Male basketball players who report hip and groin pain perceive its negative impact both on- and off-court: A cross-sectional study.

OBJECTIVES: To identify if basketball players aged <20 years (U20) self-report hip and/or groin pain and if they perceive this as a problem. To determine potential differences in self-reported playing (training and match play) loads and Copenhagen Hip and Groin Outcome Score (HAGOS) between those with and without hip/groin pain. DESIGN: Cross-sectional. METHODS: Fifty-one pre-elite (state/national representative level) male U20 basketball players (Australian n=38; Italian n=13) self-reported current/historical hip/groin 'discomfort/pain' and 'problems', and playing loads. A two-factor regression model was fitted including main effects for hip/groin pain and Cohort and their interaction, with outcome variables playing loads and HAGOS subscale scores and dependent variable hip/groin pain. RESULTS: Twenty-one players (41%) self-reported hip/groin 'discomfort/pain', of which nine perceived no 'problems'. Two of these nine players reported training/playing time loss due to pain. Those self-reporting hip/groin discomfort/pain scored lower than those without in HAGOS subscales Symptoms (mean difference in score 8.94; 95%CI -25.24, -5.97), Pain (5.00; -16.42, -2.81), Function in daily living (0.00; -26.72 to -5.59), Function in sport and recreation (6.25; -21.24, -5.33), and hip and/or groin Quality of Life (5.00; -28.63, -8.10), indicating worse hip/groin problems. Participation subscale scores were different only for Italian players (36.25; -51.25, -20.00), with players self-reporting hip/groin discomfort/pain scoring lower. CONCLUSION: Most players who perceive both hip/groin 'discomfort/pain' and 'problems' also report training/playing time loss, suggesting players' perceptions of problematic symptoms and time-loss are associated. Adolescent basketball players perceive hip/groin pain to negatively impact their daily lives and sporting function.

Chronic Hip Injury Has a Negative Emotional Impact on the Male Athlete With Femoroacetabular Impingement.

PURPOSE: To evaluate the impact of hip arthroscopy for femoroacetabular impingement (FAI) on both the physical and mental components of the 36-Item Short Form (SF-36) and assess how changes in health status compare with improvements in physical function and ability to continue to play (CTP) 2 years after surgery. METHOD: Data collected prospectively from male athletes undergoing primary arthroscopic correction of FAI between November 2008 and October 2016 were analyzed. Physical (PCS) and mental (MCS) component scores of the SF-36 were assessed preoperatively and 2 years postoperatively. The minimal clinical important difference (MCID) was calculated using an anchor-based percentage of possible improvement technique, and the proportion of athletes achieving MCID was established. Logistic regression analysis was used to identify predictors of achieving MCID. CTP was assessed at 2-year follow-up. RESULTS: 486 cases were included, age 25.9 ± 5.6 years. Median PCS improved from baseline 69.4 (51.9 to 85.0) to 91.9 (81.9 to 97.5) at 2 years (P < .001). Median MCS remained unchanged-preoperative, 88 (76 to 92); postoperative, 88 (80 to 96)-although the difference in the distribution of scores was statistically significant (P < .001). Calculated MCID was 60.1% (PCS) and 58.1% (MCS). Mean improvement was significantly higher for PCS compared with MCS (17.4 versus 3.7, P < .001) The proportion of cases achieving MCID was 56.9% and 28.7% for PCS and MCS, respectively, and the difference was statistically significant (P < .001). Lower Tonnis grade (odds ratio [OR] 0.601, 95% confidence interval [CI] 0.377 to 0.958; P = .032) and symptom duration <2 years (OR 0.624, 95% CI 0.406 to 0.960; P = .032) were predictive of achieving PCS MCID. Higher preoperative scores decreased the odds of achieving MCID (OR 0.965, 95% CI 0.955 to 0.975; P < .001; OR 0.972, 95% CI 0.958 to 0.986; P < .001 for PCS and MCS, respectively). 77.3% continued to play their main preinjury sport. Where CTP was not achieved, a significantly higher proportion of cases failed to meet MCID for the MCS compared with PCS (85% versus 60%, P < .001). CONCLUSION: Arthroscopic management of sports-related FAI results in excellent overall clinical outcome and high levels of satisfaction and CTP at 2 years. Chronic hip injury has a significant negative effect on the physical and mental well-being of athletes; corrective surgery may restore physical function but is more limited in its ability to improve mental health status in this athletic cohort. LEVEL OF EVIDENCE: IV, therapeutic case series.

