Prehabilitation for femoroacetabular impingement syndrome: intervention development using the Medical Research
Anuj Punnoose1, Leica Claydon Mueller2, Vianca Shah3
1Young Adult Hip Service & Department of Physiotherapy, Addenbrooke's - Cambridge University Hospital NHS Foundation Trust, Cambridge, UK; School of Allied Health and Social Care, Anglia Ruskin University, Cambridge, UK.
Introduction:
Effectiveness of pre-operative or pre-surgical rehabilitation also known as "prehabilitation" in patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS) is unknown. The aim of this study was to develop a novel prehabilitation intervention using structured processes as per the Medical Research Council (MRC) for this cohort.
Methods:
A multi-method intervention development process was undertaken using the MRC framework. Patient and public involvement (PPI) explored patient experiences of hip pain, barriers to exercise engagement, and preferences for intervention delivery. A systematic review and meta-analysis of prehabilitation in orthopedic surgery informed intervention dosage and delivery characteristics. An international expert consensus identified core domains to be targeted, and a focused literature review synthesized electromyographic evidence using maximum voluntary isometric contraction (MVIC) percentage to select and grade exercises based on muscle activation and symptom provocation risk.
Results:
The resulting PREHAB femoroacetabular impingement (FAI) program is an 8-week, two-phase intervention comprising progressive strengthening, range of motion, balance and proprioception, cardiovascular conditioning, and education components. Phase 1 (weeks 1-4) emphasizes low- to moderate-intensity exercises (16-40% MVIC) targeting hip abductors, extensors, adductors, and trunk muscles, while phase 2 (weeks 5-8) progresses to higher-intensity strengthening (>40% MVIC). Exercises that positioned the hip in impingement or had a high likelihood of symptom aggravation were excluded. The program is delivered using a combination of supervised and home-based sessions, supported by digital monitoring to promote adherence. The intervention was designed to optimize physical readiness for hip arthroscopy while minimizing symptom exacerbation during the pre-operative waiting period.
Conclusion:
This prehabilitation program was developed through multiple structured methods and is supported by PPI involvement, published evidence, and a consensus statement as per the MRC framework for development of an intervention. The developed program will be utilized in a feasibility study (PREHAB FAI) that will assess the feasibility, suitability, acceptability, and safety of this novel intervention in patients with FAIS undergoing arthroscopic surgery.
Level Of Evidence:
Not applicable.
