase (p<0.001) in
Y-balance score (95% CI 10.7 to 20.9). The HROM scores
(flexion and internal rotation) also revealed significant
improvements over the period of treatment. The mean
(SD) scores for flexion improved by 6.5° (95% CI 4.6 to
9.4, p<0.001) from 110.2° (24.3) at baseline to 116.7°
(23.3) at week 3. The mean (SD) scores for internal rota-
tion improved by 4.6° (95% CI 2.7 to 6.6, p<0.001) from
25.2° (13.7) at baseline to 29.8° (12.4) at week 3. There
were no pre-to-post treatment differences in the MST
scores. The mean (SD) test scores achieved were level
10.3 (4.9) at baseline and level 10.5 (5.1) at week 3.
The small mean difference of 0.2 levels was not statistic-
ally different from baseline (95% CI −1.2 to 0.7, p=0.59).
Patient-reported outcomes (pain, HAGOS)
The pre-to-post treatment scores for changes in pain
were not significant. The baseline mean (SD) VAS was
36.3 (24.2) mm and post-treatment score was 34.8 (22.3)
mm. The mean difference was a 1.5 mm reduction in
pain after treatment (95% CI −0.49 to 8.0, p=0.63).
There were no significant pre-to-post treatment improve-
ments in scores on any of the HAGOS subscales. Table 4
and figure 3 shows that five out of six subscale domains
deteriorated over the period of treatment based on the
patients self-ratings.
Occupational employability (FAA)
The median score on the FAA occupational employabil-
ity index did not change from pretreatment (Md=3.0) to
post-treatment (Md=3.0), p=0.13.
There were no between-group differences for any
outcome measure in the surgical versus non-surgical, or
male versus female subgroups.
DISCUSSION
In this first study of a short-term MDT residential
rehabilitation intervention in military personnel with
Table 2 FAA code and description
Code Grade Royal Navy description Army/RAF description
FAA 1 Fully fit Fully fit, field or seas worldwide Can do all aspects of their job and all general
military duties
FAA 2 Fit for trade and fit for
restricted general or
military duties
Fit for flying, aircrew duties Able to do all aspects of their primary task but not
all the physical aspects of their physical duties (this
might apply to a clerk but is unlikely to apply to an
infantry soldier)
FAA 3 Unfit for trade but fit for
restricted general or
military duties
Fully employable ashore/ship in
harbour or ashore only in own
trade/skill at sea
Fit for limited flying aircrew duties
Unable to do primary task but able to perform
some limited physical tasks (eg, aircraft engineer
who cannot perform his trade but can do some
other physical duties or an infantryman who can
work in MT or stores)
FAA 4 Unfit for all but sedentary
duties
Employable in restricted duties
ashore only
Only able to perform light duties
FAA 5 Off all duties Off all duties (ashore sick leave) On sick leave, Y-listed or non-effective
FAA, functional activity assessment; MT, mechanical transport; RAF, Royal Air Force.
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6. prearthritic hip pain, we report improved HROM and
dynamic balance test scores. There was no evidence for
a change in outcome scores for the patient-reported
HAGOS subscales, pain, MST and FAA employability
scale.
How do these results compare with other studies?
The results from our study are inconsistent with the find-
ings of two recent publications reporting HROM, pain
and functional outcomes following conservative treat-
ment of prearthritic hip disorders.1 12
Both studies
employed a within-group observational design similar to
the present study, and a comparable population in terms
of sample size, mean age, diagnostic inclusion criteria,
and baseline pain-related and function-related impair-
ment. Fundamental to all three programmes was an
exercise-based regimen augmented by education, advice
on activity modification and manual physiotherapy. Hunt
et al1
found significant improvements in pain (numeric
pain scale), physical function (Western Ontario and
McMaster Universities Arthritis (WOMAC) index; non-
arthritic hip score (NAHS)) and quality of life (Short
Form-12) in patients with prearthritic, intra-articular hip
pain completing a directed course of conservative treat-
ment. Emara et al12
showed a stage-based physical therapy
programme-improved pain symptoms and patient-
reported function (Modified Harris Hip Score
(MHHS)), but had no effect on HROM, in 33 patients
with FAI up to 28 months after treatment. This contra-
dicts our findings showing significant post-treatment
improvement in patients HROM (minimal clinically
important difference, 5°),29
with no change in pain or
patient-reported function measured by the HAGOS.
