Table 1.

Summary of included studies

Study	Title	Study type	Overall risk of bias	Inclusion criteria	Exclusion criteria	Number (PT/control) at baseline	Number (PT/control) at follow-up	Age mean (SD) (PT/control)	Sex (M/F) (PT/control)	BMI kg/m2 mean (SD) (PT/control)	Intervention type	Control type	Primary end point	Other follow-up	Primary outcomes	Secondary outcomes	Included in SMD calculation (Y/N)
Bennell, et al 2017 33	Efficacy of adding a physiotherapy rehabilitation programme to arthroscopic management of femoroacetabular impingement syndrome: a randomised controlled trial	Pilot RCT	Moderate	Aged >16 years; FAI; scheduled for arthroscopy	Hip OA (Tönnis >grade 1); professional athlete; concurrent injury; unable to attend study physiotherapist; unwilling refrain from rehab	14/16	11/13	31 (7) 29 (8)	12/2 12/4	24.6 (2.2) 25.2 (3.2)	7 PT sessions (1×pre-op; 6×postoperative) education manual therapy deep hip rotator retraining, stretching, bike, pool jog	No therapy allowed	14 weeks	24 weeks	IHOT-33; HOS-Sport subscale	HAGOS subscales; Tegner; HSAS; HOS-ADL	Y
Coppack, et al 2016 30	Physical and functional outcomes following multidisciplinary residential rehabilitation for prearthritic hip pain among young active UK military personnel	Case series	High	Non-surgical and postsurgical military personnel attending for Physical therapy for of hip pain	Not reported	40	40	33 (7)	27/13	25.8 (4.5)	5 hours/day 3 weeks. Hip ROM and strength, core and trunk muscle function, deep hip stabiliser exercise, correct gait balance retraining weight management, patient education	NA	3 weeks	NA	HAGOS subscales Pain VAS	Y-balance flexion ROM IR ROM; shuttle test	N
Emara, et al 2011 31	Conservative treatment for mild femoroacetabular impingement	Case series	High	Men and women with unilateral hip pain; alpha angle <60	Aged >55 years; skeletally immature; hip disease or hip surgery; alpha angle >60; hip OA	37	37	NR	27/10	NR	Stage 1=rest, NSAIDs Stage 2=stretching exercise Stage 3 and 4=ADL modification	NA	6 months	24 months	HHS NAHS VAS	Flexion ROM Extension ROM Abduction ROM Adduction ROM ER in flexion ROM ER in extension ROM IR in flexion ROM IR in extension ROM	N
Grant, et al 2017 34	The HAPI ‘Hip Arthroscopy Prehabilitation Intervention’ study: does prehabilitation affect the outcomes in patients undergoing hip arthroscopy for femoroacetabular impingement?	Pilot RCT	Moderate	Men and women aged >18 years with FAI, awaiting hip arthroscopy	Radiographic evidence of hip dysplasia; grades 3–4 OA; AVN; rheumatology disorders; <18 years; previous hip surgery	9/9	8/8	38 (6)	4/4 1/7	NR	Five visits, points of interest were two pre-operative exercise for hip strength	Five visits, two pre-operative, same as intervention group except no pre-operative exercise advice	2 weeks pre-operative	NA	NAHS	Abduction strength Adduction strength Flexion strength ER strength Knee extension strength	Y
Griffin, et al 2018 7	Hip arthroscopy vs best conservative care for the treatment of femoroacetabular impingement syndrome (UK FASHIoN): a multicentre randomised controlled trial	RCT	Moderate	Men and women aged 16+ years with hip pain, suitable for hip arthroscopy	Hip OA (Tönnis >1) significant hip pathology past hip surgery	177/171	162/157	35 (9)/35 (10)	113/64 100/71	NR	Personalised hip therapy between 6 and 10 treatments over 12–24 weeks of assessment, education, exercises (core, neuromotor control, progressive strength, stretching) pain relief	Hip arthroscopy surgery as pragmatically determined by surgeon, including acetabular rim trimming, labral dedridement or repair, femoral osteoplasty	12 months	6 months	IHOT-33	EQ-5D-5L EQ-5D VAS SF-12 PCS SF-12 MCS	Y
Guenther, et al 2017 35	A pre-operative exercise intervention can be safely delivered to people with femoroacetabular impingement and improve clinical and biomechanical outcomes	Case series	Moderate	FAI on MRA; positive impingement test; anterior groin pain	Hip OA; CSI within last month; hip surgery; significant lower body injuries or conditions; osteonecrosis of the hip; planned commencement or current enrolment in a hip strengthening exercise programme	20	20	30 (7)	18/2	24.1 (2.9)	Progressive phased strength programme, bilateral intervention. Exercises at home 4×week Phase I—activation, neuromuscular control, endurance Phase II—strength and intensity Phase III—strength and function	NA	10 weeks	NA	HOOS Symptoms HOOS-Pain HOOS-ADL HOOS-Sport HOOS-QOL	Abduction strength Adduction strength Extension strength Flexion strength ER strength IR strength timed stair climb test	N
