What is the best approach to patient education on Femoroacetabular Impingement (FAI)?

Patient Education on Femoroacetabular Impingement (FAI)

The best approach to patient education on FAI should be individualized, needs-based, and delivered throughout the course of the condition using multiple modes of delivery including written materials, multimedia resources, and both individual and group sessions. 1

Understanding FAI: Key Educational Components

What is FAI?

• FAI is a condition where abnormal bone shapes in the hip joint cause impingement
• Three types exist: cam (abnormal femoral head), pincer (acetabular overcoverage), or mixed 2
• Primary symptom is groin pain, which may also be felt in back, buttock, and thigh 1
• Diagnosis combines symptoms, clinical signs (positive FADIR test), and imaging findings 1

Natural History and Progression

• Without proper treatment, FAI can lead to progressive joint damage and early osteoarthritis 1
• FAI is a significant cause of hip pain in young, active individuals 3
• It's the main etiology of hip osteoarthritis in younger populations 4

Educational Approach and Timing

When to Provide Education

• At diagnosis
• When treatment changes are made
• When required by patient's physical or psychological condition 5
• During regular follow-up appointments (at least annually) 1

How to Deliver Education

1. Tailored to individual needs: Education should be personalized based on:

   • Patient's illness perceptions
   • Educational capability
   • Disease stage
   • Current symptoms 5

2. Multiple delivery formats:

   • Individual face-to-face consultations
   • Group sessions
   • Online interactions
   • Supplemented by phone calls
   • Written materials
   • Multimedia resources 5

3. Theoretical framework: Base education on evidence-based approaches such as:

   • Self-management programs
   • Cognitive behavioral therapy principles
   • Stress management techniques 5

Content of Patient Education

Disease Information

• Explain the nature of FAI (abnormal bone shapes causing impingement)
• Discuss specific causes pertaining to the individual
• Review consequences and prognosis 5
• Use visual aids to explain anatomy and pathology

Treatment Options

1. Conservative management:

   • Exercise therapy principles:
     • "Small amounts often" (pacing)
     • Link exercises to daily activities
     • Start within capability and build gradually
     • Include core strengthening, hip girdle muscle strengthening, range of motion exercises 5, 1
   • Pain management options
   • Activity modifications 1

2. Surgical options (when appropriate):

   • Hip arthroscopy for eligible patients (typically age <50, minimal/no osteoarthritis)
   • Procedures may include correction of bony abnormalities, labral repair, and addressing cartilage damage 1

Self-Management Strategies

• Joint protection techniques
• Activity pacing
• Pain management strategies
• Exercise routines
• When to seek additional medical attention 5

Special Considerations

Including Support Persons

• Include partners or caregivers when appropriate 5
• Ensure family understanding of activity limitations and support needed

Reinforcement and Follow-up

• Educational content should be reinforced at subsequent clinical encounters 5
• Regular monitoring of educational needs throughout disease course 5

Common Pitfalls in FAI Patient Education

1. Relying solely on imaging findings: Education should never be based on imaging alone, as many people with FAI morphology on imaging are asymptomatic 1

2. Overemphasis on surgical intervention: Conservative approaches show moderate to large effect sizes for both pain and function, with success rates of 53-78% return to play in athletes 1

3. Neglecting psychological aspects: FAI can impact quality of life and cause emotional distress; education should address these aspects 5

4. One-size-fits-all approach: Educational needs vary based on disease stage, symptoms, and individual patient factors 5

5. Inadequate explanation of prognosis: Patients need clear understanding that without proper treatment, FAI can lead to progressive joint damage and early osteoarthritis 1

By implementing this comprehensive educational approach, healthcare providers can empower patients with FAI to better understand their condition, actively participate in treatment decisions, and optimize their health outcomes.