Physical Performance Tests Correlate With Patient-reported Outcomes After Periacetabular Osteotomy: A Prospective Study

Abstract

Introduction: Individuals with hip dysplasia report significant functional disability that improves with periacetabular osteotomy (PAO). Four physical performance measures (PPMs) have been recently validated for use with nonarthritic hip conditions; however, their ability to detect functional improvement and correlate with improvements in popular hip-specific patient-reported outcome (PRO) instruments after PAO is unknown. The purpose of this study was to evaluate the responsiveness of four PPMs up to 1 year after PAO, compare PPMs with established PRO measures at these time points, and report the acceptability and utility of PPMs for assessing outcomes after PAO. Methods: Twenty-two participants aged 15 to 39 years completed the timed stair ascent (TSA), sit-to-stand five times (STS5), self-selected walking speed, four-square-step test, and seven hip-specific PRO measures before surgery and at approximately 6 months and 1 year after PAO. They completed questions regarding acceptability and utility of both types of testing. Wilcoxon rank sum test and unpaired Student t-tests were used to assess differences between time points; Spearman correlation and generalized linear modeling were used to determine the relationship between PPMs and PRO measures. Results: Six months after PAO, participants showed significant improvements on all seven PRO instruments (P < 0.001) and on the STS5 (P = 0.01). At one year, these improvements were maintained and TSA also improved (P = 0.03). Improvement in other PPMs did not reach significance (P = 0.07 and 0.08). The STS5 test demonstrated moderate to strong correlation (|r| = 0.43 to 0.76, P < 0.05) with all PRO measures, and the TSA test demonstrated moderate to strong correlation with almost all measures (|r| = 0.43 to 0.58, P < 0.05). Correlations strengthened on subanalysis of participants with unilateral disease (n = 11) (|r| = 0.56 to 0.94, P < 0.05). All participants (100%) found PPM testing acceptable despite disability; 25% preferred PPMs to PRO measures, whereas 75% of participants found them equal in usefulness. Discussion: The STS5 and TSA tests demonstrated moderate to very strong correlation with PRO measures at six and 12 months after PAO for dysplasia. These tests could be used as a functional outcome to supplement PRO instruments after PAO.

Mobility-related outcomes for periacetabular osteotomy in persons with acetabular dysplasia: setting the stage for measurement of real-world outcomes

“…In reviewing the literature, we observed that PROs were worse before PAO when compared to scores after PAO [ 3 , 7 , 22 , 23 , 28 , 31–39 ]. Before PAO, participants reported higher pain [ 3 , 23 , 28 , 32 , 33 , 35 , 37–40 ], worse hip-related function [ 3 , 7 , 29 , 31–47 ], lower quality of life [ 3 , 28 , 29 , 34 , 35 , 37 , 38 , 40 , 42 ], worse laboratory-based functional performance (such as walking speed) [ 32 ] and a significant reduction in PA levels, both through the use of patient-reported [ 3 , 22 , 23 , 28 , 34 , 35 , 38 , 39 , 43 , 47 , 48 ] or device-measured [ 23 , 28 ] PA.…”

“…In the studies referenced above, hip-related pain, function and quality of life were measured using common hip-related questionnaires that have been shown to be reliable and valid in individuals with hip pathology, including (i) the modified Harris Hip Score or the standard Harris Hip Score (mHHS/HHS; n = 15) [ 3 , 7 , 29 , 31–33 , 35 , 36 , 38–41 , 43 , 44 , 47 ], (ii) the Hip Disability and Osteoarthritis Outcomes Score (HOOS; n = 10) [ 3 , 29 , 32 , 35 , 37 , 38 , 40 , 42 , 43 , 46 ], (iii) the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC; n = 7) [ 33 , 35 , 38 , 39 , 44 , 46 , 47 ], (iv) the Copenhagen Hip and Groin Outcome Score (HAGOS; n = 3) [ 23 , 28 , 34 ], (v) the International Hip Outcome Tool (iHOT-12; n = 1) [ 32 ], (vi) the Patient-Reported Outcomes Measurement Information System (PROMIS; n = 1) [ 32 ], (vii) The Short Form 36 Health Survey Questionnaire (SF-36; n = 2) [ 33 , 42 ], (viii) the Numeric Pain Rating scale (NPRS; n = 1) [ 34 ], (ix) the Visual Analogue Scale (VAS; n = 1) [ 32 ], and the Non-Arthritic Hip Score (NAHS; n = 1) [ 45 ].…”

“…Of the overall included studies ( n = 23), 14 studies evaluated pain intensity in persons with symptomatic AD before and after PAO [ 3 , 23 , 28 , 29 , 32 , 33 , 35 , 37–40 , 42 , 44 , 47 ], using several PROs, included the HOOS ( n = 8) [ 3 , 32 , 35 , 37 , 38 , 40 , 42 , 48 ], WOMAC ( n = 6) [ 33 , 35 , 38 , 39 , 44 , 47 ], HAGOS ( n = 2) [ 28 , 34 ], VAS scale ( n = 1) [ 32 ] and NPRS ( n = 1) [ 34 ]. Average scores of pain intensity before and after PAO in persons with symptomatic AD are provided in Table I .…”

“…Average scores of pain intensity before and after PAO in persons with symptomatic AD are provided in Table I . Of the 14 studies that evaluated pain intensity in persons with symptomatic AD, 6 studies used prospective study designs monitoring pain changes over 4 months to 2 years following PAO (total combined sample = 857) [ 3 , 28 , 32–35 ]. Eight studies used retrospective study designs reviewing reports that evaluated pain intensity after 2 years [ 37 , 40 , 42 , 44 , 48 ], 3 years [ 38 ], 5 years [ 39 ] and 6 years [ 47 ] following PAO, respectively (total combined sample = 625).…”

“…Eight studies used retrospective study designs reviewing reports that evaluated pain intensity after 2 years [ 37 , 40 , 42 , 44 , 48 ], 3 years [ 38 ], 5 years [ 39 ] and 6 years [ 47 ] following PAO, respectively (total combined sample = 625). Across studies, there were significant improvements in pain intensity among persons with symptomatic AD up to 6 years following PAO (all studies reported statistically significant improvements; P < 0.05; total combined sample = 1482) [ 3 , 23 , 28 , 29 , 32 , 33 , 35 , 37–40 , 42 , 44 , 47 ].…”