MODIFY-Hip: Graded Activity Modification in Adults with Hip Pain – A Feasibility Study

The intervention is a physiotherapist-led graded activity modification program (MODIFY-Hip) delivered over 12 weeks. Prior to commencement of the intervention, participants complete a 2-week pre-intervention phase. During the pre-intervention phase, participants monitor their daily step count using a wearable activity monitor, complete an education session about hip pain and activity modification, and attend an initial telehealth consultation to identify meaningful aggravating activities and establish participant-specific activity goals. This information is used to tailor the subsequent 12-week intervention. The study includes a 2-week pre-intervention phase (Weeks 0–2). The 12-week intervention then consists of three sequential 4-week phases: Phase 1 (Weeks 3–6: pain reduction), Phase 2 (Weeks 7–10: increasing physical activity and exercise loading), and Phase 3 (Weeks 11–14: gradual return to pre-injury activity). The intervention is delivered individually by registered physiotherapists with experience in the assessment and management of hip-related pain. All consultations are delivered via telehealth (Zoom) and are tailored to the participant's symptoms, goals, aggravating activities, and physical activity levels. Participants receive five individual physiotherapy consultations over the 12-week intervention period, occurring at approximately weeks 3, 5, 7, 9, and 12. Consultations are expected to last approximately 30–45 minutes. Each consultation includes review of symptoms, monitoring of adherence and adverse events, review and progression of prescribed activity modification strategies, education, and collaborative planning of goals and progression for the subsequent phase of the intervention. During Phase 1, participants work with the physiotherapist to identify meaningful aggravating activities (e.g., squatting, running) and implement activity modifications aimed at reducing hip pain. Non-aggravating activities are identified and prescribed as appropriate. During Phase 2, the physiotherapist and participant progressively increase the duration, frequency and/or intensity of previously tolerated non-aggravating physical activities according to participant goals and symptom response. During Phase 3, previously aggravating activities are reintroduced gradually by progressively increasing exposure (e.g. duration, repetitions or intensity) while monitoring symptoms. Progression occurs only when pain does not increase by more than 2 points on a 0–10 numerical pain rating scale during or following activity. Progression between phases is guided by symptoms. Participants are required to report that pain does not increase by more than 2 points on a 0–10 numerical pain rating scale during or following activity before progressing. If symptoms worsen, adverse events occur, or the participant requests a change, the intervention may be modified or temporarily paused in consultation with the treating physiotherapist. The intervention is delivered remotely while participants remain in their home or usual environment. Participants are asked not to commence concurrent rehabilitation or new treatments during the intervention period. Adherence is promoted through regular physiotherapy contact, activity planning, and participant self-monitoring. Adherence is monitored using weekly participant logbooks, daily step-count monitoring, and physiotherapist consultation records documenting attendance, activity modifications, and progression through the intervention.