AquOTic: protocol for a type 1 hybrid effectiveness-implementation trial of an occupational therapy-based water competency intervention for children on the autism spectrum.

Hip -related pain (HRP) commonly affects young and middle-aged active individuals (). HRP encompasses non-arthritic, intra-articular hip joint conditions with and without variations in bony morphology (). The conditions associated with variant hip joint morphology include femoroacetabular impingement syndrome (FAIS) and acetabular dysplasia, while non-morphological conditions include labral tears and chondral injuries (). Most individuals with HRP exhibit chronic symptoms (> 3 months in duration) and often reduce physical activity in an attempt to minimize their symptoms (; ). Although HRP is classified as a movement-related disorder (), the relationships between important clinical factors – symptom duration, physical activity level, patient-reported hip function and quality of life, and movement patterns remain unclear. Prior work has shown that a unilateral squatting task is more sensitive in detecting alterations in lower-limb mechanics compared to a bilateral squatting task in individuals with HRP (). Our prior work demonstrated that individuals with a longer duration of HRP exhibited lower average hip extensor moments during both the eccentric and concentric phases of a single leg squat (SLS) compared to individuals with a shorter symptom duration (). However, joint moments alone do not fully characterize musculoskeletal function. An adequate amount of joint power, defined as the product of joint moment and joint angular velocity, describes the generation and absorption of energy by the musculature and provides insight into ‘how’ and ‘when’ muscles contract (i.e., eccentric – energy absorption and concentric – energy generation) during dynamic tasks (; ; ). Compared to kinematics and moments alone, joint power offers a more direct window into functional muscle capacity. Prior work has examined joint power during walking and stair climbing in individuals with hip osteoarthritis (OA) (; ) and after total hip arthroplasty (; ). Hip joint power increased after total hip arthroplasty (THA) (), yet low-functioning THA individuals continued to exhibit lower sagittal plane hip joint power than healthy controls (), suggesting a relationship between hip joint power and function. Our prior work has shown that individuals with FAIS who ambulate with greater sagittal plane hip joint loading at 6 months after surgery exhibit improved cartilage health compared to the pre-surgical time point (). These findings suggest that quantifying hip joint power production may identify muscular targets needed to optimize hip joint loading and improve clinical outcomes. However, minimal research has examined joint power in the pre-arthritic HRP population (; ), and phase-specific analysis (eccentric vs. concentric) during the SLS would provide a more detailed characterization of muscle energy absorption and generation throughout the entire lower extremity.