Prehabilitation for Femoroacetabular Impingement Syndrome: Intervention development using the Medical Research Council framework.

Abstract

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 for this cohort. A multi-method intervention development process was undertaken using the Medical Research Council 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 orthopaedic surgery informed intervention dosage and delivery characteristics. An international expert consensus identified core domains to be targeted, and a focused literature review synthesised electromyographic evidence using Maximum Voluntary Isometric Contraction percentage (MVIC%) to select and grade exercises based on muscle activation and symptom provocation risk. The resulting PREHAB FAI programme 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) emphasises 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 programme is delivered using a combination of supervised and home-based sessions, supported by digital monitoring to promote adherence. The intervention was designed to optimise physical readiness for hip arthroscopy while minimising symptom exacerbation during the pre-operative waiting period. 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 utilised 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. Not applicable.