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Psychometric properties of patient-reported outcome measures for hip arthroscopic surgery

- Kemp, Joanne, Collins, Natalie, Roos, Ewa, Crossley, Kay

  • Authors: Kemp, Joanne , Collins, Natalie , Roos, Ewa , Crossley, Kay
  • Date: 2013
  • Type: Text , Journal article
  • Relation: American Journal of Sports Medicine Vol. 41, no. 9 (2013), p. 2065-2073
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  • Description: Background: Patient-reported outcomes (PROs) are considered the gold standard when evaluating outcomes in a surgical population. While the psychometric properties of some PROs have been tested, the properties of newer PROs in patients undergoing hip arthroscopic surgery remain somewhat unknown. Purpose: To evaluate the reliability, validity, responsiveness, and interpretability of 5 PROs (Copenhagen Hip and Groin Outcome Score [HAGOS], Hip Disability and Osteoarthritis Outcome Score [HOOS], Hip Outcome Score [HOS], International Hip Outcome Tool [iHOT-33], and Modified Harris Hip Score [MHHS]) in a population undergoing hip arthroscopic surgery and also to provide a recommendation of the best PROs in patients undergoing hip arthroscopic surgery. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Study participants were adults (mean age, 37 ± 11 years) who had undergone hip arthroscopic surgery 12 to 24 months previously and pain-free, healthy age-matched controls (mean age, 35 ± 11 years). Baseline characteristics including age, height, weight, waist girth, physical activity, and occupation were collected for both groups. The hip arthroscopic surgery group completed the 5 PRO questionnaires on 3 occasions, while the healthy control group completed the PRO questionnaires on 1 occasion. The reliability (test-retest reliability [intraclass correlation coefficient, or ICC] and minimal detectable change [MDC]), validity (construct validity, ability to detect a difference between groups, acceptability including floor and ceiling effects), responsiveness, and interpretability (minimal important change [MIC]) of each measure were calculated. Results: The test-retest reliability of PROs was excellent (ICC, 0.91-0.97), with an MDC of<20%. The HOOS, HAGOS, and iHOT- 33 had acceptable content validity. All PROs demonstrated construct validity and were able to detect a difference between the hip arthroscopic surgery and control groups. No measures demonstrated a floor effect; however, the MHHS and subscales relating to activities of daily living of the HOOS, HOS, and HAGOS demonstrated a ceiling effect. The HOOS, iHOT-33, and MHHS demonstrated adequate responsiveness, and the MIC for all measures was<11 points of a possible 100 points. Conclusion: The PROs of the HOOS and iHOT-33 demonstrate psychometric properties that may enable researchers and clinicians to use them with confidence in a population undergoing hip arthroscopic surgery. The psychometric properties of the MHHS, HOS, and some subscales of the HAGOS are reduced, and these PROs may be less valuable in this group. © 2013 The Author(s). National Health and Medical Research Council (Australia) Health Professional Research Training (Postdoctoral) Fellowship (No. 628918).

Greater understanding of normal hip physical function may guide clinicians in providing targeted rehabilitation programmes

