Mallets Emma, Turner Ann, Durbin Jeremy, Bader Alexander, Murray Leigh
Walsh University; North Canton, OH, USA.
Int J Sports Phys Ther. 2019 Jul;14(4):514-524.
Femoroacetabular Impingement (FAI) is becoming increasingly more common with noted impairments in physical function, increased pain, and decreased quality of life. Typically, a conservative approach is used through physical therapy or intra-articular injections before an invasive surgical approach is utilized. Identifying the proper course of conservative care by the clinician will aid in improving outcomes.
The purpose of this systematic review and meta-analysis was to investigate short-term effects of conservative physical therapy and intra-articular injections on pain and physical function measures in patients with FAI.
Systematic Review & Meta-Analysis.
A systematic review and meta-analysis were completed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered with the International Prospective Registry of Systematic Reviews. A literature review was performed in May 2018 using Pubmed, CINAHL, Proquest, and Scopus. Inclusion criteria included humans classified as having femoroacetabular impingement, conservative rehabilitation, and utilization of outcome measures in the domains of pain or function. Exclusion criteria included absence of skilled interaction and study protocols that were not completed.
Seven studies were included that summarized physical therapy or intra-articular injection outcomes for femoroacetabular impingement management. Results showed that conservative interventions for short-term periods are effective in reducing pain and improving function for femoroacetabular impingement. Overall, physical therapy revealed moderate to large effect sizes and statistically significant differences in both pain (SMD, 0.91, CI: 0.07, 1.76, p=0.030) and function (SMD, 0.80, CI: 0.34, 1.28, p=0.001) for femoroacetabular impingement. Intra-articular injection demonstrated small effect sizes for pain outcomes (SMD, 0.29, CI: -1.25, 1.83, p = 0.710) and small to moderate effect size for improvement in function (SMD, 0.49, CI: 0.03, 0.96, p = 0.040).
Physical therapy demonstrated positive results to self-reported pain and function and may hold more promise than intra-articular injection alone. Common treatments that were associated with improved outcomes were patient education, activity modification, manual therapy, and strengthening. There are a limited number of high-quality articles on this topic, which should be addressed in future research.
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股骨髋臼撞击症（FAI）越来越常见，伴有身体功能受损、疼痛加剧和生活质量下降。通常，在采用侵入性手术方法之前，会先通过物理治疗或关节内注射进行保守治疗。临床医生确定合适的保守治疗方案将有助于改善治疗效果。
本系统评价和荟萃分析的目的是研究保守物理治疗和关节内注射对股骨髋臼撞击症患者疼痛和身体功能指标的短期影响。
系统评价与荟萃分析。
按照系统评价和荟萃分析的首选报告项目指南完成了一项系统评价和荟萃分析，并在国际前瞻性系统评价注册库进行了注册。2018年5月使用PubMed、CINAHL、ProQuest和Scopus进行了文献检索。纳入标准包括被归类为患有股骨髋臼撞击症的人群、保守康复治疗以及使用疼痛或功能领域的结局指标。排除标准包括缺乏专业互动以及未完成的研究方案。
纳入了7项总结股骨髋臼撞击症治疗中物理治疗或关节内注射结局的研究。结果表明，短期保守干预对减轻股骨髋臼撞击症患者的疼痛和改善功能有效。总体而言，物理治疗在股骨髋臼撞击症的疼痛（标准化均数差，0.91，可信区间：0.07，1.76，p = 0.030）和功能（标准化均数差，0.80，可信区间：0.34，1.28，p = 0.001）方面均显示出中等到较大的效应量和统计学显著差异。关节内注射在疼痛结局方面显示出较小的效应量（标准化均数差，0.29，可信区间：-1.25，1.83，p = 0.710），在功能改善方面显示出小到中等的效应量（标准化均数差，0.49，可信区间：0.03，0.96，p = 0.040）。
物理治疗在自我报告的疼痛和功能方面显示出积极结果，可能比单独的关节内注射更有前景。与改善结局相关的常见治疗方法包括患者教育、活动调整、手法治疗和强化训练。关于这个主题的高质量文章数量有限，这应在未来的研究中加以解决。
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