Stephens Gareth, O'Neill Seth, Clifford Chris, Cuff Andrew, Forte Felipe, Hawthorn Catrin, Littlewood Chris
The Royal Orthopaedic Hospital, Birmingham, UK.
Primary Care Centre versus Arthritis, Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, UK.
Musculoskeletal Care. 2019 Dec;17(4):390-398. doi: 10.1002/msc.1419. Epub 2019 Aug 30.
Greater trochanteric pain syndrome (GTPS) is a debilitating condition causing lateral hip pain. A recent randomized controlled trial (LEAP) demonstrated that exercise interventions for GTPS provided superior outcomes, compared with corticosteroid injection and wait-and-see approaches. However, participants were not patients seeking care and therefore may not have represented the typical patient seen within the National Health Service (NHS). The present service evaluation aimed to provide data on the characteristics of patients with GTPS presenting to NHS physiotherapy services, to enable consideration of the applicability of the findings of the LEAP trial to patients seeking care within the NHS.
Four NHS sites provided anonymized data on patients presenting to their service with a primary complaint of GTPS.
The data from 162 patients suggested that the typical patients presenting to the NHS with GTPS are female (73%), overweight (body mass index 28.5) and experiencing a 12-month or longer history of lateral hip pain (56.8%). Patients reported high levels of pain (visual analogue score 6.5), low health-related quality of life (EuroQol five-dimensions - 5-level score 0.6), coexisting medical conditions (79.0%) and high medication use (82.7%).
Patients presenting to the NHS with GTPS appear to have multifactorial issues, with high levels of pain and disability, and are often medicated for multiple coexisting conditions. These characteristics differentiate them from patients recruited to the LEAP trial. Hence, it is unclear whether the findings of the LEAP trial are applicable to patients with GTPS who consult physiotherapy services in the NHS. Further research is warranted to evaluate this.
大转子疼痛综合征(GTPS)是一种导致髋关节外侧疼痛的使人衰弱的病症。最近一项随机对照试验(LEAP)表明,与皮质类固醇注射和观察等待方法相比,针对GTPS的运动干预能带来更好的效果。然而,试验参与者并非寻求治疗的患者,因此可能无法代表英国国家医疗服务体系(NHS)中常见的典型患者。本次服务评估旨在提供有关向NHS物理治疗服务机构就诊的GTPS患者特征的数据,以便考虑LEAP试验结果对在NHS寻求治疗的患者的适用性。
四个NHS机构提供了以GTPS为主诉前来就诊患者的匿名数据。
162名患者的数据表明,向NHS就诊的典型GTPS患者为女性(73%),超重(体重指数28.5),且有12个月或更长时间的髋关节外侧疼痛病史(56.8%)。患者报告疼痛程度高(视觉模拟评分6.5),与健康相关的生活质量低(欧洲五维健康量表-5级评分0.6),并存多种疾病(79.0%),且药物使用率高(82.7%)。
向NHS就诊的GTPS患者似乎存在多因素问题,疼痛和残疾程度高,且常因多种并存疾病而用药。这些特征使他们与LEAP试验招募的患者有所不同。因此,尚不清楚LEAP试验的结果是否适用于在NHS咨询物理治疗服务的GTPS患者。有必要进行进一步研究以对此进行评估。