Discussion
pain
SESSION, SECONDARY, RECRUITMENT
Based on our findings, a large RCT to assess the efficacy of JtMob and MoveTrain may be feasible. We were on target to meet our recruitment and retention goals prior to the COVID-19 pandemic. Collection of posttreatment patient-reported outcomes was high, but laboratory testing for 6 patients could not be performed while on-site activities were suspended. Session attendance was also affected by the COVID-19 pandemic. Patient HEP adherence was greater than 80% in 2 of the 3 components assessed. Treatment fidelity was 98%. Our preliminary findings suggest that 12 weeks of rehabilitation, either JtMob or MoveTrain, is safe and may result in improvements in patient-reported pain and activity limitations.We previously established the safety and feasibility of MoveTrain.Joint mobilization techniques have been used in treatment studies for HRGPPrior to the COVID-19 pandemic, we were enrolling an average of 3 patients per month. This suggests that we could enroll 153 patients during a 5-year project. Given our experience in developing and implementing a multicenter pilot RCT,We did not achieve our target retention rate of 90%, which was based on our previous work.Attendance to weekly treatment sessions was high, although lower than our targeted 90%We implemented a number of strategies to optimize treatment fidelity among treating physical therapists. We developed a manual of operations that included specific assessment and treatment guidelines for each treatment arm. During training, we obtained feedback from the physical therapists to ensure the guidelines we proposed were consistent with their practice and would be feasible to use. Any perceived barriers to performing the treatment protocol were discussed and resolved prior to study start. Regular communication among the protocol developers and physical therapists occurred to address any issues noted during the treatment sessions. Finally, we developed standard documentation forms that are easy to complete during the treatment session; they serve to collect information related to treatment and also provide cues to remind physical therapists of specific treatment elements. We believe these methods would be useful for future RCTs.Patients displayed excellent independence, aka patient receipt, in HEP performance. The JtMob group displayed higher independence than the MoveTrain group, 98 and 88%, respectively. This may be due to the complexity of the exercises/tasks assigned. In MoveTrain, instructions for each task included the steps to perform the task and key concepts related to movement quality. In JtMob, instructions for each exercise were focused on steps to perform the exercise; no specific instruction on movement quality was provided. For a patient in MoveTrain to be independent, they must be able to replicate the activity and display the corrected movement pattern. This can be difficult for some patients, particularly early in the treatment phase.Given the nature of the pilot RCT, the study was not powered to detect significant between-group differences in secondary outcome measures. Both groups reported improvements in all HOOS subscales, suggesting both groups improved in their hip-specific function. The MoveTrain group displayed improvements in their movement quality during the single-leg task; however, neither group displayed changes in pain pressure threshold. These findings are interesting; however, we are hesitant to speculate on their meaning given the small sample size; 29 patients completed the HOOS and 22 patients completed posttreatment assessments of movement and pain pressure threshold. A larger, powered study is needed to further explore these findings. Inclusions of an attention control group or a sham treatment in future studies may provide additional information related to patient outcomes and potential mechanism.