Summary of included studies
| Study | Title | Study type | Overall risk of bias | Inclusion criteria | Exclusion criteria | Number (PT/control) at baseline | Number (PT/control) at follow-up | Age mean (SD) (PT/control) | Sex (M/F) (PT/control) | BMI kg/m2 mean (SD) (PT/control) | Intervention type | Control type | Primary end point | Other follow-up | Primary outcomes | Secondary outcomes | Included in SMD calculation (Y/N) |
| Bennell, et al 2017 33 | Efficacy of adding a physiotherapy rehabilitation programme to arthroscopic management of femoroacetabular impingement syndrome: a randomised controlled trial | Pilot RCT | Moderate | Aged >16 years; FAI; scheduled for arthroscopy | Hip OA (Tönnis >grade 1); professional athlete; concurrent injury; unable to attend study physiotherapist; unwilling refrain from rehab | 14/16 | 11/13 | 31 (7) 29 (8) | 12/2 12/4 | 24.6 (2.2) 25.2 (3.2) | 7 PT sessions (1×pre-op; 6×postoperative) education manual therapy deep hip rotator retraining, stretching, bike, pool jog | No therapy allowed | 14 weeks | 24 weeks | IHOT-33; HOS-Sport subscale | HAGOS subscales; Tegner; HSAS; HOS-ADL | Y |
| Coppack, et al 2016 30 | Physical and functional outcomes following multidisciplinary residential rehabilitation for prearthritic hip pain among young active UK military personnel | Case series | High | Non-surgical and postsurgical military personnel attending for Physical therapy for of hip pain | Not reported | 40 | 40 | 33 (7) | 27/13 | 25.8 (4.5) | 5 hours/day 3 weeks. Hip ROM and strength, core and trunk muscle function, deep hip stabiliser exercise, correct gait balance retraining weight management, patient education | NA | 3 weeks | NA | HAGOS subscales Pain VAS | Y-balance flexion ROM IR ROM; shuttle test | N |
| Emara, et al 2011 31 | Conservative treatment for mild femoroacetabular impingement | Case series | High | Men and women with unilateral hip pain; alpha angle <60 | Aged >55 years; skeletally immature; hip disease or hip surgery; alpha angle >60; hip OA | 37 | 37 | NR | 27/10 | NR | Stage 1=rest, NSAIDs Stage 2=stretching exercise Stage 3 and 4=ADL modification | NA | 6 months | 24 months | HHS NAHS VAS | Flexion ROM Extension ROM Abduction ROM Adduction ROM ER in flexion ROM ER in extension ROM IR in flexion ROM IR in extension ROM | N |
| Grant, et al 2017 34 | The HAPI ‘Hip Arthroscopy Prehabilitation Intervention’ study: does prehabilitation affect the outcomes in patients undergoing hip arthroscopy for femoroacetabular impingement? | Pilot RCT | Moderate | Men and women aged >18 years with FAI, awaiting hip arthroscopy | Radiographic evidence of hip dysplasia; grades 3–4 OA; AVN; rheumatology disorders; <18 years; previous hip surgery | 9/9 | 8/8 | 38 (6) | 4/4 1/7 | NR | Five visits, points of interest were two pre-operative exercise for hip strength | Five visits, two pre-operative, same as intervention group except no pre-operative exercise advice | 2 weeks pre-operative | NA | NAHS | Abduction strength Adduction strength Flexion strength ER strength Knee extension strength | Y |
| Griffin, et al 2018 7 | Hip arthroscopy vs best conservative care for the treatment of femoroacetabular impingement syndrome (UK FASHIoN): a multicentre randomised controlled trial | RCT | Moderate | Men and women aged 16+ years with hip pain, suitable for hip arthroscopy | Hip OA (Tönnis >1) significant hip pathology past hip surgery | 177/171 | 162/157 | 35 (9)/35 (10) | 113/64 100/71 | NR | Personalised hip therapy between 6 and 10 treatments over 12–24 weeks of assessment, education, exercises (core, neuromotor control, progressive strength, stretching) pain relief | Hip arthroscopy surgery as pragmatically determined by surgeon, including acetabular rim trimming, labral dedridement or repair, femoral osteoplasty | 12 months | 6 months | IHOT-33 | EQ-5D-5L EQ-5D VAS SF-12 PCS SF-12 MCS | Y |
| Guenther, et al 2017 35 | A pre-operative exercise intervention can be safely delivered to people with femoroacetabular impingement and improve clinical and biomechanical outcomes | Case series | Moderate | FAI on MRA; positive impingement test; anterior groin pain | Hip OA; CSI within last month; hip surgery; significant lower body injuries or conditions; osteonecrosis of the hip; planned commencement or current enrolment in a hip strengthening exercise programme | 20 | 20 | 30 (7) | 18/2 | 24.1 (2.9) | Progressive phased strength programme, bilateral intervention. Exercises at home 4×week Phase I—activation, neuromuscular control, endurance Phase II—strength and intensity Phase III—strength and function | NA | 10 weeks | NA | HOOS Symptoms HOOS-Pain HOOS-ADL HOOS-Sport HOOS-QOL | Abduction strength Adduction strength Extension strength Flexion strength ER strength IR strength timed stair climb test | N |