Relationship Between PROMIS Computer Adaptive Tests and Legacy Hip Measures Among Patients Presenting to a Tertiary Care Hip Preservation Center.

BACKGROUND: Legacy hip outcome measures may be burdensome to patients and sometimes yield floor or ceiling effects. Patient-Reported Outcomes Measurement Information System (PROMIS) computer adaptive tests (CATs) allow for low-burden data capture and limited ceiling and floor effects. PURPOSE/HYPOTHESIS: The purpose of this study was to determine whether the PROMIS CAT domains demonstrate correlation against commonly used legacy patient-reported outcome measures in a population of patients presenting to a tertiary care hip preservation center. The authors hypothesized the following: (1) PROMIS CAT scores based on physical function (PF), pain interference (PIF), pain behavior, and pain intensity would show strong correlation with the following legacy scores: modified Harris Hip Score (mHHS), International Hip Outcome Tool-12 (iHOT-12), Hip Outcome Score (HOS) Sports and Activities of Daily Living subscales, and Veterans RAND-6D (VR-6D) utility measure. (2) The mental and physical health portions of the VR-6D legacy measure would show weak correlation with mental- and psychosocial-specific PROMIS elements-depression, anxiety, fatigue, sleep, and ability to participate in social roles and activities. (3) All PROMIS measures would exhibit fewer floor and ceiling effects than legacy scores. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 3. METHODS: Prospective data were collected on 125 patients in the hip preservation clinics. Enrollees completed legacy scores (visual analog scale for pain, mHHS, iHOT-12, HOS, and VR-6D) and PROMIS CAT questionnaires (PF, PIF, pain behavior, anxiety, depression, sleep, social roles and activities, pain intensity, fatigue). Spearman rank correlations were calculated, with rs values of 0 to 0.3 indicating negligible correlation; 0.3 to 0.5, weak correlation; 0.5 to 0.7, moderately strong correlation; and >0.7, strong correlation. Floor and ceiling effects were evaluated. RESULTS: As anticipated, the PF-CAT yielded strong correlations with the iHOT-12, mHHS, HOS-Sports, HOS-Activities of Daily Living, and VR-6D, with rs values of 0.76, 0.71, 0.81, 0.87, and 0.71, respectively. The PIF-CAT was the only pain score to show moderately strong to strong correlation with all 14 patient-reported outcome measures. A strong correlation was observed between the VR-6D and the social roles and activities CAT ( rs = 0.73). The depression CAT had a significant floor effect at 19%. No additional floor or ceiling effect was present for any other legacy or PROMIS measure. CONCLUSION: The PF-CAT shows strong correlation with legacy patient-reported outcome scores among patients presenting to a tertiary care hip preservation center. The PIF-CAT also correlates strongly with legacy and PROMIS measures evaluating physical and mental well-being. PROMIS measures are less burdensome and demonstrate no floor or ceiling effects, making them a potential alternative to legacy patient-reported outcome measures for the hip.

Which Seems to Be Worst? Pain Severity and Quality of Life between Patients with Lateral Hip Pain and Low Back Pain.

Purpose: The aim of this study was to compare the pain severity, health-related quality of life (HRQoL), and risk of continue having pain with prognostic risk scores (PRS), between patients referring greater trochanteric pain syndrome (GTPS) and chronic low back pain (CLBP). Methods: A descriptive, cross-sectional design using nonprobability convenience sampling was performed. A total sample of 102 patients were recruited from two primary health-care centers and divided into GTPS (n = 51) and CLBP (n = 51) groups. The primary outcome was pain severity which was assessed with the Spanish version of the Graded Chronic Pain Scale (GCPS). The secondary outcome was the HRQoL which was measured using the Spanish version of EuroQoL Five Dimensions and Five Levels (EQ-5D-5L) as well as the PRS. Results: Significant differences (P<0.05) were found within both groups in the pain severity global score with a medium effect size showing greater values for the CLBP group with regards to the GTPS group. The PRS in both groups did not show statistical differences (P>0.05). Nevertheless, subjects referring CLBP showed greater levels in the PRS than patients with GTPS. Comparing both groups, the HRQoL showed statistical differences (P<0.05) in the "pain/discomfort" domain in the CLBP group with respect to the GTPS group, but not in the other domains. Conclusions: Patients who suffered from CLBP showed greater pain severity and HRQoL discomfort with regard to patients with GTPS. Despite greater scores for CLBP, the PRS did not seem to be different between both conditions.

