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Continued Significant Effect of Physical Training as Treatment for Overuse Injury
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March 2013
Continued Significant Effect of Physical Training as Treatment for Overuse Injury
Study Type:Therapy
OE Level Evidence:2
Journal Level of Evidence:N/A
Continued significant effect of physical training as treatment for overuse injury: 8- to 12-year outcome of a randomized clinical trial
American Journal of Sports Medicine; 2011; 39(11): 2447-2451Did you know you're eligible to earn 0.5 CME credits for reading this report? Click Here
Synopsis
47 patients with adductor-related groin pain were randomized to receive either active exercise treatment or passive treatment. The results of the 8 to 12 year follow-up indicated that active treatment continued to have a significant beneficial effect compared to passive treatment in treating adductor-related groin pain.
Publication Funding Details
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Funding:
Not Reported
Conflicts:
None disclosed
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
Yes = 1
Uncertain = 0.5
Not Relevant = 0
No = 0
The Reporting Criteria Assessment evaluates the transparency with which authors report the methodological and trial characteristics of the trial within the publication. The assessment is divided into five categories which are presented below.
4/4
Randomization
4/4
Outcome Measurements
4/4
Inclusion / Exclusion
2/4
Therapy Description
4/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
The Fragility Index is a tool that aids in the interpretation of significant findings, providing a measure of strength for a result. The Fragility Index represents the number of consecutive events that need to be added to a dichotomous outcome to make the finding no longer significant. A small number represents a weaker finding and a large number represents a stronger finding.
Why was this study needed now?
Exercise-related injuries are challenging to manage, especially with their recurrence. Groin pain due to sporting activity is a common condition particularly in activities requiring running, fast changes of direction, repetitive kicking, and physical contact. The study tests the long-term effects of the exercise program on adductor related groin pain.
What was the principal research question?
Did active exercise therapy lead to better pain and return to sport outcomes in comparison to passive therapy to treat adductor-related groin pain in athletes at 8 to 12 year follow-up?
Study Characteristics
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Population:
47 patients with adductor-related groin pain
Intervention:
Active exercise therapy - 2 modules consisting of various adduction, sit-up, one-foot, coordination and balance exercises (n=24)
Comparison:
Passive exercise therapy - consisting of laser, massage and electrical stimulation therapy (n=23)
Outcomes:
Pain at palpation of the adductor tendons, pain during active adduction against resistance, groin pain in connection with or after athletic activity, return to the same sport rate
Methods:
RCT; Arthroscopic Center Amager, Copenhagen University Hospital, Amager, Denmark
Time:
8-10 year follow-up
What were the important findings?
- The majority of athletes reduced their activity level by 8-10 year follow-up; however, there were no significant difference in the level of reduction for both groups (p=0.508)
- 50% of athletes in the active group reported excellent outcomes in comparison to 22% in the passive group (p=0.047)
- There was a trend towards a higher effect in the active treatment group (p=0.126)
What should I remember most?
Active therapy for the treatment of adductor-related groin pain resulted in beneficial long term outcomes in comparison to passive treatment.
How will this affect the care of my patients?
Even though this study finds a beneficial effect of active treatment in the long-term, larger sample sizes are required for future research.
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