Marsha Tijssen

Patient-Reported Outcome questionnaires for hip arthroscopy: a systematic review of the psychometric evidence

BackgroundHip arthroscopies are often used in the treatment of intra-articular hip injuries. Patient-reported outcomes (PRO) are an important parameter in evaluating treatment. It is unclear which PRO questionnaires are specifically available for hip arthroscopy patients. The aim of this systematic review was to investigate which PRO questionnaires are valid and reliable in the evaluation of patients undergoing hip arthroscopy.MethodsA search was conducted in Pubmed, Medline, CINAHL, the Cochrane Library, Pedro, EMBASE and Web of Science from 1931 to October 2010. Studies assessing the quality of PRO questionnaires in the evaluation of patients undergoing hip arthroscopy were included. The quality of the questionnaires was evaluated by the psychometric properties of the outcome measures. The quality of the articles investigating the questionnaires was assessed by the COSMIN list.ResultsFive articles identified three questionnaires; the Modified Harris Hip Score (MHHS), the Nonarthritic Hip Score (NAHS) and the Hip Outcome Score (HOS). The NAHS scored best on the content validity, whereas the HOS scored best on agreement, internal consistency, reliability and responsiveness. The quality of the articles describing the HOS scored highest. The NAHS is the best quality questionnaire. The articles describing the HOS are the best quality articles.ConclusionsThis systematic review shows that there is no conclusive evidence for the use of a single patient-reported outcome questionnaire in the evaluation of patients undergoing hip arthroscopy. Based on available psychometric evidence we recommend using a combination of the NAHS and the HOS for patients undergoing hip arthroscopy.

Diagnostics of Femoroacetabular Impingement and Labral Pathology of the Hip: A Systematic Review of the Accuracy and Validity of Physical Tests

PURPOSE Femoroacetabular impingement (FAI) and labral pathology have been recognized as causative factors for hip pain. The clinical diagnosis is now based on MRI-A (magnetic resonance imaging-arthrogram) because the physical diagnostic tests available are diverse and information on diagnostic accuracy and validity is lacking. The purpose of this systematic review was to identify the diagnostic accuracy and validity of physical tests that are used to assess FAI and labral pathology of the hip joint. METHODS We performed a computerized literature search using PubMed, Medline, Web of Science, PEDro, the Cochrane Library, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) (through EBSCO). Studies describing tests and diagnostic accuracy studies were included. All included studies were assessed by the Levels of Evidence for Primary Research Questions list. All diagnostic accuracy studies were assessed by the QUADAS (Quality Assessment of Diagnostic Accuracy Studies) score. RESULTS We included 21 studies in which 18 different tests were described. For 11 of these tests, diagnostic accuracy figures were presented. Sensitivity was examined for all tests. Other diagnostic accuracy figures were often lacking, and when available, these were low. All articles describing tests had Level IV or V evidence. All diagnostic accuracy studies, except 1, had Level II or III evidence. Three articles had a good QUADAS score. CONCLUSIONS In previous studies a wide range of physical diagnostic tests have been described. Little is known about the diagnostic accuracy and validity of these tests, and if available, these figures were low. The quality of the studies investigating these tests is too low to provide a conclusive recommendation for the clinician. Thus, currently, no physical tests are available that can reliably confirm or discard the diagnoses of FAI and/or labral pathology of the hip in clinical practice. LEVEL OF EVIDENCE Level III, systematic review of Level III studies.

Hip joint pathology: relationship between patient history, physical tests, and arthroscopy findings in clinical practice

The purpose of this retrospective cohort study was to (a) describe the clinical presentation of femoroacetabular impingement (FAI) and hip labral pathology; (b) describe the accuracy of patient history and physical tests for FAI and labral pathology as confirmed by hip arthroscopy. Patients (18–65 years) were included if they were referred to a physical therapist to gather pre‐operative data and were then diagnosed during arthroscopy. Results of pre‐operative patient history and physical tests were collected and compared to arthroscopy. Data of 77 active patients (mean age: 37 years) were included. Groin as main location of pain, the Anterior Impingement test (AIT), Flexion‐Abduction‐External Rotation (FABER) test, and Fitzgerald test had a high sensitivity (range 0.72–0.91). Sensitivity increased when combining these tests (0.97) as either groin as main location of pain and a positive FABER test or a positive AIT and a positive FABER test were the shortest most sensitive combinations. The results of this study point out that in clinical practice absence of groin as main location of pain combined with a negative FABER test or the combination of a negative AIT and a negative FABER test are suggested to rule out the diagnosis of symptomatic FAI and/or labral pathology.