Harris-Hayes, et al 201639	Movement pattern training to improve function in people with chronic hip joint pain: a feasibility randomised clinic trial	Pilot RCT	Low	Aged 18–40 years; anterior hip or groin pain >3 months; positive FADIR test	Previous hip surgery or fracture; contraindication to MRI; pregnancy; neurological involvement; knee or low back pain; BMI >30	18/17	16/16	27 (5)/29 (5)	1/15 4/12	24.2 (3.0) 24.4 (2.6)	Movement pattern retraining; task-specific training for basic functional tasks; progressive strengthening of hip musculature. 6×1 hour visits over 6 weeks individualised and progressed	Wait list control	6 weeks	NA	HOOS Symptoms HOOS-Pain HOOS-ADL HOOS-Sport HOOS-QOL	ABD strength ER 0 strength ER 90 strength Adduction single leg squat	Y
Hunt, et al 2012 32	Clinical outcomes analysis of conservative and surgical treatment of patients with clinical indications of prearthritic, intra-articular hip disorders	Case-control	High	Anterior or lateral hip pain; pain on activity; pain-associated mechanical symptoms; pain at rest; positive anterior hip impingement test, FABER test, log roll or resisted straight leg-raise test	Aged >50 years; history hip surgery; inflammatory arthropathy, hip infection or tumour, current lumbar radiculopathy; hip OA (Tönnis 2–3)	27/29	27/29	33 (11)/36 (11)	2/23 27/29	25.3 (7) 25.9 (5)	Conservative interventions, patient education, activity modification, directed physical therapy protocol medications	Same as PT plus injection and surgery (when patient not satisfied with PT)	12 months	NA	Numeric pain scale HHS WOMAC Baecke Questionnaire SF-12 PCS SF-12 MCS NAHS	NA	N
Kemp, et al 201836	A pilot randomised clinical trial of physiotherapy (manual therapy, exercise and education) for early onset hip osteoarthritis posthip arthroscopy	Pilot RCT	Moderate	Aged 18–50 years; 4–14 months posthip arthroscopy for early hip OA (chondropathy outerbridge grade ≥1); pain ≥30/100	Hip bursitis or tendinopathy; surgical complications; planned further surgery in the following 12 months	10/7	9/6	32 (10)/31 (6)	6/4 2/5	26.3 (5.3) 24.4 (4.7)	8×30 min sessions over 12 weeks, and home exercise programme 4×week (i) Manual hip joint and soft tissue mobilisation and stretching; (ii) hip muscle retraining; (iii) trunk muscle retraining; (iv) functional, proprioceptive and sports-specific or activity-specific retraining; (v) enhancing physical activity and (vi) education	8×30 min sessions over 12 weeks, education only	12 weeks	NA	HOOS Symptoms HOOS-Pain HOOS-ADL HOOS-Sport HOOS-QOL IHOT	Abduction strength Adduction strength Extension strength Flexion strength ER Strength IR Strength Flexion ROM	Y
Kemp, et al 201840	The Physiotherapy for Femoroacetabular Impingement Rehabilitation Study: a pilot randomised controlled trial	Pilot RCT	Low	Aged 18–50 years; no surgery; FAI (pain >3/10, >6 weeks, in hip or groin; alpha angle >60)	Past surgery; significant other hip disease; significant other disease; pregnancy; physiotherapy within past 3 months	17/7	14/6	37 (8)/38 (10)	5/12 2/5	25.1 (3.7) 26.1 (2.4)	Individualised, progressive programme 8×30 min 1:1 and 12×30 min supervised gym, 2×HEP (12-week intervention). Hip strength, trunk strength, functional retraining, manual therapy, education, fitness programme	Standardised programme 8×30 min 1:1 and 12×30 min supervised gym, 2×HEP (12-week intervention). Stretching, manual therapy, education	12 weeks	Nil	IHOT	HOOS-QOL HOOS-Pain Adduction strength Abduction strength Extension strength ER strength Flexion ROM Single leg hop Side bridge	Y
Mansell, et al 2018 8	Arthroscopic surgery or physical therapy for patients with femoroacetabular impingement syndrome	RCT	Low	Military personnel and families, FAI and/or labral tear (pain in hip or groin; pain on flexion, pain on FADIR; pain relief after injection), candidate for surgery (failed 6/52 conservative; positive cross-over or alpha angle >50)	Hip OA; other concurrent hip disease; workers compensation; positive LBP findings; pregnancy; past surgery; physiotherapy within previous 6 months	40/40	33/29	31 (7)/30 (7)	21/19 26/14	27.5 (4.3) 28.2 (4.4)	Standardised, supervised PT, 2×week for 6 weeks. Included elements=manual therapy (joint mob, MWM, soft tissue therapy), stretching, therapeutic and motor control exercises	Pragmatic hip arthroscopy surgery (acetabular rim trimming, labral dedridement or repair, femoral osteoplasty)	2 years	6, 12 months	HOS-ADL HOS-Sport	IHOT Global rating of change	Y
