Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
Division of Physical Therapy, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio, USA.
PM R. 2022 Mar;14(3):297-308. doi: 10.1002/pmrj.12661. Epub 2021 Aug 16.
Physical therapy and hip arthroscopy are two viable treatment options for patients with nonarthritic hip pain (NAHP); however, patients may experience considerable decisional conflict when making a treatment decision. Interdisciplinary evaluation with a physical therapist and surgeon may better inform the decision-making process and reduce decisional conflict.
To identify the extent to which an interdisciplinary evaluation between a surgeon, physical therapist, and patient influences treatment plans and decisional conflict of persons with NAHP.
Randomized controlled trial.
Hip preservation clinic.
Adults with primary NAHP.
Participants were randomized to receive a standard (surgeon) or interdisciplinary (surgeon+physical therapist) evaluation. Surgeon evaluations included patient interview, strength and range-of-motion examination, palpation, gross motor observation, and special testing. Interdisciplinary evaluations started with the surgeon evaluation, then a physical therapist evaluated movement impairments during sitting, sit-to-stand, standing, single-leg stance, single-leg squat, and walking. All evaluations concluded with treatment planning with the respective provider(s).
Treatment plan and decisional conflict were collected pre- and postevaluation. Inclusion of physical therapy in participants' postevaluation treatment plans and postevaluation decisional conflict were compared between groups using chi-square tests and Mann-Whitney U tests, respectively.
Seventy-eight participants (39 in each group) met all eligibility criteria and were included in all analyses. Sixty-six percent of participants who received an interdisciplinary evaluation included physical therapy in their postevaluation treatment plan, compared to 48% of participants who received a standard evaluation (p = .10). Participants who received an interdisciplinary evaluation reported 6.3 points lower decisional conflict regarding their postevaluation plan (100-point scale; p = .04). The interdisciplinary and standard groups reduced decisional conflict on average 24.8 ± 18.9 and 23.6 ± 14.6 points, respectively.
Adding a physical therapist to a surgical clinic increased interest in physical therapy treatment, but this increase was not statistically significant. The interdisciplinary group displayed lower postevaluation decisional conflict; however, both groups displayed similar reductions in decisional conflict from pre- to postevaluation. This study also demonstrated the feasibility of an interdisciplinary evaluation in a hip preservation clinic.
对于非关节炎性髋痛（NAHP）患者，物理治疗和髋关节镜检查是两种可行的治疗选择；然而，患者在做出治疗决策时可能会经历相当大的决策冲突。物理治疗师和外科医生的跨学科评估可以更好地为决策过程提供信息，并减少决策冲突。
确定外科医生、物理治疗师和患者之间的跨学科评估对非关节炎性髋痛患者的治疗计划和决策冲突的影响程度。
随机对照试验。
髋关节保存诊所。
原发性 NAHP 成人。
参与者被随机分配接受标准（外科医生）或跨学科（外科医生+物理治疗师）评估。外科医生评估包括患者访谈、力量和活动范围检查、触诊、大体运动观察和特殊检查。跨学科评估从外科医生评估开始，然后物理治疗师评估坐姿、坐站、站立、单腿站立、单腿深蹲和行走时的运动障碍。所有评估均以相应提供者的治疗计划结束。
在评估前和评估后收集了治疗计划和决策冲突。使用卡方检验和曼-惠特尼 U 检验分别比较两组参与者在接受跨学科评估后的治疗计划和评估后决策冲突中纳入物理治疗的情况。
78 名参与者（每组 39 名）符合所有入选标准，并纳入所有分析。接受跨学科评估的参与者中有 66%在评估后治疗计划中纳入了物理治疗，而接受标准评估的参与者中有 48%（p=.10）。接受跨学科评估的参与者报告说，他们对评估后计划的决策冲突减少了 6.3 分（100 分制；p=.04）。跨学科组和标准组的决策冲突平均分别减少了 24.8±18.9 分和 23.6±14.6 分。
在外科诊所增加物理治疗师可以增加对物理治疗的兴趣，但这一增加没有统计学意义。跨学科组显示出较低的评估后决策冲突；然而，两组从评估前到评估后都显示出类似的决策冲突减少。本研究还证明了跨学科评估在髋关节保存诊所中的可行性。
