Identification of a Patient Acceptable Symptomatic State Score for the International Hip Outcome Tool in People Undergoing Hip Arthroscopy

Maxwell, Samuel; Pergaminelis, Nicholas; Renouf, Jesse; Tirosh, Oren; Tran, Phong

doi:10.1016/j.arthro.2018.06.049

Cited by 21 publications

(30 citation statements)

References 26 publications

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“…In total, 52 out of the 78 participants (67%) achieved an iHOT33 MIC, with one third of participants reported no meaningful improvement in hip health-related quality of life, independent of gender. The twenty point iHOT33 improvement (from 40 to 60) noted at six months is very similar to iHOT33 changes previously reported at two years (37 to 65 [149]) and those reported in studies using other hip PROMs (modified Harris Hip score (mHHS), Hip and Groin Outcome Score (HAGOS), Hip disability and Osteoarthritis Outcome Score (HOOS)) [46,127,219]. The proportion of participants reporting MIC (67%) is also similar to the previously reported outcomes [219].…”

Section: Discussionsupporting

confidence: 88%

“…The iHOT33 PASS score used in this study was based on individuals at 2.25 years post surgery being asked the question "taking into account all the activities you do during your daily life, your level of pain and also your functional impairment, are you satisfied with your current state following your surgery?" [149]. It is possible the PASS score may be higher at 6-months post surgery as individuals may anticipate further recovery of function and reduction of symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…This presents a limitation of the use of a PASS score when trying to generalize response to a treatment such as hip arthroscopy. Although a PASS score can be helpful in interpreting PROM results both clinically and in research, satisfactory response to an individual treatment for an individual patient should ultimately be decided on by the patient within his or her own context [149]. In total, 52 out of the 78 participants (67%) achieved an iHOT33 MIC, with one third of participants reported no meaningful improvement in hip health-related quality of life, independent of gender.…”

Section: Discussionmentioning

confidence: 99%

“…All participants completed the iHOT33 before arthroscopy (30 days ± 36) and at six months post arthroscopy (189 days± 13) ( [179]. A PASS score for the iHOT33 at two years following hip arthroscopy has been reported as 58/100 [149].…”

Section: Outcome Variablementioning

confidence: 99%

“…The International Hip Outcome Tool (iHOT33) is a reliable [90], selfadministered evaluative tool to measure health-related quality of life in young, active patients with hip disorders [161]. Improvement has been determined by (i) observing a predetermined minimal important change (MIC) in a PROM score [241], which represents the smallest difference in score which participants perceive as beneficial and which would mandate, in the absence of adverse side effects and excessive cost, a change in the patient's management [101] or (ii) a Patient Acceptable Symptomatic State (PASS) score which is an absolute value on a PROM that represents a level of symptoms acceptable to patients [149].…”

Section: Introductionmentioning

confidence: 99%

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Clinical predictors of outcome following hip arthroscopy

Freke¹

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Intra-articular hip pathology, including femoro-acetabular impingement syndrome (FAIS), is a cause of hip and groin pain in otherwise healthy young adults. While arthroscopic surgery in the hip joint has historically lagged behind its counterparts in the shoulder and knee, there has recently been a rapid evolution of the management of hip injuries in the young, active population utilizing hip arthroscopic techniques which has improved understanding of mechanical hip pathology. The aims of this thesis were to; investigate the clinical presentation of individuals scheduled to undergo hip arthroscopy; assess and report pre-operative deficits in hip strength, range of movement (ROM) and dynamic balance; determine the changes that occur post surgery, and; identify potentially modifiable predictors of outcome post arthroscopy.A review of literature revealed that there is limited evidence that those with FAI syndrome have reduced hip abduction and flexion ROM compared to healthy matched controls. There were no differences in hip adduction or extension ROM, and conflicting results for external rotation and internal rotation ROM. However, people with symptomatic FAIS demonstrated deficits in hip muscle strength and reduced dynamic balance on one leg when compared to controls. For hip joint ROM, there were no significant within-group differences between pre and post intervention time points while hip muscle strength improved significantly from pre to post-hip arthroscopy in a single case series.In people undergoing hip arthroscopy, severe femoral head chondropathy, large labral tears, along with a high prevalence of labral pathology and acetabular chondropathy, were relatively common findings. Severe femoral head chondropathy and large labral tears were most associated with patient related outcomes (PROs), however, at best only explained 22% of the variability. Individuals with hip pain and severe scores in the International Hip Outcome Tool (iHOT33) subscale of symptoms and functional limitations presented with significantly lesser hip muscle strength and hip flexion ROM when compared to individuals with moderate or mild scores. Individuals scheduled for arthroscopic hip surgery were also significantly weaker, had less hip mobility and reduced dynamic balance compared to healthy matched controls. In the hip pain population, dynamic balance performance was associated with various hip strength and ROM measurements in a direction specific manner. The clinical significance of these findings may assist therapists in providing targeted rehabilitation programs for people with FAIS and chondrolabral hip pain to improve hip strength and ROM, help reduce symptoms and to improve function. 3 By three months post arthroscopy to address bony morphology and/or chondrolabral pathology, all directions of hip strength (with the exception of adduction squeeze in crook lying and flexion) and hip flexion ROM were significantly improved. While by six months post arthroscopy, strength in all directions, and flexion and rotation ROM were signifi...

