Abstract
BackgroundUK FASHIoN was a multicentre randomised controlled trial comparing hip arthroscopic surgery (HA) with personalised hip therapy (PHT, physiotherapist-led conservative care), for patients with hip pain attributed to femoroacetabular impingement (FAI) syndrome. Our aim was to describe the treatment and trial participation experiences of patients, to contextualise the trial results and offer further information to assist treatment decision-making in FAI.MethodsWe conducted in-depth semi-structured telephone interviews with a purposive sample of trial participants from each of the trial arms. They were interviewed after they received treatment and completed their first year of trial participation. Thematic analysis and constant comparison analytical approaches were used to identify themes of patient treatment experiences during the trial.ResultsForty trial participants were interviewed in this qualitative study. Their baseline characteristics were similar to those in the main trial sample. On average, their hip-related quality of life (iHOT-33 scores) at 12 months follow-up were lower than average for all trial participants, indicating poorer hip-related quality of life as a consequence of theoretical sampling. Patient experiences occurred in five patient groups: those who felt their symptoms improved with hip arthroscopy, or with personal hip therapy, patients who felt their hip symptoms did not change with PHT but did not want HA, patients who decided to change from PHT to HA and a group who experienced serious complications after HA. Interviewees mostly described a trouble-free, enriching and altruistic trial participation experience, although most participants expected more clinical follow-up at the end of the trial.ConclusionBoth HA and PHT were experienced as beneficial by participants in the trial. Treatment success appeared to depend partly on patients’ prior own expectations as well as their outcomes, and future research is needed to explore this further. Findings from this study can be combined with the primary results to inform future FAI patients.Trial registrationArthroscopic surgery for hip impingement versus best conventional care (ISRCTN64081839). 28/02/2014.
Highlights
UK FASHIoN was a multicentre randomised controlled trial comparing hip arthroscopic surgery (HA) with personalised hip therapy (PHT, physiotherapist-led conservative care), for patients with hip pain attributed to femoroacetabular impingement (FAI) syndrome
Findings from this study can be combined with the primary results to inform future FAI patients
We identified and approached trial participants that theoretically were likely to yield important information to have the greatest impact in the development of understanding [17]
Summary
UK FASHIoN was a multicentre randomised controlled trial comparing hip arthroscopic surgery (HA) with personalised hip therapy (PHT, physiotherapist-led conservative care), for patients with hip pain attributed to femoroacetabular impingement (FAI) syndrome. Femoroacetabular impingement (FAI) syndrome is a painful hip disorder characterised by premature contact between the proximal femur and the acetabulum (socket) [1, 2]. The other treatment arm was a course of a physiotherapist-led structured programme comprising education, activity modification, pain relief and exercise, which changed muscle co-ordination and hip movement patterns, in the FASHIoN trial referred to as Personalised Hip Therapy (PHT). 344 trial participants were randomly allocated to one of these two treatments They completed hip-related quality of life questionnaires. The results indicated that, on average, both treatments improved hip-related quality of life, HA led to greater clinically significant improvement than PHT at 12 months [5]
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