| Harris-Hayes, et al 201639 | Movement pattern training to improve function in people with chronic hip joint pain: a feasibility randomised clinic trial | Pilot RCT | Low | Aged 18–40 years; anterior hip or groin pain >3 months; positive FADIR test | Previous hip surgery or fracture; contraindication to MRI; pregnancy; neurological involvement; knee or low back pain; BMI >30 | 18/17 | 16/16 | 27 (5)/29 (5) | 1/15 4/12 | 24.2 (3.0) 24.4 (2.6) | Movement pattern retraining; task-specific training for basic functional tasks; progressive strengthening of hip musculature. 6×1 hour visits over 6 weeks individualised and progressed | Wait list control | 6 weeks | NA | HOOS Symptoms HOOS-Pain HOOS-ADL HOOS-Sport HOOS-QOL | ABD strength ER 0 strength ER 90 strength Adduction single leg squat | Y |
| Hunt, et al 2012 32 | Clinical outcomes analysis of conservative and surgical treatment of patients with clinical indications of prearthritic, intra-articular hip disorders | Case-control | High | Anterior or lateral hip pain; pain on activity; pain-associated mechanical symptoms; pain at rest; positive anterior hip impingement test, FABER test, log roll or resisted straight leg-raise test | Aged >50 years; history hip surgery; inflammatory arthropathy, hip infection or tumour, current lumbar radiculopathy; hip OA (Tönnis 2–3) | 27/29 | 27/29 | 33 (11)/36 (11) | 2/23 27/29 | 25.3 (7) 25.9 (5) | Conservative interventions, patient education, activity modification, directed physical therapy protocol medications | Same as PT plus injection and surgery (when patient not satisfied with PT) | 12 months | NA | Numeric pain scale HHS WOMAC Baecke Questionnaire SF-12 PCS SF-12 MCS NAHS | NA | N |
| Kemp, et al 201836 | A pilot randomised clinical trial of physiotherapy (manual therapy, exercise and education) for early onset hip osteoarthritis posthip arthroscopy | Pilot RCT | Moderate | Aged 18–50 years; 4–14 months posthip arthroscopy for early hip OA (chondropathy outerbridge grade ≥1); pain ≥30/100 | Hip bursitis or tendinopathy; surgical complications; planned further surgery in the following 12 months | 10/7 | 9/6 | 32 (10)/31 (6) | 6/4 2/5 | 26.3 (5.3) 24.4 (4.7) | 8×30 min sessions over 12 weeks, and home exercise programme 4×week (i) Manual hip joint and soft tissue mobilisation and stretching; (ii) hip muscle retraining; (iii) trunk muscle retraining; (iv) functional, proprioceptive and sports-specific or activity-specific retraining; (v) enhancing physical activity and (vi) education | 8×30 min sessions over 12 weeks, education only | 12 weeks | NA | HOOS Symptoms HOOS-Pain HOOS-ADL HOOS-Sport HOOS-QOL IHOT | Abduction strength Adduction strength Extension strength Flexion strength ER Strength IR Strength Flexion ROM | Y |
| Kemp, et al 201840 | The Physiotherapy for Femoroacetabular Impingement Rehabilitation Study: a pilot randomised controlled trial | Pilot RCT | Low | Aged 18–50 years; no surgery; FAI (pain >3/10, >6 weeks, in hip or groin; alpha angle >60) | Past surgery; significant other hip disease; significant other disease; pregnancy; physiotherapy within past 3 months | 17/7 | 14/6 | 37 (8)/38 (10) | 5/12 2/5 | 25.1 (3.7) 26.1 (2.4) | Individualised, progressive programme 8×30 min 1:1 and 12×30 min supervised gym, 2×HEP (12-week intervention). Hip strength, trunk strength, functional retraining, manual therapy, education, fitness programme | Standardised programme 8×30 min 1:1 and 12×30 min supervised gym, 2×HEP (12-week intervention). Stretching, manual therapy, education | 12 weeks | Nil | IHOT | HOOS-QOL HOOS-Pain Adduction strength Abduction strength Extension strength ER strength Flexion ROM Single leg hop Side bridge | Y |
| Mansell, et al 2018 8 | Arthroscopic surgery or physical therapy for patients with femoroacetabular impingement syndrome | RCT | Low | Military personnel and families, FAI and/or labral tear (pain in hip or groin; pain on flexion, pain on FADIR; pain relief after injection), candidate for surgery (failed 6/52 conservative; positive cross-over or alpha angle >50) | Hip OA; other concurrent hip disease; workers compensation; positive LBP findings; pregnancy; past surgery; physiotherapy within previous 6 months | 40/40 | 33/29 | 31 (7)/30 (7) | 21/19 26/14 | 27.5 (4.3) 28.2 (4.4) | Standardised, supervised PT, 2×week for 6 weeks. Included elements=manual therapy (joint mob, MWM, soft tissue therapy), stretching, therapeutic and motor control exercises | Pragmatic hip arthroscopy surgery (acetabular rim trimming, labral dedridement or repair, femoral osteoplasty) | 2 years | 6, 12 months | HOS-ADL HOS-Sport | IHOT Global rating of change | Y |
