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

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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.

Level of Evidence

Level III, systematic review of Level III studies.

Section snippets

Literature Search

Two computerized literature searches were conducted in consultation with a medical librarian. The purpose of the first search was to identify the PRO instruments used in the assessment of subjects with FAI or hip labral pathology. We combined Medical Subject Heading and title words related to FAI and labrum/labral tears. There were no language restrictions. We searched for articles published from 1966 to November 2008. The Ovid interface was used to search the following databases: Medline,

Results

The first literature search identified 1,147 titles potentially relevant to FAI or hip labral pathology. Of these, 22 articles fit the inclusion criteria and were analyzed to find the different PRO instruments used. We identified the following 6 hip-related PRO instruments:

  • 1

    Harris Hip Score (HHS)

  • 2

    Modified HHS

  • 3

    Merle d'Aubigne Hip Score

  • 4

    Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index

  • 5

    Non-Arthritic Hip Score (NAHS)

  • 6

    Hip Outcome Score (HOS)

A second literature search for clinimetric

Discussion

This study provides a comprehensive evaluation of the clinimetric properties of PRO instruments used in patients with FAI and labral pathology. We have identified 3 PRO instruments that have undergone clinimetric analysis for use in femoroacetabular and labral pathology subjects. None of the questionnaires showed positive ratings in all 9 categories; however, the HOS clearly had the most data describing its properties. Furthermore, several instruments used in the FAI and labral pathology

Conclusions

Only 3 PRO instruments have shown clinimetric evidence to support their use to measure outcomes in patients with FAI and labral pathology. The HOS has the greatest amount of clinimetric evidence and thus far 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. Additional studies of these instruments include language translations, respondent and administrative

Acknowledgment

The authors thank Dean Guistini, Reference Librarian, Biomedical Branch Library, University of British Columbia, for his help with the literature searches.

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    The authors report no conflict of interest.

    Note: To access the video accompanying this report, visit the February issue of Arthroscopy at www.arthroscopyjournal.org.

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