Movement pattern training improves function in people with intra-articular, pre-arthritic hip disease: Preliminary data

s / Osteoarthritis and Cartilage 23 (2015) A82eA416 A369 607 MOVEMENT PATTERN TRAINING IMPROVES FUNCTION IN PEOPLE WITH INTRA-ARTICULAR, PRE-ARTHRITIC HIP DISEASE: PRELIMINARY DATA M. Harris-Hayes y, S. Czuppon y, L.R. Van Dillen y, S.A. Sahrmann y, M. Schootman z, G.B. Salsich x, J.C. Clohisy k, M.J. Mueller y. y Program in Physical Therapy, Washington Univ. Sch. of Med., Saint Louis, MO, USA; zColl. for Publ. Hlth.& Social Justice, Saint Louis Univ., Saint Louis, MO, USA; x Program in Physical Therapy, Saint Louis Univ., Saint Louis, MO, USA; kDept. of Orthopaedic Surgery, Washington Univ. Sch. of Med., Saint Louis, MO, USA Purpose: Intra-articular, pre-arthritic hip disease (IAHD), such as femoroacetabular impingement, structural instability and labral tears, is associated with significant hip joint dysfunction in young adults and a proposed precursor to osteoarthritis (OA). Effective treatment of IAHD is needed to improve function in young adults and prevent or delay the onset of hip OA. Current treatment has focused primarily on surgical intervention, in part, due to lack of evidence related to rehabilitation. Some authors believe that rehabilitation can improve the activity of people with IAHD, however others have stated that rehabilitation is contra-indicated and recommend surgery as the only option. A clear need exists to investigate the effectiveness of rehabilitation in people with IAHD. As a component of a larger study investigating proposed risk factors of IAHD (K23HD067343), we are conducting a pilot treatment trial to obtain preliminary data on the efficacy of a rehabilitation program using Movement Pattern Training (MPT). We hypothesize that participants with IAHD will report improved function after 6 weeks of MPT and this improvement will be maintained 12 months after treatment. Methods: Participants between 18-40 years old, with IAHD greater than 3 months were recruited to participate in the study. After baseline assessment, participants completed MPT, which was provided in 6 sessions over 6 weeks. The MPT program incorporated two primary components including 1) task-specific instruction to modify their abnormal movement pattern during daily and fitness activities such as walking, stairs and running and 2) strengthening weak hip musculature thought to contribute to the abnormal movement pattern. In addition to formal treatment sessions, participants were provided with a home program to practice the task-specific modifications and perform strengthening exercises. At each treatment session, the activities and exercises were assessed and progressed based on the participant’s performance. Each participant was encouraged to continue the taskspecific modifications and strengthening exercises after formal treatment sessions were completed. The primary outcomes were the Modified Harris Hip Score (MHHS) and the Hip disability and Osteoarthritis Outcome Score (HOOS) subscales. The MHHS and HOOS are patient-reported outcome measures to assess pain and hip-specific functional ability. The MHHS and HOOS were collected at baseline, immediately after treatment and 12 months after treatment. Repeatedmeasures ANOVA with Bonferroni adjustment was used to assess changes in MHHS and HOOS immediately after treatment and at 12 months. A p value of <.05 was considered significant for all comparisons. Results: 28 participants (age: 27.4þ5.1 years, BMI: 24.3þ2.8 kg/m2, sex: 23F:5M, pain duration 3.2þ 3 years) completed treatment and the posttreatment outcome measures. One participant elected to have surgery at 5 months. Of the remaining 27 participants, 17 have completed the study and provided 12 month data at the time of this analysis. Compared to baseline, there was significant improvement in all MHHS and HOOS subscales immediately after treatment (p< .03, Figure 1), and in MHHS and the HOOS Pain, ADL and QOL subscales at 12months (p< .02, Figure 2). Conclusions: Our preliminary results suggest Movement Pattern Training may improve pain and function in patients with IAHD and these improvements may be maintained at 12 months after treatment. Movement Pattern Training may be an appropriate treatment approach for patients with IAHD and should be considered prior to surgery. Future analyses will assess change in muscle strength and movement patterns after treatment. Relationships among strength, movement patterns, bony abnormalities and patient-reported outcomes will be investigated to inform future clinical trials needed to assess the efficacy of rehabilitation in people with IAHD. Figure 1. Patient-reported outcomes and baseline and immediately after treatment. *p<0.03. Figure 2. Patient-reported outcomes and baseline, immediately after treatment and 12 months after treatment. *p<0.02. 608 MEN WITH KNEE OSTEOARTHRITIS GRADES I AND II PRESENT IMPAIRMENTS IN PERFORMANCE AND IN ELECTRICAL ACTIVITY OF THE QUADRICEPS FEMURIS MUSCLE M. Petrella, P.R. Serr~ ao, K. Gramani-Say, L.A. Selistre, G.C. Lessi, S.M. Mattiello. Federal Univ. of S~ ao Carlos., S~ ao Carlos, Brazil Purpose: The objective of this study was to evaluate whether changes in voluntary activation and strength of the quadriceps muscles are already present in individuals in the early stages of knee OA. Methods: Participated in this study 28 men divided in two groups: Osteoarthritis Group (OAG, n1⁄414, 52,86±6,64 years old), composed of individuals with knee OA grades I and II (according to Kellgren&Lawrance criteria) and Control Group (CG, n1⁄414, 50,43±8,47 years old). An isokinetic dynamometer (Biodex Multi-Joint System 3, Biodex Medical Inc., NY, USA) was used to evaluate the knee extensor peak torque during concentric and eccentric knee extension at angular speed of 90 / s. Concomitantly with concentric and eccentric knee extensor peak torque evaluation, the electromyographic signal was collected. The electromyography data were collected with an 8 channel