None listed
Conditions
Brief summary
Osteoarthritis (OA) is a common condition affecting many people. The number of people affected with hip OA is expected to rise exponentially over the coming years due to the ageing population and growing obesity rates. Conservative, targeted interventions (including exercise) are theoretically considered important in order to negate the economic cost and potential adverse events related to the typical intervention for end-stage hip OA; total hip replacement. However, recent studies conclude that current rehabilitation programs are limited in terms of improving hip function and reducing pain. It is suggested that current programs are ineffective due to their inability to target the right muscles, and they don't align with progressive resistance strength and conditioning principles, limiting their scope to cause effective change in muscle function over time. Our research team has devised an innovative exercise program that targets the hip muscles that are most affected in people with hip OA. Using these techniques, in combination with contemporary strength and conditioning principles, we wish to investigate whether this program has better success in improving function, pain and quality of life than a standard exercise program. This study is being conducted jointly by La Trobe University, University of Queensland and University of Otago and will recruit 90 participants over 4 sites (Bendigo, Melbourne, Brisbane and Dunedin). This research is funded by Arthritis Australia and La Trobe University.
Interventions
Comparison of two exercise programs
Participants will be randomly allocated to the GHOst intervention or the sham intervention. Both groups will receive standardised education for hip osteoarthritis, delivered by a physiotherapist and supplemented with handouts. Education will focus on an understanding of the condition and advice on physical activity.
The intervention (Gluteal Hip Osteoarthritis; GHOst) program will consist of once weekly, 30-minute supervised physiotherapy sessions and a se
Comparison of two exercise programs Participants will be randomly allocated to the GHOst intervention or the sham intervention. Both groups will receive standardised education for hip osteoarthritis, delivered by a physiotherapist and supplemented with handouts. Education will focus on an understanding of the condition and advice on physical activity. The intervention (Gluteal Hip Osteoarthritis; GHOst) program will consist of once weekly, 30-minute supervised physiotherapy sessions and a self-managed exercise program over 12 weeks. The self-managed home exercise program will consist of the same exercises prescribed during the supervised sessions. The initial physiotherapy session will be a one to one session for one hour, incorporating education and exercises, delivered by the physiotherapist. The additional supervised sessions will be conducted in an individual or group setting (i.e. 1-3 participants per session), based on availability of participants and scheduling of the community physiotherapist. Participants will only attend group sessions with other participants who have been randomised to the same intervention. Whether participants attended group or individual sessions will be documented by the physiotherapist, and accounted for as a covariate in statistical analysis. The GHOst protocol is composed of three phases; gait retraining, motor control, and pelvic stability with global strengthening. The aim of the gait retraining phase is to normalize, prevent or retard gait related impairments that are commonly associated with hip osteoarthritis. Physiotherapists will instruct participants to normalise stride length and asymmetry. The second phase of the GHOst intervention aims to promote the function of the anterior hip muscles using targeted, functional progressions of a squat and bridge exercise. The third phase of the GHOst protocol aims to improve pelvic stability and overall lower limb and trunk strength and function. These exercises progress from isometric hip hitching exercises, through to high resistance strength training of multiple muscle groups (e.g. double leg squat and dead-lift) with the aid of thera-band and power-bands to achieve the required 'heavy' load dose. Each phase can begin simultaneously at their first supervised physiotherapy session. Exercises are progressed based on quality (judged by the physiotherapist) and symptoms (pain not exceeding 5/10). All phases will be incorporated into each session, with approximately 5 minutes for gait retraining and the remaining time used for motor control and pelvic stability. Daily exercise adherence will be monitored with an exercise diary
Sponsors
La Trobe University
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Subject, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
35 Years to No maximum
Healthy volunteers
No
Inclusion criteria
(i) aged > 35 years; (ii) pain in the hip or groin for more than 3 months; (iii) pain intensity over the past week of 3/10 or more on a numerical rating scale during functional tasks like walking, climbing stairs or climbing in/ out of a car; (iv) radiographic confirmation of hip osteoarthritis with Kellgren-Lawrence score = 2; (v) Mild to moderate disability indicated by; (a) Oxford hip score of 25-45 indicating mild to moderate disability; (b) Still able to reciprocally ascend and descend 10 stairs unaided; (c) still able to safely walk one city block; (d) still able to jog 5 meters
Exclusion criteria
Volunteers will be ineligible for the following reasons; (i) Other musculoskeletal lower limb conditions requiring assessment or treatment in the last 6 months; (ii) Primary complaint of gluteal tendinopathy (clinical diagnosis), low back pain or referred back pain; (iii) History of hip trauma or surgery on the affected side (leading to secondary hip osteoarthritis); (iv) Known knee joint pathology or reduced knee range of motion (<90 deg Flexion) (v) Corticosteroid use (oral or intra-articular) in the past 3 months (vi) Neurological impairment or condition affecting lower limb function (vii) Conditions or factors affecting their ability to take part in the exercise intervention, e.g, unavailable for a 12 week intervention period, routine use of gait aids, uncontrolled hypertension, or morbid obesity (BMI>40); (viii) Systemic inflammatory disease (e.g. rheumatoid arthritis); (ix) Unable to write, read or comprehend English. In addition, participants at one site (total of 30 participants) will be asked to complete a magnetic resonance imaging (MRI) scan and undergo fine-wire electromyography (EMG) of gluteus minimus and gluteus medius muscles. These volunteers will be ineligible to participate if they have contraindication to fine-wire EMG (e.g. fear of needles, taking blood thinning medication) or MRI (e.g. pacemaker, claustrophobia).
Outcome results
None listed