Between-study differences in outcome measures
(MHHS; NAHS; WOMAC; HAGOS), time to follow-up
(3 weeks; 12 months; 28 months) and residential versus
outpatient settings may explain the inconsistencies in
results. The observational design of our study limits the
conclusions that can be drawn concerning the causal
effects of treatment on rehabilitation outcomes. Further
high-quality randomised trials investigating longer term
effects of rehabilitation with our military population are
required. This is particularly important as there may be
a delayed period of adaptation before reductions in pain
Table 3 Baseline descriptive characteristics of study participants (N=40)
Variable/characteristic Male (n=27) Female (n=13) Total (n=40)
Age, year, mean (SD) 32⋅8 (7⋅1) 32⋅9 (3⋅8) 32⋅8 (7⋅1)
Height, cm, mean (SD) 178⋅4 (5⋅3) 169⋅3 (3⋅2) 175⋅4 (6⋅4)
Weight, kg, mean (SD) 81⋅8 (11⋅5) 75⋅9 (16⋅9) 79⋅7 (13⋅5)
Body mass index, kg/m2
, mean (SD) 25⋅5 (3⋅5) 26⋅5 (6⋅1) 25⋅8 (4⋅5)
Treatment duration, days, mean (SD) 16⋅2 (1⋅3) 16⋅1 (1⋅2) 16⋅2 (1⋅3)
Service branch, N (%)
Army 18 (66⋅7) 8 (61⋅5) 26 (65⋅0)
RAF 5 (18⋅5) 5 (38⋅5) 10 (25⋅0)
RM 4 (14⋅8) 0 (0⋅0) 4 (10⋅0)
Rank seniority, N (%)
Junior rank 15 (55⋅5) 8 (61⋅5) 23 (57⋅5)
Senior rank 8 (29⋅7) 2 (15⋅5) 10 (25⋅0)
Officer rank 4 (14⋅8) 3 (23⋅0) 7 (17⋅5)
Diagnosis, N (%)
FAI/acetabular labral tear (right) 7 (25⋅9) 6 (46⋅2) 13 (32⋅5)
FAI/acetabular labral tear (left) 7 (25⋅9) 3 (23⋅0) 10 (25.0)
FAI/acetabular labral tear (bilateral) 3 (11⋅1) 3 (23⋅0) 6 (15⋅0)
Other hip pain diagnosis 10 (37⋅0) 1 (7⋅8) 11 (27⋅5)
Previous surgery, N (%)
Arthroscopy 7 (26⋅0) 12 (92⋅3) 19 (47⋅5)
‘Other’ surgery 7 (26⋅0) 0 (0⋅0) 7 (17⋅5)
No surgery 13 (48⋅1) 1 (7⋅7) 14 (35⋅0)
Previous treatment, N (%)
RRU
Yes 21 (77⋅7) 8 (61⋅5) 29 (72⋅5)
No 6 (22⋅2) 5 (38⋅5) 11 (27⋅5)
PCRF
Yes 25 (92⋅6) 11 (84⋅6) 36 (90⋅0)
No 2 (7⋅4) 2 (15⋅4) 4 (10⋅0)
Medication, N (%)
Yes 20 (74⋅0) 11 (84⋅6) 31 (77⋅5)
No 7 (26⋅0) 2 (15⋅4) 9 (22⋅5)
FAI, femoroacetabular impingement; PCRF, primary care rehabilitation facility; RAF, Royal Air Force; RM, Royal Marines; RRU, regional
rehabilitation unit.
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7. are realised following 3 weeks of intensive rehabilitation,
which appears to have stimulated improvements in
dynamic balance and HROM.
When considering the structure and process of rehabili-
tation, comparisons between our study and other similar
studies are extremely limited due to the lack of published
research focusing on MDTresidential treatment for prear-
thritic hip pain. In terms of structure, the most relevant
findings are reported in patients with hip OA. Angst et al30
found a comprehensive 3-week residential rehabilitation
intervention led to statistically and clinically important
improvements in pain and function (WOMAC) for
patients with comorbid hip pain. In an older study, Weigl
et al31
reported improvements in pain and physical func-
tion at 2-year follow-up in 44 patients with hip OA com-
pleting a 3–4-week residential programme.
The duration and content of treatment in our study
closely approximates those utilised by Angst and collea-
gues and Weigl and colleagues (eg, 3 weeks group
exercise, individual physiotherapy, patient education,
NSAIDs); however, we did not observe similar improve-
ments in patients’ pain and function following residen-
tial treatment. The composition of the MDT, study
population and treatment outcomes differed between
studies, and a potential reason for the discrepancies
between our findings and those of previous studies is
the heterogeneity with respect to participant case mix,
outcome measures, treatment setting (hospital vs special-
ist rehabilitation centre) and MDT size and composition.