| Palmer, et al 2019 41 | Arthroscopic hip surgery compared with physiotherapy and activity modification for the treatment of symptomatic femoroacetabular impingement: multicentre randomised controlled trial | RCT | Low | Aged 18–60 years, referred to secondary or tertiary care. Clinically and radiologically diagnosed FAIS (no imaging thresholds used. Instead surgeons qualitatively assessed morphology). | Physiotherapy in past 12 months, past hip surgery, hip OA (KL≥2), hip dysplasia (LCEA<20). | 110/112 | 88/100 | 36 (10)/36 (10) | 37/73 38/74 | 26.6 (4.8)/25.9 (4.8) | Goal-based supervised PT, up to 8 sessions over 5 months. Patient goals supplemented with programme focusing on muscle strength, core stability and movement control. Avoidance of extreme ROM encouraged. No specific programme details available | Pragmatic hip arthroscopy surgery (osteochondroplasty, labral repair or debridement, chondral debridement and microfracture as deemed appropriate by surgeon) | 8 months | HOS-ADL | HOS-Sport NAHS OHS HAGOS IHOT-33 EQ-5D-3L PainDETECT HADS Hip flexion ROM Hip extension ROM Hip abduction ROM Hip adduction ROM Hip ER ROM Hip IR ROM | ||
| Smeatham, et al 2017 37 | Does treatment by a specialist physiotherapist change pain and function in young adults with symptoms from femoroacetabular impingement? A pilot project for a randomised controlled trial | Pilot RCT | Moderate | FAI diagnosed Surgeon (FAI on X-ray; Aged 18 and 50 years; groin/anterolateral hip pain; mechanical symptoms; pain FADIR); willing for treatment by a specialist physiotherapist, and abstain from treatment outside study protocol | Previous hip surgery to the hip or pelvis; other significant hip pathology; back symptom; chronic pain; inability to comply with the physiotherapy protocol | 15/15 | 11/12 | 36/33 | 7/8 5/10 | NR | Pragmatic care from specialist physio. Any number of sessions allowed. Manual therapy and exercise to address movement deficits | Routine care (analgesia, continuation self-management or exercise previously given | 3 months | NA | NAHS HOS LEFS VAS | NA | Y |
| Wright, et al 2016 38 | Non-operative management of femoroacetabular impingement: a prospective, randomised controlled clinical trial pilot study | Pilot RCT | Moderate | Aged 18–50 years clinical diagnosis FAI (hip flexion <95°, internal rotation <10°, positive FADIR or FABER) radiological diagnosis FAI (alpha angle >55°; lateral centre edge angle >35; crossover sign) | Previous hip surgery; other surgical procedure of lower limb in the prior 6 months; pre-existing hip disease pregnancy; opioid analgesia or CSI past 30 days; advanced osteoporosis; BMI >38; cardiopulmonary disease | 8/7 | 8/7 | 31 (5)/36 (12) | 3/4 1/7 | 25.6 (3.7) 24.1 (7.4) | Manual therapy and supervised exercise | Advice and home exercise | 7 weeks | NA | HOS-ADL HOS-Sport NPRS LEFS SANE-ADL SANE-Sport | Depth of squat Triple hip Hip flexion ROM Hip flexion Strength FABER | Y |
ADL, activity of daily living; AVN, avascular necrosis; BMI, body mass index; CSI, corticosteroid injection; EQ-5D-5L, Euroquol Questionnaire; ER, external rotation; F, female; FABER, flexion-abduction-external rotation test; FADIR, flexion-adduction-internal rotation test; FAI, femoroacetabular impingement; HAGOS, Copenhagen Hip and Groin Outcome Score; HHS, Harris Hip Score; HOOS, Hip Osteoarthritis and disability Outcome Score; HOS, Hip Outcome Score; HSAS, Hip Sports Activity Scale; IHOT, International Hip Outcome Tool; IR, internal rotation; KL, Kellgren Lawrence; LCEA, lateral centre edge angle; LEFS, lower extremity functional scale; m, metre; M, male; MCS, emotional function subscale; MRA, magnetic resonance arthrogram; n, no; NA, not applicable; NAHS, Non-Arthritic Hip Score; NPRS, Numeric Pain Rating Scale; NR, not reported; NSAIDs, non-steroidal anti-inflammatory drugs; OA, osteoarthritis; PA, physical activity; PCS, physical function subscale ; PT, physiotherapy/physical therapy; QOL, quality of life; RCT, randomised controlled trial; ROM, range of motion; SANE, single assessment numeric evaluation; SF-12, Short Form-12 Questionnaire; SMD, standardised mean difference; VAS, Visual Analogue Scale; WOMAC, Western Ontario and McMaster Universities Arthritis Index; Y, yes.