Hofte- og lyskesmerter hos yngre fysisk aktive personer. Fagkongres 2015
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1 Hofte- og lyskesmerter hos yngre fysisk aktive personer Fagkongres 2015
2 Hofte- og lyskesmerter hos yngre fysisk aktive personer Introduktion, v. Fysioterapeut, PhD Kristian Thorborg, Amager-Hvidovre Hospital, Københavns Universitetshospital Undersøgelse af hofte og lyskeregion en klinisk udfordring, v. Læge, Dr. Med. Per Hölmich, Amager-Hvidovre Hospital, Københavns Universitetshospital Billeddiagnostik Klinisk anvendelse af MR, v. Læge, PhD Sonia Branci, Rigshospitalet, Københavns Universitetshospital Billeddiagnostik Klinisk anvendelse af UL, v. Fysioterapeut, cand.scient.san. Julie Jacobsen, Aarhus Universitetshospital Smerte og funktionsnedsættelse hos forskellige patientgrupper med hofte- og lyskesmerter, v. Fysioterapeut, PhD Kristian Thorborg, Amager-Hvidovre Hospital Behandling: Træning og kirurgi til hvem og hvornår! v. Læge, Dr. Med. Per Hölmich, Amager-Hvidovre Hospital Paneldiskussion med spørgsmål fra salen
3 Hofte- og lyskesmerter hos yngre fysisk aktive personer Introduktion, v. Fysioterapeut, PhD Kristian Thorborg, Amager-Hvidovre Hospital, Københavns Universitetshospital Undersøgelse af hofte og lyskeregion en klinisk udfordring, v. Læge, Dr. Med. Per Hölmich, Amager-Hvidovre Hospital, Københavns Universitetshospital Billeddiagnostik Klinisk anvendelse af MR, v. Læge, PhD Sonia Branci, Rigshospitalet, Københavns Universitetshospital Billeddiagnostik Klinisk anvendelse af UL, v. Fysioterapeut, cand.scient.san. Julie Jacobsen, Aarhus Universitetshospital Smerte og funktionsnedsættelse hos forskellige patientgrupper med hofte- og lyskesmerter, v. Fysioterapeut, PhD Kristian Thorborg, Amager-Hvidovre Hospital Behandling: Træning og kirurgi til hvem og hvornår! v. Læge, Dr. Med. Per Hölmich, Amager-Hvidovre Hospital Paneldiskussion med spørgsmål fra salen
4 Hofte- og lyskesmerter hos yngre fysisk aktive personer Introduktion, v. Fysioterapeut, PhD Kristian Thorborg, Amager-Hvidovre Hospital, Københavns Universitetshospital Undersøgelse af hofte og lyskeregion en klinisk udfordring, v. Læge, Dr. Med. Per Hölmich, Amager-Hvidovre Hospital, Københavns Universitetshospital Billeddiagnostik Klinisk anvendelse af MR, v. Læge, PhD Sonia Branci, Rigshospitalet, Københavns Universitetshospital Billeddiagnostik Klinisk anvendelse af UL, v. Fysioterapeut, cand.scient.san. Julie Jacobsen, Aarhus Universitetshospital Smerte og funktionsnedsættelse hos forskellige patientgrupper med hofte- og lyskesmerter, v. Fysioterapeut, PhD Kristian Thorborg, Amager-Hvidovre Hospital Behandling: Træning og kirurgi til hvem og hvornår! v. Læge, Dr. Med. Per Hölmich, Amager-Hvidovre Hospital Paneldiskussion med spørgsmål fra salen
5 Hofte- og lyskesmerter hos yngre fysisk aktive personer Introduktion, v. Fysioterapeut, PhD Kristian Thorborg, Amager-Hvidovre Hospital, Københavns Universitetshospital Undersøgelse af hofte og lyskeregion en klinisk udfordring, v. Læge, Dr. Med. Per Hölmich, Amager-Hvidovre Hospital, Københavns Universitetshospital Billeddiagnostik Klinisk anvendelse af MR, v. Læge, PhD Sonia Branci, Rigshospitalet, Københavns Universitetshospital Billeddiagnostik Klinisk anvendelse af UL, v. Fysioterapeut, cand.scient.san. Julie Jacobsen, Aarhus Universitetshospital Smerte og funktionsnedsættelse hos forskellige patientgrupper med hofte- og lyskesmerter, v. Fysioterapeut, PhD Kristian Thorborg, Amager-Hvidovre Hospital Behandling: Træning og kirurgi til hvem og hvornår! v. Læge, Dr. Med. Per Hölmich, Amager-Hvidovre Hospital Paneldiskussion med spørgsmål fra salen
6 Smerte og funktionsniveau hos fysiske aktive individer med hofte og lyskesmerter Kristian Thorborg, Lektor, MSc, PhD, Specialist i Idrætsfysioterapi
7 Emner i dag 1) Selvrapporteret smerte og funktion 2) Muskelstyrkemålinger omkring hoften
8 Patient-Reported Outcome (PRO) PRO is any report coming directly from patients about a health condition and its treatment. (FDA, Patrick et al., 2007)
9 PRO questionnaires
10 PRO questionnaires
11 PRO questionnaires
12 PRO questionnaires
13 PRO questionnaires
14 PRO questionnaires
15 Arthroscopic Centre Amager, Copenhagen
16 HAGOS 2013 ihot-12 ihot-33 Arthroscopic Centre Amager, Copenhagen
17 New Systematic Review Patient-reported outcome questionnaires (PROs) for young to middle-aged adults with hip and groin disability: a systematic review of the clinimetric evidence Thorborg K (1), Tijssen M (2), Habets B (2), Bartels EM (3) Roos EM (4), Kemp J (5), Crossley KM (6), Hölmich P (1)
18 New Systematic Review Patient-reported outcome questionnaires (PROs) for young to middle-aged adults with hip and groin disability: a systematic review of the clinimetric evidence Thorborg K (1), Tijssen M (2), Habets B (2), Bartels EM (3) Roos EM (4), Kemp J (5), Crossley KM (6), Hölmich P (1)
19 Artroskopisk Center Amager (Mokkink et al., 2010)