Palmer, et al 2019 41	Arthroscopic hip surgery compared with physiotherapy and activity modification for the treatment of symptomatic femoroacetabular impingement: multicentre randomised controlled trial	RCT	Low	Aged 18–60 years, referred to secondary or tertiary care. Clinically and radiologically diagnosed FAIS (no imaging thresholds used. Instead surgeons qualitatively assessed morphology).	Physiotherapy in past 12 months, past hip surgery, hip OA (KL≥2), hip dysplasia (LCEA<20).	110/112	88/100	36 (10)/36 (10)	37/73 38/74	26.6 (4.8)/25.9 (4.8)	Goal-based supervised PT, up to 8 sessions over 5 months. Patient goals supplemented with programme focusing on muscle strength, core stability and movement control. Avoidance of extreme ROM encouraged. No specific programme details available	Pragmatic hip arthroscopy surgery (osteochondroplasty, labral repair or debridement, chondral debridement and microfracture as deemed appropriate by surgeon)	8 months		HOS-ADL	HOS-Sport NAHS OHS HAGOS IHOT-33 EQ-5D-3L PainDETECT HADS Hip flexion ROM Hip extension ROM Hip abduction ROM Hip adduction ROM Hip ER ROM Hip IR ROM
Smeatham, et al 2017 37	Does treatment by a specialist physiotherapist change pain and function in young adults with symptoms from femoroacetabular impingement? A pilot project for a randomised controlled trial	Pilot RCT	Moderate	FAI diagnosed Surgeon (FAI on X-ray; Aged 18 and 50 years; groin/anterolateral hip pain; mechanical symptoms; pain FADIR); willing for treatment by a specialist physiotherapist, and abstain from treatment outside study protocol	Previous hip surgery to the hip or pelvis; other significant hip pathology; back symptom; chronic pain;  inability to comply with the physiotherapy protocol	15/15	11/12	36/33	7/8 5/10	NR	Pragmatic care from specialist physio. Any number of sessions allowed. Manual therapy and exercise to address movement deficits	Routine care (analgesia, continuation self-management or exercise previously given	3 months	NA	NAHS HOS LEFS VAS	NA	Y
Wright, et al 2016 38	Non-operative management of femoroacetabular impingement: a prospective, randomised controlled clinical trial pilot study	Pilot RCT	Moderate	Aged 18–50 years clinical diagnosis FAI (hip flexion <95°, internal rotation <10°, positive FADIR or FABER) radiological diagnosis FAI (alpha angle >55°; lateral centre edge angle >35; crossover sign)	Previous hip surgery; other surgical procedure of lower limb in the prior 6 months; pre-existing hip disease pregnancy; opioid analgesia or CSI past 30 days; advanced osteoporosis; BMI >38; cardiopulmonary disease	8/7	8/7	31 (5)/36 (12)	3/4 1/7	25.6 (3.7) 24.1 (7.4)	Manual therapy and supervised exercise	Advice and home exercise	7 weeks	NA	HOS-ADL HOS-Sport NPRS LEFS SANE-ADL SANE-Sport	Depth of squat Triple hip Hip flexion ROM Hip flexion Strength FABER	Y

ADL, activity of daily living; AVN, avascular necrosis; BMI, body mass index; CSI, corticosteroid injection; EQ-5D-5L, Euroquol Questionnaire; ER, external rotation; F, female; FABER, flexion-abduction-external rotation test; FADIR, flexion-adduction-internal rotation test; FAI, femoroacetabular impingement; HAGOS, Copenhagen Hip and Groin Outcome Score; HHS, Harris Hip Score; HOOS, Hip Osteoarthritis and disability Outcome Score; HOS, Hip Outcome Score; HSAS, Hip Sports Activity Scale; IHOT, International Hip Outcome Tool; IR, internal rotation; KL, Kellgren Lawrence; LCEA, lateral centre edge angle; LEFS, lower extremity functional scale; m, metre; M, male; MCS, emotional function subscale; MRA, magnetic resonance arthrogram; n, no; NA, not applicable; NAHS, Non-Arthritic Hip Score; NPRS, Numeric Pain Rating Scale; NR, not reported; NSAIDs, non-steroidal anti-inflammatory drugs; OA, osteoarthritis; PA, physical activity; PCS, physical function subscale; PT, physiotherapy/physical therapy; QOL, quality of life; RCT, randomised controlled trial; ROM, range of motion; SANE, single assessment numeric evaluation; SF-12, Short Form-12 Questionnaire; SMD, standardised mean difference; VAS, Visual Analogue Scale; WOMAC, Western Ontario and McMaster Universities Arthritis Index; Y, yes.