ABSTRACT
OBJECTIVES: Femoroacetabular impingement is gaining increased recognition as a cause of hip dysfunction. Of great concern is its potential association with labral tears and osteoarthritis. This systematic review examines the evidence regarding radiographic variables associated with the progression of femoroacetabular impingement. DESIGN: Systematic review. METHODS: Articles were selected following a comprehensive search of PubMed, CINAHL, SportDiscus, Embase, and Medline databases from database inception through October 2012. Inclusion criteria involved (1) estimates of the association between prognostic variables and progression of femoroacetabular impingement, (2) prospective or retrospective design, (3) patients diagnosed with femoroacetabular impingement based on established criteria, (4) the outcome of interest was radiologic and/or clinical progression of femoroacetabular impingement, and (5) access to the full text. Two independent reviewers assessed the methodological quality of each study and the association between prognostic variables and femoroacetabular impingement progression. RESULTS: Thirteen articles met the inclusion criteria; nine were considered to be of high quality. Moderate evidence of progression of femoroacetabular impingement to labral pathology was associated with increased alpha angle. Moderate evidence for their lack of association with progression of FAI was associated with alpha angle with respect to development of osteoarthritis, acetabular index, center edge angle, coxa profunda, coxa vara, and pistol grip deformity. CONCLUSIONS: There is moderate evidence that increased alpha angle at baseline is associated with progression of femoroacetabular impingement to labral tear. Moderate evidence suggests a lack of association between other radiographic variables and progression of femoroacetabular impingement.
Subject(s)
Femoracetabular Impingement/diagnostic imaging , Disease Progression , Humans , RadiographyABSTRACT
Minimal clinically important difference (MCID) scores are commonly used by clinicians when determining patient response to treatment and to guide clinical decision-making during the course of treatment. For research purposes, the MCID score is often used in sample size calculations for adequate powering of a study to minimize the false-positives (type 1 errors) and the false-negatives (type 2 errors). For clinicians and researchers alike, it is critical that the MCID score is a valid and stable measure. A low MCID value may result in overestimating the positive effects of treatment, whereas a high MCID value may incorrectly classify patients as failing to respond to treatment when in fact the treatment was beneficial. The wide range of methodologies for calculating the MCID score results in varied outcomes, which leads to difficulties with interpretation and application. This clinimetrics corner outlines key factors influencing MCID estimates and discusses limitations with the use of the MCID in both clinical and research practice settings.
ABSTRACT
SYNOPSIS: Pain is a common complaint among clients seeking physical therapy services, yet interpretation of associated sensory changes can be difficult for the clinician. Musculoskeletal injury typically results in nociceptive pain due to noxious stimuli of the damaged muscle or joint tissues. However, with progression from acute to chronic stages, altered nociceptive processing can give rise to an array of sensory findings. Specifically, patients with chronic joint injury may present with signs and symptoms typically associated with neuropathic injury, due to changes in nociceptive processing. Clinical presentation may include expansion of hyperalgesia into adjacent and remote areas, allodynia, dysesthesias, and perceptual deficits. Quantitative sensory testing (QST) may provide an objective method of examining sensation and, thereby, of recognizing potential changes in the nociceptive pathways. The purpose of this paper is to provide an overview of altered nociceptive processing and somatosensory changes that may occur following a musculoskeletal injury without associated neural injury. Recommendations are made on clinical uses of quantitative sensory testing in orthopaedic physical therapy practice, and supporting clinical and laboratory evidence are presented. Examples related to joint injury are discussed, specifically, osteoarthritis of the knee and low back pain. Quantitative sensory testing may be a useful clinical tool to aid clinical decision making and for determination of prognosis.