- Kemp, Joanne, Schache, Anthony, Makdissi, Michael, Sims, Kevin, Crossley, Kay

  • Authors: Kemp, Joanne , Schache, Anthony , Makdissi, Michael , Sims, Kevin , Crossley, Kay
  • Date: 2013
  • Type: Text , Journal article
  • Relation: Journal of Science and Medicine in Sport Vol. 16, no. 4 (2013), p. 292-296
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  • Description: Objectives: This study investigated tests of hip muscle strength and functional performance. The specific objectives were to: (i) establish intra- and inter-rater reliability; (ii) compare differences between dominant and non-dominant limbs; (iii) compare agonist and antagonist muscle strength ratios; (iv) compare differences between genders; and (v) examine relationships between hip muscle strength, baseline measures and functional performance. Design: Reliability study and cross-sectional analysis of hip strength and functional performance. Methods: In healthy adults aged 18-50. years, normalised hip muscle peak torque and functional performance were evaluated to: (i) establish intra-rater and inter-rater reliability; (ii) analyse differences between limbs, between antagonistic muscle groups and genders; and (iii) associations between strength and functional performance. Results: Excellent reliability (intra-rater ICC = 0.77-0.96; inter-rater ICC = 0.82-0.95) was observed. No difference existed between dominant and non-dominant limbs. Differences in strength existed between antagonistic pairs of muscles: hip abduction was greater than adduction (p < 0.001) and hip ER was greater than IR (p < 0.001). Men had greater ER strength (p = 0.006) and hop for distance (p < 0.001) than women. Strong associations were observed between measures of hip muscle strength (except hip flexion) and age, height, and functional performance. Conclusions: Deficits in hip muscle strength or functional performance may influence hip pain. In order to provide targeted rehabilitation programmes to address patient-specific impairments, and determine when individuals are ready to return to physical activity, clinicians are increasingly utilising tests of hip strength and functional performance. This study provides a battery of reliable, clinically applicable tests which can be used for these purposes. © 2012 Sports Medicine Australia.

Patients with chondrolabral pathology have bilateral functional impairments 12 to 24 months after unilateral hip arthroscopy : A cross-sectional study

- Kemp, Joanne, Risberg, May, Schache, Anthony, Makdissi, Michael, Pritchard, Michael, Crossley, Kay

  • Authors: Kemp, Joanne , Risberg, May , Schache, Anthony , Makdissi, Michael , Pritchard, Michael , Crossley, Kay
  • Date: 2016
  • Type: Text , Journal article
  • Relation: Journal of Orthopaedic and Sports Physical Therapy Vol. 46, no. 11 (2016), p. 947-956
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  • Description: STUDY DESIGN: Cross-sectional study. BACKGROUND: Functional task performance in patients with chondrolabral pathology following hip arthroscopy is unknown. OBJECTIVES: To investigate in people with chondrolabral pathology following hip arthroscopy (1) the bilateral differences in functional task performance compared to controls, (2) the association of hip muscle strength with functional task performance, and (3) the association of functional task performance scores with good outcome, as measured by International Hip Outcome Tool score. METHODS: Seventy-one patients who had unilateral hip arthroscopy for hip pain and 60 controls were recruited. Patient-reported outcomes included the 4 subscales of the International Hip Outcome Tool. Hip muscle strength measures included abduction, adduction, extension, flexion,external rotation, and internal rotation. Functional tasks assessed included the single hop test, the side bridge test, and the single-leg rise test. For aim 1, analyses of covariance tests were used. For aim 2, stepwise multiple linear regression analyses were used. For aim 3, receiver operating characteristic curve analyses were used. RESULTS: Compared to controls, the chondrolabral pathology group had significantly worse performance on both legs for each of the functional tasks (P<.001). Greater hip abduction strength was moderately associated with better performance on functional tasks in the chondrolabral pathology group (adjusted R2 range, 0.197-0.407; P<.001).Cutoff values associated with good outcome were 0.37 (hop distance/height) for the single hop, 16 repetitions for the single-leg rise, and 34 seconds for the side bridge test. CONCLUSION: Patients with hip chondrolabral pathology had reduced functional task performance bilaterally 12 to 24 months after unilateral hip arthroscopy when compared to controls. Copyright © 2016 Journal of Orthopaedic & Sports Physical Therapy.

