Patient-Reported Outcome Instruments for Femoroacetabular Impingement and Hip Labral Pathology: A Systematic Review of the Clinimetric Evidence

Lodhia, Parth; Slobogean, Gerard P.; Noonan, Vanessa K.; Gilbart, Michael K.

doi:10.1016/j.arthro.2010.08.002

« Previous Next »Arthroscopy: The Journal of Arthroscopic and Related Surgery
Volume 27, Issue 2 , Pages 279-286, February 2011

Patient-Reported Outcome Instruments for Femoroacetabular Impingement and Hip Labral Pathology: A Systematic Review of the Clinimetric Evidence

Parth Lodhia, M.D.
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
Gerard P. Slobogean, M.D., M.P.H.
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
Vanessa K. Noonan, Ph.D.
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Spine, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
Michael K. Gilbart, M.D., M.Ed., F.R.C.S.C
- Division of Athletic Injuries and Arthroscopy, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Upper Extremity Surgery, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
- Address correspondence and reprint requests to Michael K. Gilbart, M.D., M.Ed., F.R.C.S.(C), Divisions of Athletic Injuries and Arthroscopy and Upper Extremity Surgery, Department of Orthopaedic Surgery, University of British Columbia, University of British Columbia Hospital, 2nd Floor Unit 2C2211 Wesbrook Mall, Vancouver, BC V6T 2B5, Canada

Received 26 April 2010; accepted 2 August 2010. published online 01 November 2010.

Purpose

The purpose of this study is to systematically review the content and clinimetric evidence (rigor of rating scales and indexes for the description of clinical phenomena) of published patient-reported outcome (PRO) instruments used to assess femoroacetabular impingement (FAI) and labral hip pathology.

Methods

We used Medical Subject Heading terms related to FAI and labrum/labral tears to search the Medline, Embase, and Cochrane databases for studies of FAI and labral hip pathology. Studies with hip-related PRO instruments, with any operative intervention except total hip arthroplasty, were included. We excluded studies with a skeletally immature population, revision surgeries in more than 10% of cases, or a primary diagnosis of hip osteoarthritis. We conducted a second review using the same databases for studies reporting clinimetric properties of at least 1 of the PRO instruments identified previously. Articles were selected in an independent, stepwise manner by 2 reviewers. Selected articles were evaluated to determine the presence and quality of measurement properties of the outcome instruments.

Results

We found 5 articles assessing 3 PRO instruments: the Hip Outcome Score (HOS), the Non-Arthritic Hip Score, and the 12-item modified Western Ontario and McMaster Universities Osteoarthritis Index. The HOS had the highest positive rating for internal consistency, construct validity, agreement, responsiveness, lack of floor/ceiling effect, and interpretability. The Non-Arthritic Hip Score showed evidence for validity and lack of floor/ceiling effect. The modified Western Ontario and McMaster Universities Osteoarthritis Index was only strong for internal consistency and was indeterminate for construct validity.

Conclusions

Only 3 PRO instruments have shown clinimetric evidence to support their use to measure outcomes in FAI and labral pathology patients. The HOS has the greatest amount of clinimetric evidence and is the most proven instrument for use in this population. This review shows that further clinimetric evaluation of commonly used PRO instruments for nonarthritic hip pathology is warranted.