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Outcome Variablementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clinical predictors of outcome following hip arthroscopy

Freke¹

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Treatment decisions after interdisciplinary evaluation for nonarthritic hip pain: A randomized controlled trial

Brown‐Taylor

Harris‐Hayes

Foraker

et al. 2021

PM&R

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Background Physical therapy and hip arthroscopy are two viable treatment options for patients with nonarthritic hip pain (NAHP); however, patients may experience considerable decisional conflict when making a treatment decision. Interdisciplinary evaluation with a physical therapist and surgeon may better inform the decision‐making process and reduce decisional conflict. Objective To identify the extent to which an interdisciplinary evaluation between a surgeon, physical therapist, and patient influences treatment plans and decisional conflict of persons with NAHP. Design Randomized controlled trial. Setting Hip preservation clinic. Participants Adults with primary NAHP. Interventions Participants were randomized to receive a standard (surgeon) or interdisciplinary (surgeon+physical therapist) evaluation. Surgeon evaluations included patient interview, strength and range‐of‐motion examination, palpation, gross motor observation, and special testing. Interdisciplinary evaluations started with the surgeon evaluation, then a physical therapist evaluated movement impairments during sitting, sit‐to‐stand, standing, single‐leg stance, single‐leg squat, and walking. All evaluations concluded with treatment planning with the respective provider(s). Outcome Measures Treatment plan and decisional conflict were collected pre‐ and postevaluation. Inclusion of physical therapy in participants' postevaluation treatment plans and postevaluation decisional conflict were compared between groups using chi‐square tests and Mann‐Whitney U tests, respectively. Results Seventy‐eight participants (39 in each group) met all eligibility criteria and were included in all analyses. Sixty‐six percent of participants who received an interdisciplinary evaluation included physical therapy in their postevaluation treatment plan, compared to 48% of participants who received a standard evaluation (p = .10). Participants who received an interdisciplinary evaluation reported 6.3 points lower decisional conflict regarding their postevaluation plan (100‐point scale; p = .04). The interdisciplinary and standard groups reduced decisional conflict on average 24.8 ± 18.9 and 23.6 ± 14.6 points, respectively. Conclusions Adding a physical therapist to a surgical clinic increased interest in physical therapy treatment, but this increase was not statistically significant. The interdisciplinary group displayed lower postevaluation decisional conflict; however, both groups displayed similar reductions in decisional conflict from pre‐ to postevaluation. This study also demonstrated the feasibility of an interdisciplinary evaluation in a hip preservation clinic.

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Editorial Commentary: Is It Acceptable to Have Symptoms After Hip Arthroscopy?? Depends on Whom You Ask…

Lall

Maldonado

Domb

2018

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Patient-reported outcome measures are considered the gold standard metrics of symptomatic state. However, with a multitude of patient-reported outcome measures and statistical analyses, it can be easy to lose sight of the primary goal of surgery: a happy patient who is satisfied with his or her condition. In this editorial commentary, we briefly review the metrics of hip arthroscopy (and aviation).

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Identification of a Patient Acceptable Symptomatic State Score for the International Hip Outcome Tool in People Undergoing Hip Arthroscopy

Cited by 21 publications

References 26 publications

Clinical predictors of outcome following hip arthroscopy

Clinical predictors of outcome following hip arthroscopy

Treatment decisions after interdisciplinary evaluation for nonarthritic hip pain: A randomized controlled trial

Editorial Commentary: Is It Acceptable to Have Symptoms After Hip Arthroscopy?? Depends on Whom You Ask…

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