Hip and knee osteoarthritis affects younger people, too

- Ackerman, Ilana, Kemp, Joanne, Crossley, Kay, Culvenor, Adam, Hinman, Rana

  • Authors: Ackerman, Ilana , Kemp, Joanne , Crossley, Kay , Culvenor, Adam , Hinman, Rana
  • Date: 2017
  • Type: Text , Journal article , Review
  • Relation: Journal of Orthopaedic and Sports Physical Therapy Vol. 47, no. 2 (2017), p. 67-79
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  • Description: Although osteoarthritis (OA) has traditionally been considered a disease of older age, hip and knee OA can and does affect younger adults, with a profound impact on psychosocial well-being and work capacity. Obesity and a history of traumatic knee injury (eg, anterior cruciate ligament rupture and/or meniscal tear) are key risk factors for the accelerated development of knee OA, while structural hip deformities (including those contributing to femoroacetabular impingement syndrome) are strong predictors of early-onset hip OA. In view of these associations, rising rates of obesity and sports injuries are concerning, and may signal a future surge in OA incidence among younger people. Assessment of hip and knee OA in younger people should focus on a patient-centered history, comprehensive physical examination, performance-based measures, and patient-reported outcome measures to enable monitoring of symptoms and function over time. Referral for imaging should be reserved for people presenting with atypical signs or symptoms that may indicate diagnoses other than OA. Nonpharmacological approaches are core strategies for the management of hip and knee OA in younger people, and these include appropriate disease-related education, activity modifcation (including for work-related tasks), physical therapist-prescribed exercise programs to address identifed physical impairments, and weight control or weight loss. High-quality evidence has shown no beneft of arthroscopy for knee OA, and there are no published clinical trials to support the use of hip arthroscopy for OA. Referral for joint-conserving or joint replacement surgery should be considered when nonpharmacological and pharmacological management strategies are no longer effective. © 2017 Journal of Orthopaedic & Sports Physical Therapy.

Patient-Reported Outcome (PRO) questionnaires for young to middle-aged adults with hip and groin disability : A systematic review of the clinimetric evidence

- Thorborg, Kristian, Tijssen, M., Habets, B., Bartels, Else, Roos, Ewa, Kemp, Joanne, Crossley, Kay, Hölmich, Per

  • Authors: Thorborg, Kristian , Tijssen, M. , Habets, B. , Bartels, Else , Roos, Ewa , Kemp, Joanne , Crossley, Kay , Hölmich, Per
  • Date: 2015
  • Type: Text , Journal article
  • Relation: British Journal of Sports Medicine Vol. 49, no. 12 (2015), p. 812
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  • Description: Background/aim: To recommend Patient-Reported Outcome (PRO) questionnaires to measure hip and groin disability in young-aged to middle-aged adults. Methods: A systematic review was performed in June 2014. The methodological quality of the studies included was determined using the COnsensus-based Standards for the selection of health Measurement INstruments list (COSMIN) together with standardised evaluations of measurement properties of each PRO. Results: Twenty studies were included. Nine different questionnaires for patients with hip disability, and one for hip and groin disability, were identified. Hip And Groin Outcome Score (HAGOS), Hip Outcome Score (HOS), International Hip Outcome Tool-12 (IHOT-12) and IHOT-33 were the most thoroughly investigated PROs and studies including these PROs reported key aspects of the COSMIN checklist. HAGOS and IHOT-12 were based on studies with the least ratings of poor study methodology (23% and 31%, respectively), whereas IHOT-33 and HOS had a somewhat larger distribution (46%). These PROs all contain adequate measurement qualities for content validity (except HOS), test-retest reliability, construct validity, responsiveness and interpretability. No information or poor quality rating on methodological aspects made it impossible to fully evaluate the remaining PROs at present. Conclusions: HAGOS, HOS, IHOT-12 and IHOT-33 can be recommended for assessment of young-aged to middle-aged adults with pain related to the hip joint, undergoing non-surgical treatment or hip arthroscopy. At present, HAGOS is the only PRO also aimed for young-aged to middle-aged adults presenting with groin pain and is recommended for use in this population. Trial registration number: CRD42014009995. © 2015, BMJ Publishing Group. All rights reserved.

Patients with chondrolabral pathology have bilateral functional impairments 12 to 24 months after unilateral hip arthroscopy : A cross-sectional study

- Kemp, Joanne, Risberg, May, Schache, Anthony, Makdissi, Michael, Pritchard, Michael, Crossley, Kay

