Education and Exercise for Patients With Longstanding Hip and Groin Pain

iHOT-33 is a 33 question self-reported outcome scale, measuring hip-related quality of life. This outcome measure has been validated and translated to Swedish. The scores are summed on a 0 (worst)-100 (best) scale.

iHOT-33 is a 33 question self-reported outcome scale, measuring hip-related quality of life. This outcome measure has been validated and translated to Swedish. The scores are summed on a 0 (worst)-100 (best) scale.

The patient acceptable symptom state (PASS) will be collected using a dichotomized question ("Taking into account your hip and groin function and pain, and how it affects your daily life, including your ability to participate in sport and social activities, do you consider that your current state is acceptable if it remained like that for the rest of your life?").

Treatment failure will be collected using a dichotomized question "Do you consider your current state so unsatisfactory that you think your treatment has failed?".

Perceived symptom improvement will be collected using a 7-point Global rating of change (GROC) scale, ranging from -3 (a lot worse), to +3 (a lot better).

Patient desire and beliefs regarding surgical intervention will be collected using two dichotomized questions; "Do you want to undergo surgery?" and "Do you believe surgery is needed for you to get better?".

Physical activity and return to sport/exercise will be collected using questions based on the Swedish National Board of Health and Welfare (Socialstyrelsen) physical activity screening, a self-reported measure of minutes spent doing strenuous and everyday activities.

Pain catastrophizing will be measured with the Pain Catastrophizing Scale (PCS), a valid patient-reported outcome with 13 items. It is scored 0 to 52, with higher values indicating higher degrees of catastrophizing.

Pain-related self-efficacy will be collected with the short-form Pain Self-efficacy Questionnaire (PSEQ-2), a commonly used measure of self-efficacy in musculoskeletal pain. PSEQ-2 consists of 2 questions. It is scored 0 to 12, with higher score indicating a greater degree of pain self-efficacy.

Generic health-related quality of life will be measured using EQ5D. It is scored from 0 to 1, where 1 corresponds to perfect health, and is available in Swedish.

Employment status will be measured using a Likert scale, from unemployed, student, part time work, full time work or retired.

Self-reported documentation of other non-operative treatments, like medications, injections etc.

Any physical therapist-led intervention in the usual care group will be collected using self-reported questions regarding volume (number of sessions), content (overall focus of intervention) and adherence (patient compliance to prescribed intervention).

Adherence will be collected by reporting of the number of supervised visits to a treating physical therapist as well as percentage of prescribed exercises completed, and any educational resources accessed.

Hip range of motion (in degrees) will be measured with a digital inclinometer in internal rotation in 90° of hip flexion and zero° flexion.

Isometric hip muscle force production will be measured (in Newton and nm/kg) with a belt-fixated handheld dynamometer for hip adduction, flexion and hip extension.

Hop performance will be assessed using the single leg hop for distance test. Distance (cm) and kinematics (joint angles) and forces (joint moments) will be measured.

Single leg balance will be assessed using the Y-balance test. Distance (cm) and Limb symmetry index will be collected.

Single leg balance will be evaluated by postural sway using markers, 3D-motion capture and force plates.

Single leg squat performance will be evaluated using markers, 3D-motion capture and force plates to calculate kinematics (joint angles) and kinetics (joint moments) related to the task.

Lower body power will be evaluated using markers, 3D-motion capture and force plats to collect kinematics (joint angles) and kinetics (joint moments) during the task.

As part of standard procedure at the Department of Orthopedics at Skåne University hospital, an AP pelvic radiograph is used to measure the Lateral Centre Edge Angle and the Tönnis grade.

As part of standard procedure at the Department of Orthopedics at Skåne University Hospital, the modified Dunn projection will be used to calculate the alpha angle.

Any performed surgical interventions to the hip and/or groin region will be collected from medical records and self-reported questions.

A sub-group of participants (about 15 or until saturation) will be interviewed on-line in a semi-standardised fashion, about their perceptions of living with, and seeking care for, longstanding hip and groin pain.

Participants randomized to the experimental arm (n=10), will also be asked to participate in interviews/workshops about their perception of the intervention.

Physical therapists trained in delivering the intervention in the experimental arm will be interviewed in a semi-standardised fashion, about their experiences of treating this patient population and their experience of delivering the experimental intervention.

A subgroup (n=20 from each treatment arm) will answer additional questionnaires, as part of an exploratory nested study on the psychosocial response to patient education and treatment.

17 questions will cover 7 contructs (Support, Fear, Motivation, Self-efficacy, Expectations, Enablement & Acceptability), using Likert scales.