Robert van Cingel

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.

Evidence-based clinical practice update: practice guidelines for anterior cruciate ligament rehabilitation based on a systematic review and multidisciplinary consensus.

Aim The Royal Dutch Society for Physical Therapy (KNGF) instructed a multidisciplinary group of Dutch anterior cruciate ligament (ACL) experts to develop an evidence statement for rehabilitation after ACL reconstruction. Design Clinical practice guideline underpinned by systematic review and expert consensus. Data sources A multidisciplinary working group and steering group systematically reviewed the literature and wrote the guideline. MEDLINE and the Cochrane Library were searched for meta-analyses, systematic reviews, randomised controlled trials and prospective cohort studies published between January 1990 and June 2015. Eligibility criteria for selecting studies Included literature must have addressed 1 of 9 predetermined clinical topics: (1) preoperative predictors for postoperative outcome, (2) effectiveness of physical therapy, (3) open and closed kinetic chain quadriceps exercises, (4) strength and neuromuscular training, (5) electrostimulation and electromyographic feedback, (6) cryotherapy, (7) measurements of functional performance, (8) return to play and (9) risk for reinjury. Summary Ninety studies were included as the basis for the evidence statement. Rehabilitation after ACL injury should include a prehabilitation phase and 3 criterion-based postoperative phases: (1) impairment-based, (2) sport-specific training and (3) return to play. A battery of strength and hop tests, quality of movement and psychological tests should be used to guide progression from one rehabilitation stage to the next. Postoperative rehabilitation should continue for 9–12 months. To assess readiness to return to play and the risk for reinjury, a test battery, including strength tests, hop tests and measurement of movement quality, should be used.

Injuries in Runners; A Systematic Review on Risk Factors and Sex Differences

Background The popularity of running continues to increase, which means that the incidence of running-related injuries will probably also continue to increase. Little is known about risk factors for running injuries and whether they are sex-specific. Objectives The aim of this study was to review information about risk factors and sex-specific differences for running-induced injuries in adults. Search Strategy The databases PubMed, EMBASE, CINAHL and Psych-INFO were searched for relevant articles. Selection Criteria Longitudinal cohort studies with a minimal follow-up of 1 month that investigated the association between risk factors (personal factors, running/training factors and/or health and lifestyle factors) and the occurrence of lower limb injuries in runners were included. Data Collection and Analysis Two reviewers’ independently selected relevant articles from those identified by the systematic search and assessed the risk of bias of the included studies. The strength of the evidence was determined using a best-evidence rating system. Sex differences in risk were determined by calculating the sex ratio for risk factors (the risk factor for women divided by the risk factor for men). Main Results Of 400 articles retrieved, 15 longitudinal studies were included, of which 11 were considered high-quality studies and 4 moderate-quality studies. Overall, women were at lower risk than men for sustaining running-related injuries. Strong and moderate evidence was found that a history of previous injury and of having used orthotics/inserts was associated with an increased risk of running injuries. Age, previous sports activity, running on a concrete surface, participating in a marathon, weekly running distance (30–39 miles) and wearing running shoes for 4 to 6 months were associated with a greater risk of injury in women than in men. A history of previous injuries, having a running experience of 0–2 years, restarting running, weekly running distance (20–29 miles) and having a running distance of more than 40 miles per week were associated with a greater risk of running-related injury in men than in women. Conclusions Previous injury and use of orthotic/inserts are risk factors for running injuries. There appeared to be differences in the risk profile of men and women, but as few studies presented results for men and women separately, the results should be interpreted with caution. Further research should attempt to minimize methodological bias by paying attention to recall bias for running injuries, follow-up time, and the participation rate of the identified target group.

Intra-examiner reproducibility of ankle inversion-eversion isokinetic strength in healthy subjects

The isokinetic strength of ankle inversion-eversion was twice tested, over a period of one week, by the same examiner in apparently healthy 15 women and 15 men at 30 and 120°/s. Test-retest measurements were examined for 1 and 3 sets of three repetitions. Intraclass correlation coefficients for the highest peak torque out of 1 set of 3 repetitions varied from 0.47-0.82 for men and 0.70-0.94 for women. The ICC for the mean-based PT (the 3 highest PTs out of 3 sets of 3 replicates) ranged 0.74-0.83 for men and 0.80-0.97 for women. Bland-Altman plots have indicated a largely homoscedastic distribution of the test-retest parameters. The standard error of measurement (SEM) varied from 3.6-7.00 Nm for men and 3.3-4.7 Nm for women (highest PT-based) and 2.9-5.7 Nm for men and 1.6-4.0 Nm for women (mean PT-based). Irrespective of either paradigm, there was much dispersion in the ICCs for both genders in other isokinetic parameters such as the time to PT and angle at PT. It is therefore concluded that the only reproducible isokinetic parameter under this test protocol is the peak torque.