  • Authors: Kemp, Joanne , Risberg, May , Schache, Anthony , Makdissi, Michael , Pritchard, Michael , Crossley, Kay
  • Date: 2016
  • Type: Text , Journal article
  • Relation: Journal of Orthopaedic & Sports Physical Therapy Vol. 46, no. 11 (2016), p. 947-956
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  • Description: STUDY DESIGN: Cross-sectional study. BACKGROUND: Functional task performance in patients with chondrolabral pathology following hip arthroscopy is unknown. OBJECTIVES: To investigate in people with chondrolabral pathology following hip arthroscopy (1) the bilateral differences in functional task performance compared to controls, (2) the association of hip muscle strength with functional task performance, and (3) the association of functional task performance scores with good outcome, as measured by International Hip Outcome Tool score. METHODS: Seventy-one patients who had unilateral hip arthroscopy for hip pain and 60 controls were recruited. Patient-reported outcomes included the 4 subscales of the International Hip Outcome Tool. Hip muscle strength measures included abduction, adduction, extension, flexion, external rotation, and internal rotation. Functional tasks assessed included the single hop test, the side bridge test, and the single-leg rise test. For aim 1, analyses of covariance tests were used. For aim 2, stepwise multiple linear regression analyses were used. For aim 3, receiver operating characteristic curve analyses were used. RESULTS: Compared to controls, the chondrolabral pathology group had significantly worse performance on both legs for each of the functional tasks (P<.001). Greater hip abduction strength was moderately associated with better performance on functional tasks in the chondrolabral pathology group (adjusted R' range, 0.197-0.407; P<.001). Cutoff values associated with good outcome were 0.37 (hop distance/height) for the single hop, 16 repetitions for the single-leg rise, and 34 seconds for the side bridge test. CONCLUSION: Patients with hip chondrolabral pathology had reduced functional task performance bilaterally 12 to 24 months after unilateral hip arthroscopy when compared to controls.

Is hip range of motion and strength impaired in people with hip chondrolabral pathology?

- Kemp, Joanne, Schache, Anthony, Makdissi, Michael, Pritchard, Michael, Sims, Kevin, Crossley, Kay

  • Authors: Kemp, Joanne , Schache, Anthony , Makdissi, Michael , Pritchard, Michael , Sims, Kevin , Crossley, Kay
  • Date: 2014
  • Type: Text , Journal article
  • Relation: Journal of Musculoskeletal and Neuronal Interactions Vol. 14, no. 3 (2014), p.
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  • Description: Objective: The aims of this study were to i) to compare physical impairments in people with chondrolabral pathology identified at hip arthroscopy 12-24 months previously to age-matched healthy people; and ii) to understand whether gendersex has any influence on impairments. Methods: 84 patients (42 female; age=36±10) 12-24 months post hip arthroscopy and 60 controls (41 female; age=36±10) were included. Measurements of active hip ROM and strength were assessed. Two-way analyses of co-variance examined the effect of gendersex and chondrolabral pathology on hip ROM and strength. Results: Patients exhibited less hip internal rotation (IR) ROM (p=0.001) and more extension (p=0.014) ROM; and less hip adduction (p<0.001), extension (p=0.001), flexion (p<0.001), ER (p=0.044) and IR (p<0.001) strength when compared to controls. For abduction strength, a significant interaction was found between the presence of chondrolabral pathology and gendersex (p=0.035). Conclusions: People with hip chondrolabral pathology have differences in hip ROM and strength when compared to controls. Rehabilitation programs should focus on addressing these specific physical impairments in order to enhance outcomes. This information may be of great value to both researchers and clinicians alike in determining interventions to improve outcomes in people with early hip OA.
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Effects of exercise and manual therapy on pain associated with hip osteoarthritis : A systematic review and meta-analysis

- Beumer, Lucy, Wong, Jennie, Warden, Stuart, Kemp, Joanne, Foster, Paul, Crossley, Kay