These methodological inconsistencies must be addressed
to allow a better understanding of the benefits of MDT
residential rehabilitation for prearthritic hip pain.
Patient-reported outcomes (PROs) are considered the
gold standard when measuring the patient’s perspective
of treatment efficacy.32
The HAGOS did not demon-
strate any significant pre-to-post treatment improvements
in our study. This PRO is used in the UK military hip
rehabilitation pathway because it was developed for phys-
ically active young-to-middle-aged adults with hip and/or
groin pain,14
and is designed to assess treatment-
induced changes from week-to-week.33
However, while
the HAGOS subscales have shown good test-retest reli-
ability and responsiveness in athletic populations,14 33 34
its performance in a military population is unknown,
and it is possible this scoring system fails to address activ-
ities of most relevance to Armed Forces personnel.
Studies reporting clinically meaningful changes in other
PROs following hip rehabilitation used a minimum
6-week period between tests.35 36
The reference values of
the HAGOS over longer testing periods with a military
population need to be established.
The primary aim of UK military rehabilitation is to
return personnel fit to undertake their technical trade
and general duties.26
Therefore, outcome measures pro-
viding information on a patient’s military-specific occu-
pational status are important. The FAA scores showed
the same median rating of 3.0 (unfit for trade but fit for
Figure 3 Participants (N=40) mean Copenhagen Hip and
Groin Outcome Score (HAGOS) pre-to-post treatment. Total
score for each subscale is summed and transformed such
that 100=best score (no problems) and 0=worst score
(extreme problems). Data are presented as mean (95% CI).
Table 4 Pre-to-post rehabilitation mean differences (paired t test) for all outcomes
Outcome measure Pretreatment mean (SD) Post-treatment mean (SD) Difference, mean (95% CI) p Value
Y-balance* 240.5 (26.9) 256.3 (20.8) 15.8 (10.7 to 20.9) <0.001
HROM (flexion)* 110.2 (24.3) 116.7 (23.3) 6.5 (4.6 to 9.4) <0.001
HROM (internal rot)* 25.2 (13.7) 29.8 (12.4) 4.6 (2.7 to 6.6) <0.001
Modified shuttle test 10.3 (4.9) 10.5 (5.1) 0.2 (−1.2 to 0.7) 0.60
Pain (VAS 1–100 mm) 36.3 (24.2) 34.8 (22.8) 1.5 (−0.5 to 8.0) 0.63
HAGOS subscales†
Pain 37.7 (20.9) 35.1 (23.7) 2.6 (−1.5 to 6.8) 0.21
Symptoms 45.8 (23.2) 46.3 (24.2) 0.5 (−4.9 to 4.1) 0.83
ADL 32.2 (24.1) 31.0 (24.7) 1.2 (−2.1 to 4.7) 0.46
Sport/recreation 51.0 (28.1) 48.5 (28.6) 2.5 (−2.1 to 7.1) 0.28
PA 84.7 (24.9) 77.5 (31.2) 7.2 (0.0 to 14.4) 0.05
QOL 69.5 (20.4) 64.9 (23.3) 4.6 (−0.5 to 9.7) 0.08
*Reflects pre-to-post treatment differences for the symptomatic hip. Bilateral hip pain scores are summed and aggregated for analysis.
†A normalised score (100 indicating no symptoms and 0 indicating extreme symptoms) is calculated for each subscale.
ADL, activities of daily living; HAGOS, Copenhagen Hip and Groin Outcome Score; HROM, hip range of motion; PA, participation in physical
activity; QOL, quality of life; VAS, visual analogue scale.
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8. restricted general or military duties) before and after
treatment. The FAA has shown adequate construct and
concurrent validity as a surrogate measure of physical
health27
; however, our results suggest its ability to track
changes in employment status following a single residen-
tial admission period is unproven.
Study limitations
Despite the novelty of these findings, they must be con-
sidered in the light of limitations of the study design. It
is a retrospective cohort study with no control group.
This limits the conclusions that can be drawn on the
effectiveness of our rehabilitation programme. Although
improvement in symptoms and function could be a
result of treatment, a control group is needed to gain a
causal estimate of the effect of rehabilitation.