A clinical observational study on patient-reported outcomes, hip functional performance and return to sports activities in hip arthroscopy patients

OBJECTIVES To describe data of short- and midterm results of hip arthroscopy patients based on patient-reported hip function, hip functional performance and return to sports activities. DESIGN Observational cohort study. SETTING Sports medical center. PARTICIPANTS 37 recreational athletes (21 men) at least six months after finishing rehabilitation for hip arthroscopy. MAIN OUTCOME MEASURES International Hip Outcome Tool 33 (IHOT-33), Pain Visual Analogue Scale (VAS), Global Perceived Effect Scale (GPE), sports questionnaires and hip functional performance tests. RESULTS At a mean follow-up time of 2.3 years, 81% of participants reported improvement on the GPE and 84% returned to sports activities. The mean IHOT-33 score was 69.3; the mean VAS score was 35.0. Range of motion (ROM) and strength were within the 90% Limb Symmetry Index (LSI) limit, except for hip internal rotation ROM. A full recovery of hip functional performance, as measured with balance and hop tests, was established based on the 90% LSI limit. CONCLUSIONS The overall short- and midterm results of these follow-up data show good recovery of hip arthroscopy patients on patient-reported outcomes, functional performance and return to sports activities. The functional performance tests used in this study seem adequate for measuring recovery in hip arthroscopy patients.

The Dutch Hip and Groin Outcome Score: Cross-cultural Adaptation and Validation According to the COSMIN Checklist

•STUDY DESIGN: Clinical measurement. •BACKGROUND: The Copenhagen Hip and Groin Outcome Score (HAGOS) was developed as a patient‐reported outcome measure for young, active individuals with hip and groin pain. •OBJECTIVES: To cross‐culturally adapt and validate a Dutch version of the HAGOS. •METHODS: Adaptation and validation were performed according to existing guidelines and the COnsensus‐based Standards for the selection of health Measurement INstruments checklist. Physically active (Tegner activity score of greater than 2) adults between 18 and 50 years of age with hip and groin pain (numeric pain score of 1 or greater) were included in the study. Reliability (test‐retest, internal consistency) was assessed in clinically stable patients. Construct validity was determined by calculating Spearman correlations between the scores on the HAGOS and scores on the Hip disability and Osteoarthritis Outcome Score and European Quality of Life‐5 Dimensions subscales. Fifteen hypotheses were defined a priori. Interpretability was considered good when floor and ceiling effects were present in less than 15% of individuals. •RESULTS: A Dutch version of the HAGOS was created. Its reliability was tested in 129 individuals and its validity in 194 participants. Test‐retest reliability was good (intraclass correlation coefficient = 0.83‐0.87). Internal consistency was good (Cronbach &agr; = .81‐.92). Construct validity was considered good: 13 of 15 (87%) hypotheses were confirmed. Floor effects (21%) were present for the physical activity subscale. •CONCLUSION: The Dutch HAGOS is a reliable and valid patient‐reported outcome measure and performs similarly to the original version in its target population. It can be used in clinical as well as research settings. Presence of floor effects should be considered for the physical activity subscale.

Translation, Cross-cultural Adaptation, and Validation of the Dutch International Hip Outcome Tool-33 (iHOT-33 NL) in Young, Physically Active Individuals With Symptomatic Hip Joint Pathology

•STUDY DESIGN: Prospective cohort. •BACKGROUND: The international Hip Outcome Tool‐33 (iHOT‐33), developed in English, has been shown to be a valid and reliable questionnaire for young, physically active individuals with symptomatic hip joint pathology. •OBJECTIVES: To translate and validate the iHOT‐33 in Dutch (iHOT‐33 NL) in the target population. •METHODS: Translation and cross‐cultural adaptation of the iHOT‐33 were performed following existing guidelines. Young to middle‐aged (18‐50 years), active (Tegner activity score of 3 or greater) individuals presenting with symptomatic hip joint‐related pain (numeric pain‐rating score of 1 or greater) in a primary health care/hospital setting were included. The iHOT‐33 NL, Hip disability and Osteoarthritis Outcome Score (HOOS), European Quality of Life‐5 Dimensions questionnaire (EQ‐5D), numeric pain‐rating score, and Global Perceived Effect score were completed by 214 patients. •RESULTS: The intraclass correlation coefficient for test‐retest reliability was 0.92 (95% confidence interval: 0.88, 0.94). Smallest detectable changes at individual and group levels were, respectively, 16.7 and 1.1 points. The Cronbach alpha was .9. Principal‐component analysis revealed 4 domains of the iHOT‐33 NL. Of the hypotheses used for construct validity, 87% were confirmed. No floor and ceiling effects were detected for the iHOT‐33 NL total score. The minimal important change was 10.7 points. •CONCLUSION: The iHOT‐33 NL is a reliable and valid patient‐reported outcome questionnaire for young, physically active individuals with symptomatic hip joint pathology. It can be used in research and clinical settings.