  • Authors: Beumer, Lucy , Wong, Jennie , Warden, Stuart , Kemp, Joanne , Foster, Paul , Crossley, Kay
  • Date: 2016
  • Type: Text , Journal article , Review
  • Relation: British Journal of Sports Medicine Vol. 50, no. 8 (2016), p. 458-463
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  • Description: Aim: To explore the effects of exercise (water-based or land-based) and/or manual therapies on pain in adults with clinically and/or radiographically diagnosed hip osteoarthritis (OA). Methods: A systematic review and meta-analysis was performed, with patient reported pain assessed using a visual analogue scale (VAS) or the Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain subscale. Data were grouped by follow-up time (0-3 months=short term; 4-12 months=medium term and; >12 months=long term), and standardised mean differences (SMD) with 95% CIs were used to establish intervention effect sizes. Study quality was assessed using modified PEDro scores. Results: 19 trials were included. Four studies showed short-term benefits favouring water-based exercise over minimal control using the WOMAC pain subscale (SMD -0.53, 95% CI -0.96 to -0.10). Six studies supported a short-term benefit of land-based exercise compared to minimal control on VAS assessed pain (SMD -0.49, 95% CI -0.70 to -0.29). There were no medium (SMD -0.23, 95% CI -0.48 to 0.03) or long (SMD -0.22, 95% CI -0.51 to 0.06) term benefits of exercise therapy, or benefit of combining exercise therapy with manual therapy (SMD -0.38, 95% CI -0.88 to 0.13) when compared to minimal control. Conclusions: Best available evidence indicates that exercise therapy (whether land-based or water-based) is more effective than minimal control in managing pain associated with hip OA in the short term. Larger highquality RCTs are needed to establish the effectiveness of exercise and manual therapies in the medium and long term.

What fooled us in the knee may trip us up in the hip: Lessons from arthroscopy

- Kemp, Joanne, Crossley, Kay, Roos, Ewa, Ratzlaff, Charles

A phase II trial for the efficacy of physiotherapy intervention for early-onset hip osteoarthritis: Study protocol for a randomised controlled trial

- Kemp, Joanne, Moore, Kate, Fransen, Marlene, Russell, Trevor, Crossley, Kay

  • Authors: Kemp, Joanne , Moore, Kate , Fransen, Marlene , Russell, Trevor , Crossley, Kay
  • Date: 2015
  • Type: Text , Journal article
  • Relation: Trials Vol. 16, no. 1 (2015), p. 1-8
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  • Description: Background: Early-onset hip osteoarthritis is commonly seen in people undergoing hip arthroscopy and is associated with increased pain, reduced ability to participate in physical activity, reduced quality of life and reduced range of motion and muscle strength. Despite this, the efficacy of non-surgical interventions such as exercise therapies remains unknown. The primary aim is to establish the feasibility of a phase III randomised controlled trial investigating a targeted physiotherapy intervention for people with early-onset hip osteoarthritis. The secondary aims are to determine the size of treatment effects of a physiotherapy intervention, targeted to improve hip joint range and hip-related symptoms in early-onset hip osteoarthritis following hip arthroscopy, compared to a health-education control. Methods: This protocol describes a randomised, assessor- and participant-blind, controlled clinical trial. We will include 20 participants who are (i) aged between 18 and 50 years; (ii) have undergone hip arthroscopy during the past six to 12 months; (iii) have early-onset hip osteoarthritis (defined as chondrolabral pathology) at the time of hip arthroscopy; and (iv) experience hip-related pain during activities. Primary outcome will be the feasibility of a phase III clinical trial. Secondary outcomes will be (i) perceived global change score; (ii) hip-related symptoms (measured using the Hip disability and Osteoarthritis Outcome Score (HOOS) pain subscale, activity subscale, and sport and recreation subscale); (iii) hip quality of life (measured using the HOOS quality of life subscale and International Hip Outcome tool; (iv) hip muscle strength and (v) hip range of motion. The physiotherapy intervention is semi-standardised, including joint and soft tissue mobilisation and stretching, hip and trunk muscle retraining and functional and activity-specific retraining and education. The control intervention encompasses individualised health education, with the same frequency and duration as the intervention. The trial primary end-point is the conclusion of the 12-week intervention, and follow-up measures will be collected at the 12-week post-baseline assessment. Discussion: The findings of this study will provide guidance regarding the feasibility of a full-scale phase III randomised controlled trial, prior to its undertaking. Trial registration: The trial protocol was registered with the Australian Clinical Trials Registry (number: 12614000426684) on 17 April 2014. © Kemp et al.

Is quality of life following hip arthroscopy in patients with chondrolabral pathology associated with impairments in hip strength or range of motion?

