Improving research quality on primary cam morphology

Introduction: Primary cam morphology—a cartilage or bony prominence at the head-neck junction of the hip—develops due to high-load sporting activity during maturation. Although prevalent in many athlete populations, this morphology generally occurs without ill-effects; however, some individuals develop femoroacetabular impingement syndrome or hip osteoarthritis. Existing research on primary cam morphology and its natural history is mired in confusion partly because clinicians, athletes, patients, and researchers have not agreed on key primary cam morphology elements or a prioritised research agenda.
Aim and objectives: The overall aim of the programme of research presented in this thesis is to support a transformation of both research and clinical practice related to primary cam morphology and its natural history so that it takes a more pragmatist and patient-centred direction, with specific objectives to: (1) explore the concept of primary cam morphology and its natural history; (2) mobilise and engage a community of athletes, patients, clinicians, and researchers; (3) ensure buy-in and diverse participation to facilitate inclusive co-production partnerships; (4) inform a more rigorous, inclusive, and evidence-based approach to research on primary cam morphology and its natural history by ascertaining the level of agreement among experts on key primary cam morphology elements and a prioritised research agenda; (5) surface and discuss competing perspectives on primary cam morphology and its natural history; (6) explore stakeholders’ perspectives on research quality relevant to primary cam morphology and its natural history; and (7) disseminate findings.
Methods: The hybrid mixed methods approach adopted for this programme of research include: (1) a literature review of primary cam morphology using concept analysis method; (2) a consensus exercise (Delphi panel, interacting group process and Essential National Health Research ranking strategy) to ascertain the level of agreement among experts on terminology, taxonomy, definitions, and imaging outcome measures for primary cam morphology and to work collaboratively towards agreement on a set of research priorities on conditions affecting the young person’s hip; and (3) a qualitative interview study to explore stakeholders’ perspectives on research quality relevant to primary cam morphology and its natural history.
Results: The concept analysis introduced and clarified primary cam morphology. Reported in the Oxford Consensus Study, stakeholders agreed—and surfaced areas of tension and dissent—on: (1) a new conceptual definition for the morphology; (2) more consistent terminology; (3) a taxonomy distinguishing between primary and secondary cam morphology; (4) challenges of operationalising the hip morphology, and (5) a prioritised research agenda for the field. We constructed five action-inviting themes for higher quality research based on stakeholders’ perspectives on research quality, which are that research communities in this field should: (1) partner with athletes/patients; (2) collaborate with one another; (3) champion equity, diversity, and inclusion; (4) pursue open science; and (5) nurture young scholars.
Conclusion: The empirical work presented in this thesis could move both research and clinical practice related to primary cam morphology and its natural history in a more pragmatist and patient-centred direction. It serves as a foundation for concrete actions by research communities in the field to pursue high value research and generate less research waste.

Keywords: primary cam morphology
load
femoroacetabular impingement syndrome
FAI syndrome
athlete
osteoarthritis
hip
Delphi consensus
sport
research quality
Advisor: Greenhalgh, P
Glyn-Jones, S
Oke, J
Clarke, M
Karim, K