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 5- or 10-km Marikenloop Run: A Prospective Study of the Etiology of Running-Related Injuries in Women

Study Design Prospective cohort. Background The popularity of running events is still growing, particularly among women; however, little is known about the risk factors for running-related injuries in female runners. Objectives The aims of this study were to determine the incidence and characteristics (site and recurrence) of running-related injuries and to identify specific risk factors for running-related injuries among female runners training for a 5- or 10-km race. Methods Four hundred thirty-five women registered for the Marikenloop run of 5 or 10 km were recruited. Follow-up data were collected over 12 weeks using questionnaires, starting 8 weeks before the event and ending 4 weeks after the event. Two orthopaedic tests (navicular drop test and extension of the first metatarsophalangeal joint) were performed in the 8 weeks before the event. Running-related injuries, defined as running-related pain of the lower back and/or the lower extremity that restricted running for at least 1 day, were assessed at 1-, 2-, and 3-month follow-ups. Results Of 417 female runners with follow-up data (96%), 93 runners (22.3%) reported 109 running-related injuries, mainly of the hip/groin, knee, and lower leg. Multivariable Cox regression analysis showed that a weekly training distance of more than 30 km (hazard ratio = 3.28; 95% confidence interval [CI]: 1.23, 8.75) and a previous running injury longer than 12 months prior (hazard ratio = 1.88; 95% CI: 1.03, 3.45) were associated with the occurrence of running-related injuries. Conclusion Hip/groin, knee, and lower-leg injuries were common among female runners. Only weekly training distance (greater than 30 km) and previous running injury (greater than 12 months prior) were associated with running-related injuries in female runners training for a 5- or 10-km event. Level of Evidence Etiology, 2b. J Orthop Sports Phys Ther 2016;46(6):462-470. Epub 26 Apr 2016. doi:10.2519/jospt.2016.6402.

Reproducibility of a battery of commonly used clinical tests to evaluate lumbopelvic motor control

OBJECTIVE To determine reproducibility of a battery of clinical tests for evaluating lumbopelvic motor control (LMC). DESIGN Test-retest design. PARTICIPANTS Fifty healthy subjects. OUTCOME MEASURES Two raters independently examined performance on 12 clinical tests for evaluating LMC. All tests were scored on a seven-point scale, based on qualitative and quantitative performance. Subjects were measured twice, with a two week interval between examinations. Intra- and inter-rater reproducibility of each test were determined using intraclass correlation coefficients (ICCs), standard error of measurement, smallest detectable change (SDC) and limits of agreement. RESULTS Reliability of the tests ranged from poor to excellent. Intra-rater ICCs ranged from 0.00 to 0.82, whereas inter-rater ICCs varied from 0.00 to 0.96. SDC values were smallest for supine leg raising, bent knee fall out, prone bridge and unilateral prone bridge (<2 points). CONCLUSION This study shows limited reproducibility of a battery of 12 clinical tests for the evaluation of LMC in a healthy population. Supine leg raising, bent knee fall out, prone bridge, and unilateral prone bridge showed the smallest measurement errors. The other 8 tests were found to have large measurement errors. Based on these results, dichotomization of the rating method might be considered in order to improve reproducibility values.

Return to Sport in Athletes with Midportion Achilles Tendinopathy: A Qualitative Systematic Review Regarding Definitions and Criteria

BackgroundMidportion Achilles tendinopathy (AT) can cause long-term absence from sports participation, and shows high recurrence rates. It is important that the decision to return to sport (RTS) is made carefully, based on sharply delimited criteria. Lack of a well-defined definition and criteria hampers the decision to RTS among athletes with AT, and impedes comparison of RTS rates between different studies.ObjectiveThe aim of this study was to systematically review the literature for definitions of, and criteria for, RTS in AT research.Study DesignQualitative systematic review.MethodsThe PubMed, EMBASE, Cochrane, CINAHL, PEDro, and Scopus electronic databases were searched for articles that reported on the effect of a physiotherapeutic intervention for midportion AT. Article selection was independently performed by two researchers. Qualitative content analysis was used to analyze the included studies and extract definitions of, and criteria for, RTS.ResultsThirty-five studies were included in the content analysis, showing large variety in both the definitions and criteria. Thirty-two studies reported a definition of RTS, but only 19 studies described the criteria for RTS. The content analysis revealed that ‘reaching pre-injury activity/sports level, with the ability to perform training and matches without limitations’, ‘absence of pain’, and ‘recovery’ were the main content categories used to define RTS. Regarding the criteria for RTS, eight different content categories were defined: (1) ‘level of pain’; (2) ‘level of functional recovery’; (3) ‘recovery of muscle strength’; (4) ‘recovery of range of motion’; (5) ‘level of endurance of the involved limb’; (6) ‘medical advice’; (7) ‘psychosocial factors’; and (8) ‘anatomical/physiological properties of the musculotendinous complex’. Many criteria were not clearly operationalized and lacked specific information.ConclusionsThis systematic review shows that RTS may be defined according to the pre-injury level of sports (including both training and matches), but also with terms related to the absence of pain and recovery. Multiple criteria for RTS were found, which were all related to level of pain, level of functional recovery, muscular strength, range of motion, endurance, medical advice, psychosocial factors, or anatomical/physiological properties of the Achilles tendon. For most of the criteria we identified, no clear operationalization was given, which limits their validity and practical usability. Further research on how RTS after midportion AT should be defined, and which criteria should be used, is warranted.PROSPERO Registration NumberCRD42017062518.

Solution space: Monitoring the dynamics of motor rehabilitation

ABSTRACT This article presents and discusses a perspective on the concept of “solution space” in physiotherapy. The model is illustrated with a subjective assessment of the way movements are performed and an objective quantification of the dynamics of the recovery process for a patient with a knee injury. Based on insights from the domain of human motor control, solution space is a key concept in our recovery model that explains the emergence of a variety of adaptive changes that may occur in the movement system recovering from an injury. The three dimensions that span the solution space are: (1) information and control processes; (2) time; and (3) degrees of freedom. Each dimension is discussed within the context of feasible physiotherapeutic assessments to identify and facilitate desirable behavioral patterns or bypass emerging but undesirable behavioral patterns that could impede both short- and long-term recovery. Central to this article is our view on the relationship between the recovery process and the three dimensions of the solution space, which determines the model’s usefulness as a motor-rehabilitation monitoring tool.