Scott Elizabeth J, Willey Michael C, Mercado Arthur, Davison John, Wilken Jason M
Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, Iowa, USA.
Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA.
Orthop J Sports Med. 2020 Feb 27;8(2):2325967120903290. doi: 10.1177/2325967120903290. eCollection 2020 Feb.
Lower extremity physical performance measures (PPMs), which can objectively quantify functional ability, are an attractive adjuvant to patient-reported outcome (PRO) instruments. However, few tests have been validated for use in hip instability.
To evaluate 4 different PPMs for their ability to differentiate between young adults with hip dysplasia indicated for treatment with periacetabular osteotomy (PAO) and asymptomatic controls and to test inter- and intratest reliability and relationship with popular hip PRO instruments.
Cohort study (diagnosis); Level of evidence, 2.
A total of 24 symptomatic patients aged 15 to 39 years (100% female) with hip dysplasia (lateral center-edge angle <25°) indicated for treatment with PAO completed the visual analog scale (VAS) for pain, Hip disability and Osteoarthritis Outcome (HOOS) Pain subscale, HOOS Short Version (HOOS PS), International Hip Outcome Tool Short Version (iHOT-12), modified Harris Hip Score (mHHS), Patient Reported Outcome Measurement Information System (PROMIS) physical function (PF) and pain interference (PI), and 4 physical function tests: (1) self-selected walking speed (SSWS), sit-to-stand 5 times (STS5), (3) 4-square step test (FSST), and (4) timed stair ascent (TSA). A further 21 young, asymptomatic adults aged 18 to 39 years (91% female) also underwent testing. Between-group comparisons were made with unpaired test with Bonferroni-Holm correction. Inter- and intrarater reliability was assessed in 38 participants by repeating PPMs at a second visit and using 2 raters. Spearman rank correlation coefficients were used to determine associations between PPMs and PRO instruments.
Significant differences between patients with hip dysplasia and controls were observed for all PRO instruments (HOOS Pain, 47.8 vs 99.2; HOOS PS, 61.9 vs 99.2; iHOT-12, 32.2 vs 99.2; mHHS, 54.5 vs 90.6; PROMIS PF, 41.4 vs 65.6; and PROMIS PI, 62.0 vs 39.1 [all < .001]), and all PPMs (SSWS, 1.21 vs 1.53 m/s; STS5, 10.85 vs 5.95 s; FSST, 6.59 vs 4.03 s [all < .001]; and TSA, 4.58 vs 3.29 s [ = .002]). All 4 PPMs demonstrated excellent intra- and intertest reliability (intraclass correlation coefficient, 0.83-0.99). STS5, FSST, and TSA were correlated highly ( > 0.5) with physical function PRO instruments, including PROMIS PF, mHHS, and iHOT-12.
Patients with symptomatic hip dysplasia demonstrated significant impairment on functional testing compared with asymptomatic controls, and performance measure testing demonstrated excellent test-retest reliability. Timed stair ascent and sit-to-stand testing in particular were correlated strongly with physical function PRO instruments. PPMs may be a viable and well-received adjuvant to PRO instrument administration for patients with nonarthritic hip conditions, and investigation of the ability of PPMs to assess surgical outcomes for hip dysplasia is warranted.
下肢身体功能测量指标（PPMs）能够客观地量化功能能力，是患者报告结局（PRO）工具的一种有吸引力的辅助手段。然而，很少有测试在髋关节不稳定的情况下得到验证。
评估4种不同的PPMs区分因髋臼周围截骨术（PAO）治疗而患有髋关节发育不良的年轻成年人与无症状对照组的能力，并测试测试间和测试内的可靠性以及与常用髋关节PRO工具的关系。
队列研究（诊断）；证据等级，2级。
共有24例15至39岁有症状的患者（100%为女性），患有髋关节发育不良（外侧中心边缘角<25°），拟接受PAO治疗，完成了疼痛视觉模拟量表（VAS）、髋关节残疾和骨关节炎结局（HOOS）疼痛子量表、HOOS简版（HOOS PS）、国际髋关节结局工具简版（iHOT-12）、改良Harris髋关节评分（mHHS）、患者报告结局测量信息系统（PROMIS）身体功能（PF）和疼痛干扰（PI），以及4项身体功能测试：（1）自选步行速度（SSWS）、5次坐立试验（STS5）、（3）四方步试验（FSST）和（4）定时上楼梯试验（TSA）。另外21例18至39岁无症状的年轻成年人（91%为女性）也接受了测试。采用Bonferroni-Holm校正的非配对检验进行组间比较。在38名参与者中，通过第二次重复PPMs并使用2名评估者来评估评估者间和评估者内的可靠性。采用Spearman等级相关系数来确定PPMs与PRO工具之间的关联。
所有PRO工具（HOOS疼痛，47.8对99.2；HOOS PS，61.9对99.2；iHOT-12，32.2对99.2；mHHS，54.5对90.6；PROMIS PF，41.4对65.6；PROMIS PI，62.0对39.1[均P<0.001]）以及所有PPMs（SSWS，1.21对1.53 m/s；STS5，10.85对5.95 s；FSST，6.59对4.03 s[均P<0.001]；TSA，4.58对3.29 s[P=0.002]）在髋关节发育不良患者与对照组之间均观察到显著差异。所有4种PPMs均显示出出色的测试间和测试内可靠性（组内相关系数，0.83 - 0.99）。STS5、FSST和TSA与身体功能PRO工具，包括PROMIS PF、mHHS和iHOT-12高度相关（r>0.5）。
与无症状对照组相比，有症状的髋关节发育不良患者在功能测试中表现出显著受损，并且性能测量测试显示出出色的重测可靠性。特别是定时上楼梯试验和坐立试验与身体功能PRO工具密切相关。对于非关节炎性髋关节疾病患者，PPMs可能是PRO工具管理中一种可行且受欢迎的辅助手段，并且有必要研究PPMs评估髋关节发育不良手术结局的能力。
