Comparative Analysis of Patient-Reported Outcome Measures for Proximal Hamstring Injuries: A Systematic Review

Abstract

Background: There is controversy regarding which patient-reported outcome measures (PROMs) should be used for proximal hamstring tendon injuries. Hypothesis: It was hypothesized that (1) most (>50%) of the questions on the 13 most common PROMs for proximal hamstring injuries would demonstrate extensive overlap in the health domains and question categories and (2) each of the PROMs would contain a variable distribution of questions within each health domain. Study Design: Systematic review. Methods: We conducted a literature review through PubMed, Scopus, and CINAHL and identified the 13 most common PROMs for proximal hamstring injuries: Lower Extremity Functional Scale (LEFS), Marx activity rating scale (MARS), 12-item Short Form Survey (SF-12), Tegner activity scale (TAS), Single Assessment Numeric Evaluation (SANE), Perth Hamstring Assessment Tool (PHAT), Proximal Hamstring Injury Questionnaire (PHIQ), modified Harris Hip Score (mHHS), University of California, Los Angeles activity score (UCLA), International Hip Outcome Tool (iHOT-12), Hip Outcome Score (HOS), Sydney Hamstring Origin Rupture Evaluation (SHORE), and Non-Arthritic Hip Score (NAHS). All PROM questions were sorted into 5 health domains (pain, symptoms, activities of daily living, sports, and mindset) and further divided into question categories if they referred to similar tasks or aspects of health. Questions in the same health domain and question category were considered overlapping, and those within a health domain that did not fit into a question category were considered unique. For each PROM, we analyzed the distribution of questions within particular health domains and question categories as well as the amount of overlapping and unique questions. Results: Of the 165 questions evaluated, 116 (70.3%) were overlapping, and 49 (29.7%) were unique. The SF-12 contained the most unique questions (9/12 [75.0%]). The MARS, TAS, SANE, and UCLA had 0 unique questions. The PHIQ and iHOT-12 contained questions in all 5 health domains. The PHAT, SHORE, and NAHS contained questions in every health domain except mindset. The LEFS, MARS, SF-12, TAS, mHHS, SANE, UCLA, and HOS contained questions in ≤3 health domains. Conclusion: The evaluated PROMs had a high degree of overlapping questions (≥50%) and demonstrated a statistically significant variance in the distribution of questions within each health domain.

Validation of the Parisian Hamstring Avulsion Score (PHAS) in the Evaluation and Follow-up of Patients Operated for Proximal Hamstring Avulsion

“…[22][23][24][25] Although both are used to evaluate the outcome of surgery for the reinsertion of proximal hamstring tendon, they are not specific for this injury. 6,11,21 The Perth Hamstring Assessment Tool (PHAT) was the first PROM developed to evaluate the outcome of surgical repair of proximal hamstring tendon avulsions. 4 This score evaluates the different functional parameters of the hamstring tendons (flexibility, strength) and their effect on daily life (sports activities, driving).…”

“… 22 - 25 Although both are used to evaluate the outcome of surgery for the reinsertion of proximal hamstring tendon, they are not specific for this injury. 6 , 11 , 21 …”

“…The psychometric properties of this score have been validated, and it is the score evaluated in the greatest number of publications to date. 9 , 11 , 20 , 21 The Sidney Hamstring Origin Rupture Evaluation (SHORE) is another PROM developed for the same purpose that has psychometric results similar to those of the PHAT. Although these 2 scores have been validated for the assessment of PHAs, there is no consensus on their use because of the limited number of studies in the literature and the small study groups.…”