Prehabilitation for femoroacetabular impingement syndrome: intervention development using the Medical Research Council Framework.

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.