Self-Reported Hip Problems in Professional Ballet Dancers: The Impact on Quality of Life.

Hip problems are common in ballet dancers, and it is likely that dancers' perceived quality of life is impaired by their presence. There are no instruments to detect functional impairments related to hip injuries in young, athletic populations. The aim of this study was to evaluate the impact of hip related problems on the quality of life in professional ballet dancers. Thirty-seven professional ballet dancers, ages 18 to 33, completed a post-hire health screening prior to the start of their company's season. Participants completed the Hip Disability and Osteoarthritis Outcome Score (HOOS) questionnaire, which assesses level of disability due to a hip problem, and answered additional questions regarding the presence of pain with ballet-specific movements. Subjects were also asked to self-report current or prior history of hip problems or injuries. Dancers with a self-reported history of a hip problem (8 of 37, 21.6%) recorded relatively low HOOS sub-scores (indicative of enhanced disability) for pain and quality of life. The remaining sub-scores-for symptoms, activities of daily living (ADLs), and sports-were not significantly different from those of dancers who were problem-free. Dancers with a history of hip problem were also more likely to report hip pain with two or more dance movements. The impact of hip problems on the quality of life in professional ballet dancers tends to persist despite a lack of significant effect on the ability to perform ADLs or sports-related tasks. Therefore, the self-reported presence of a hip problem should be viewed as a risk factor for decreased quality of life in this population.

Association between coping skills, past injury and hip pain and function in adolescent elite female ballet dancers.

OBJECTIVES: The purpose of this study was to investigate the relationship between coping skills and current hip pain and function scores in ballet dancers. Secondly, we examined the relationship between coping skills and past injuries. Thirdly, we investigated the association between past injuries and current pain and function scores. METHODS: This was a cross-sectional observational study. Twenty-six young elite female dancers (mean age 15.9 years, range 14-17 years) participated. Participants completed surveys indicating past injury history, rating pain and function on the short International Hip Outcome Tool (iHOT-12), and assessing coping skills on the Athletic Coping Skills Inventory Score (ACSI-28). Independent t-tests, Cohen's d, effect size, chi-square and correlation coefficient and determination analyses were conducted. RESULTS: There was no significant relationship between iHOT-12 scores and ACSI-28 scores (r = -0.250, p = 0.087). There was no significant difference (p = 0.289) in past injuries comparing those with ACSI-28 scores above and below the mean ACSI-28. A significant moderate negative correlation was detected between both iHOT-12 scores and total past injuries (r = -0.609, p < 0.001), and iHOT-12 scores and past non-hip injuries (r = -0.628, p < 0.001). CONCLUSION: Past injuries may influence current hip pain and function in young female dancers. Correlation determination (r2) indicated that 37% of current pain and function scores were explained by total past injuries in a small group of young high-level ballet dancers. Further research should engage a prospective design to investigate the predictive ability of findings.

Differences in physician and patient ratings of items used to assess hip disorders.

BACKGROUND: The purpose of this study was to determine what issues are important to active individuals with hip lesions and to assess whether these issues are different from those that surgeons think are important. HYPOTHESIS: A discrepancy will be noted between what patients and surgeons believe to be important. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: This study comprised 150 consecutive patients (73 men, 77 women) from the international practices of 9 orthopaedic surgeons specializing in the management of hip disorders. All participants were seeking treatment for musculoskeletal hip disease. Average patient age was 42 +/- 11 years (range, 18-60). Patients and surgeons rated the importance of 146 potential hip outcome assessment items on a 6-point Likert-type scale. RESULTS: Of the 23 items identified as being important to patients, 16 were in the sports and recreation category. The top 11 items that the clinicians thought were most important were rated significantly lower by patients (P < .0005). Specifically, surgeons rated several items as being important that fell into the symptoms, functional limitations, and occupational issues categories, whereas patients did not. That is, a difference was found between patients and clinicians in how they rated items related to symptoms, functional limitations, and occupation (P < .01). A difference was not found between patients and surgeons in how they rated items related to sports and recreation and social-emotional lifestyle (P > .01). CONCLUSION: The hypothesis of this study was affirmed: a discrepancy was found between what issues patients believe are important and what surgeons perceive as being important to patients. This information may be particularly important when assessing treatment outcomes from a patient's perspective. Clinicians must be careful in presuming that the issues that they are attempting to improve with treatment are issues that are important to patients. These findings also emphasize the importance of discussing appropriate postoperative expectations for those considering surgery.