Nonarthritic Hip Disease Evaluation And Treatment

The clinical evaluation by the physician is standard-of-care and performed as part of
potential participants' scheduled appointment. Participants in this study will complete a
HIPAA authorization to allow data from their clinical evaluation by the physician to be
utilized for this study, including any imaging the physician used in their clinical
evaluation and the evaluation note entered into the participant's electronic health record.
The physician notes are standardized, allowing streamlined data analysis from the electronic
health record.

Research activities to occur the same day as the informed consent process include
randomization to receive or not receive a clinical evaluation by a physical therapist along
with surveys for treatment decisions, expected outcomes, and patient-reported function. A
small sub-group of patients will also complete interviews to identify how they felt about
their evaluation that day. The HIPAA authorization will also allow the data from the physical
therapy evaluation and any subsequent posture and movement training at OSUWMC to be utilized
for this study.

Regardless of randomization to receive or not receive a same-day physical therapy evaluation
in the physician clinic, all participants will be randomized to receive posture and movement
training (PMT) or undergo a 3-week wait period. Participants who are randomized to receive
PMT as part of this research study will schedule based on their availability, twice weekly
for 3 weeks with an OSUWMC Sports Medicine physical therapist who also hold IRB-approved
status as research personnel. Participants will be made aware during the informed consent
process that any PMT they receive as part of this study will be their responsibility to pay
for using either self-pay or insurance-based methods.

Participants who refuse randomization to receive PMT will be offered to participate in the
observational group. These participants proceed with the same baseline and follow-up testing,
but continue with their treatment-of-choice rather than an assigned treatment during the
3-week intervention period.

All participants will complete baseline and follow-up biomechanical and clinical follow-up
testing in the Motion Analysis and Performance Laboratory. Biomechanical testing involves
using 3-dimensional motion capture techniques to analyze movement during 3 functional tasks
including walking, sit-to-stand, and a forward tap-down. Clinical testing involves obtaining
anthropometric measures, hip strength, patient-reported function, and planned treatment
decisions with respective expected outcomes. A small sub-group of patients will also complete
interviews at these testing sessions to identify how they feel about the intervention (wait
or posture & movement training).

Posture and movement training involves the physical therapist prescribing therapeutic
exercises and activities to improve posture and movement (Harris-Hayes 2016), focusing
heavily on extrinsic cueing (Benjaminse 2015). Therapeutic exercises and activities will be
individualized based on the participant's presentation and will progress according to pain
and quality of movement from double-leg to single-leg activities and from functional to more
dynamic tasks.

Participants who are randomized to undergo a 3-week wait period will be required to withhold
any treatment during the 3-week wait period. These participants will complete the same
testing as the participants in the PMT group (see next paragraph). These participants will
not receive any intervention during the 3-week wait period; however, after their first
follow-up testing session (within 1 week of completing the 3-week wait period), these
participants may proceed with any intervention of their choice. The participants in the PMT
group may also proceed with any intervention after their first follow-up testing session.
These follow-up interventions will not be provided or required as part of the research study,
but participants will be asked to report if they completed any follow-up interventions
between their first follow-up testing session and their 3month and 6month follow-up testing
sessions.

Follow-up testing will occur within 1-week of completing the 3-week intervention period. At
this point, participants in both the PMT and no-PMT groups may proceed with any intervention
(i.e. surgery, injection, physical therapy). All participants will perform additional
follow-up testing at 3- and 6-months post-intervention.

Qualitative interviews will be conducted to evaluate how physicians and physical therapists
involved in the study feel about the evaluation and treatment protocols.

Inclusion Criteria:

Over 18 years old NAHD diagnosis

Exclusion Criteria:

- Osteoporosis or rheumatoid arthritis

- Systemic health condition

- Legal representative required for treatment decisions

- Bilateral symptoms

- Current spine, hip, knee, or ankle surgery or major injury*

- Pregnancy

- Total hip arthroplasty candidate (Tönnis grade > 2)

- Periacetabular osteotomy candidate (lateral center edge angle<20, anterior center edge
angle<18, acetabular index >10)

- Participants with history of spine, hip, knee, or ankle surgery or major injury
will be evaluated by the physician to determine appropriateness for evaluation
(and treatment) by a physical therapist