Prospective studies employing a randomised controlled
design should be undertaken to compare available treat-
ment options. The lack of follow-up beyond 3 weeks
would not capture any longer term benefits of rehabili-
tation which may explain the non-significant findings for
some outcomes in our study. Therefore, we have
restricted our comments to the 3-week period of
rehabilitation and do not speculate on the long-term
benefits of MDT residential rehabilitation. Future studies
should address longer term compliance to and effective-
ness of conservative treatment. While the use of a well-
defined military population may limit the generalisability
of our results to other populations and settings, we
believe the findings may also be relevant to young active
sportsmen and women. Our patients underwent
rehabilitation at varying stages of their recovery, and
while this approach mimics our clinical practice, some
heterogeneity in clinical severity of the sample may have
attenuated the treatment effect. Finally, we did not
record psychological variables (eg, anxiety, irritability,
depression) that may be related to pain.22
Notwithstanding these limitations, the observational
design did provide the opportunity to obtain data with a
young active cohort, and document the acute responses
to treatment reflecting the clinical reality of a military
rehabilitation setting.
CONCLUSIONS
With increased pressure to ensure military personnel
remain fit for operations against the backdrop of reduc-
tions in manpower, it is expected that intensive residen-
tial rehabilitation will become an increasingly important
component of future healthcare provision in the UK
Armed Forces. This is particularly important given
recent increases in operational deployments and the
commensurate increase in occupational exposure asso-
ciated with loaded marching. This study is the first to
report outcomes of MDT residential rehabilitation in a
military cohort with prearthritic hip pain.
Comprehensive residential treatment showed evidence
of improvements in a functional capacity (Y-balance) test
and HROM (flexion, internal rotation). The interven-
tion did not confer any benefits on pain, the patient-
reported HAGOS, or occupational employability (FAA).
The study is strongly suggestive of some short-term bene-
fits for the current UK military approach to MDT resi-
dential rehabilitation in the management of prearthritic
hip pain. Further studies should adopt longer follow-up
observations, evaluating longer term adaptations and
assessing compliance to post-residential treatment plans.
There is a clear need for further research using rando-
mised designs examining MDT residential rehabilitation
against other treatment options to ensure patients
receive treatment in the optimal clinical setting. Future
studies should also focus on the measurement properties
of hip PROs with a military population.
Author affiliations
1
Academic Department of Military Rehabilitation, Defence Medical
Rehabilitation Centre (DMRC), Epsom, UK
2
Department for Health, University of Bath, Bath, UK
3
School of Clinical Sciences, University of Bristol, Bristol, UK
4
Centre for Lower Limb Rehabilitation, Defence Medical Rehabilitation Centre
(DMRC), Epsom, UK
5
Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of
Leeds, Leeds, UK
Acknowledgements The authors wish to thank Major James Watson, Captain
Paul Thompson and all the staff and patients on the Centre for Lower Limb
Rehabilitation at DMRC Headley Court for their assistance with this study.
Contributors RJC designed the study, conducted the initial analysis, drafted
the initial manuscript and approved the final manuscript as submitted. JLB,
AKW and ANB supervised the conduct of the study, assisted with data
analysis, reviewed and revised the manuscript, and approved the final
manuscript as submitted. IMM, AMN and LKP collected the data, reviewed
and revised the manuscript, and approved the final manuscript as submitted.
Funding This trial is the first in a series comprising the Military Hip
Rehabilitation Outcome (MILO) Study. The MILO study is supported
financially by the Arthritis Research UK Centre for Sport, Exercise and
Osteoarthritis (Grant reference 20194).
Competing interests None declared.
Ethics approval The University of Bath Research Ethics Approval Committee
for Health (REACH).
Provenance and peer review Not commissioned; internally peer reviewed.
Data sharing statement No additional data are available.
Open Access This is an Open Access article distributed in accordance with
the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license,
which permits others to distribute, remix, adapt, build upon this work non-
commercially, and license their derivative works on different terms, provided
the original work is properly cited and the use is non-commercial. See: http://
creativecommons.org/licenses/by-nc/4.0/
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10. military personnel
prearthritic hip pain among young active UK
multidisciplinary residential rehabilitation for
Physical and functional outcomes following
Laura K Partridge, Alastair M Nicol and Alexander N Bennett
Russell J Coppack, James L Bilzon, Andrew K Wills, Ian M McCurdie,
doi: 10.1136/bmjsem-2015-000107
2016 2:BMJ Open Sport Exerc Med
http://bmjopensem.bmj.com/content/2/1/e000107
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