- Kemp, Joanne, Makdissi, Michael, Schache, Anthony, Finch, Caroline, Pritchard, Michael, Crossley, Kay

  • Authors: Kemp, Joanne , Makdissi, Michael , Schache, Anthony , Finch, Caroline , Pritchard, Michael , Crossley, Kay
  • Date: 2016
  • Type: Text , Journal article
  • Relation: Knee Surgery Sports Traumatology Arthroscopy Vol. 24, no. 12 (2016), p. 3955-3961
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  • Description: If physical impairments that are associated with poorer outcomes can be identified in people with chondrolabral hip pathology, then rehabilitation programmes that target such modifiable impairments could potentially be established to improve quality of life. The aim of this study was to examine the relationship between quality-of-life PROs and physical impairment measurements in people with chondrolabral pathology post-hip arthroscopic surgery. This was a cross-sectional study where multiple stepwise linear regression analyses were conducted to determine which physical impairment measurements were most associated with poorer quality-of-life patient-reported outcomes (PROs). Eighty-four patients (42 women; all aged 36 +/- 10 years) with hip chondrolabral pathology 12- to 24-month post-hip arthroscopy were included. The Hip disability and Osteoarthritis Outcome Score Quality-of-life (HOOS-Q) subscale and International Hip Outcome Tool (IHOT-33) PROs were collected. Measurements of active hip ROM and strength were assessed. Modifiable post-surgical physical impairments were associated with PRO in patients with chondrolabral pathology. Greater hip flexion ROM was independently associated with better scores in both HOOS-Q and IHOT-33 (adjusted r (2) values ranged from 0.249 to 0.341). Greater hip adduction strength was independently associated with better HOOS-Q and IHOT-33 (adjusted r (2) 0.227-0.317). Receiver Operator Curve analyses determined that the limit value for hip flexion ROM was 100A degrees (sensitivity 92 %, specificity 75 %), and hip adduction strength was 0.86 Nm/kg (sensitivity 96 %, specificity 70 %). Hip flexion ROM and adduction strength were associated with better quality-of-life PRO scores in patients with chondrolabral pathology 12- to 24-month post-hip arthroscopy. These impairments could be targeted by clinicians designing rehabilitation programmes to this patient group.

Hip arthroscopy in the setting of hip osteoarthritis : Systematic review of outcomes and progression to hip arthroplasty

- Kemp, Joanne, MacDonald, David, Collins, Natalie, Hatton, Anna, Crossley, Kay

  • Authors: Kemp, Joanne , MacDonald, David , Collins, Natalie , Hatton, Anna , Crossley, Kay
  • Date: 2015
  • Type: Text , Journal article
  • Relation: Clinical Orthopaedics and Related Research Vol. 473, no. (2015), p. 1055-1073
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  • Description: Background: Hip arthroscopy is now commonly used to treat hip pain and pathology, including osteoarthritis (OA). Despite this, little is known about the effect of hip arthroscopy on outcomes of pain and function and progression to total hip arthroplasty (THA) in hip OA. Questions/purposes: This systematic review aimed to (1) determine pain and function outcomes after hip arthroscopy in people with hip OA; (2) compare the outcome after hip arthroscopy between people with and without hip OA; and (3) report the likelihood of progression to THA in patients with hip OA after hip arthroscopy. Methods: This review was conducted in accordance with the PRISMA statement. The Downs and Black checklist was used for quality appraisal. Studies scoring positively on at least 50% of items were included in final analyses. Standardized mean differences (SMDs) were calculated where possible or study conclusions are presented. Results: Twenty-two studies were included in the final analyses. Methodological quality and followup time varied widely. Moderate to large SMDs were reported for people with and without hip OA; however, the positive effects of the intervention were smaller for people with hip OA. Greater severity of hip OA and older age each predicted more rapid progression to THA. Conclusions: Patients with hip OA report positive outcomes from hip arthroscopy, although observed positive effects may be inflated as a result of methodological limitations of the included studies. Patients with hip OA had inferior results compared with those who did not. Chondropathy severity and patient age were associated with a higher risk and more rapid progression to THA. High-quality comparative studies are required to confirm the effects of hip arthroscopy on symptoms and structural change in people with hip OA.
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