20 Methodological quality (COSMIN) The methodological quality of the included studies was determined by the Consensus-based Standards for the selection of health Measurement Instruments list (COSMIN). Nine criteria are used to assess whether a study meets the standard for good methodological quality. Each criterion is rated as excellent, good, fair or poor in accordance with the criteria described by Terwee et al. (Terwee et al. 2012)
21 Criteria List (Terwee) for Rating the Measurement Properties of Patient-Reported Outcome Questionnaires Measurement Properties Content validity Internal consistency Construct validity Floor and ceiling effects The measurement properties were rated as: positive (+), indeterminate (±), negative ( ) no information available ( ) Test-retest reliability Inter-tester reliability Agreement (Terwee et al, 2007) Responsiveness Interpretability
22 Table 3: Included PRO Questionnaires for Patients with Hip and/or Groin Disability Abbreviation Full name Measurement dimension(s) Nr. of Rating scales HAGOS Hip And Groin Outcome Score Symptoms, pain, ADL, sport/recreational function, participation physical activity, QOL 6 HOOS Hip Disability and Osteoarthritis Outcome Score Pain, symptoms, ADL, sport/recreational function, QOL 5 HOS Hip Outcome Score ADL, sport 2 HSAS Hip Sports Activity Score Sport 1 IHOT-33 IHOT-12 International Hip Outcome Tool- 33 International Hip Outcome Tool- 12 Symptoms, function, sport, occupational function, QOL Symptoms, Function, sport, occupational function, QOL mhhs modified Harris Hip Score Pain, function, ADL, 1 NAHS Nonarthritic Hip Score Pain, symptoms, ADL, activities SUSHI Super Simple Hip Score General, pain, limitations, activity 1 WOMAC-12 and McMaster Universities Osteoarthritis index 12 Pain, ADL/physical function 1 ADL, Activities of Daily Living; QOL, Quality Of Life Arthroskopic Centre Amager, Copenhagen
23 Table 3: Included PRO Questionnaires for Patients with Hip and/or Groin Disability Abbreviation Full name Measurement dimension(s) Nr. of Rating scales HAGOS Hip And Groin Outcome Score Symptoms, pain, ADL, sport/recreational function, participation physical activity, QOL 6 HOOS Hip Disability and Osteoarthritis Outcome Score Pain, symptoms, ADL, sport/recreational function, QOL 5 HOS Hip Outcome Score ADL, sport 2 HSAS Hip Sports Activity Score Sport 1 IHOT-33 IHOT-12 International Hip Outcome Tool- 33 International Hip Outcome Tool- 12 Symptoms, function, sport, occupational function, QOL Symptoms, Function, sport, occupational function, QOL mhhs modified Harris Hip Score Pain, function, ADL, 1 NAHS Nonarthritic Hip Score Pain, symptoms, ADL, activities SUSHI Super Simple Hip Score General, pain, limitations, activity 1 WOMAC-12 and McMaster Universities Osteoarthritis index 12 Pain, ADL/physical function 1 ADL, Activities of Daily Living; QOL, Quality Of Life Arthroskopic Centre Amager, Copenhagen
24 Table 3: Included PRO Questionnaires for Patients with Hip and/or Groin Disability Abbreviation Full name Measurement dimension(s) Nr. of Rating scales HAGOS Hip And Groin Outcome Score Symptoms, pain, ADL, sport/recreational function, participation physical activity, QOL 6 HOOS Hip Disability and Osteoarthritis Outcome Score Pain, symptoms, ADL, sport/recreational function, QOL 5 HOS Hip Outcome Score ADL, sport 2 HSAS Hip Sports Activity Score Sport 1 IHOT-33 IHOT-12 International Hip Outcome Tool- 33 International Hip Outcome Tool- 12 Symptoms, function, sport, occupational function, QOL Symptoms, Function, sport, occupational function, QOL mhhs modified Harris Hip Score Pain, function, ADL, 1 NAHS Nonarthritic Hip Score Pain, symptoms, ADL, activities SUSHI Super Simple Hip Score General, pain, limitations, activity 1 WOMAC-12 and McMaster Universities Osteoarthritis index 12 Pain, ADL/physical function 1 ADL, Activities of Daily Living; QOL, Quality Of Life Arthroskopic Centre Amager, Copenhagen
25 Table 3: Included PRO Questionnaires for Patients with Hip and/or Groin Disability Abbreviation Full name Measurement dimension(s) Nr. of Rating scales HAGOS Hip And Groin Outcome Score Symptoms, pain, ADL, sport/recreational function, participation physical activity, QOL 6 HOOS Hip Disability and Osteoarthritis Outcome Score Pain, symptoms, ADL, sport/recreational function, QOL 5 HOS Hip Outcome Score ADL, sport 2 HSAS Hip Sports Activity Score Sport 1 IHOT-33 IHOT-12 International Hip Outcome Tool- 33 International Hip Outcome Tool- 12 Symptoms, function, sport, occupational function, QOL Symptoms, Function, sport, occupational function, QOL mhhs modified Harris Hip Score Pain, function, ADL, 1 NAHS Nonarthritic Hip Score Pain, symptoms, ADL, activities SUSHI Super Simple Hip Score General, pain, limitations, activity 1 WOMAC-12 and McMaster Universities Osteoarthritis index 12 Pain, ADL/physical function 1 ADL, Activities of Daily Living; QOL, Quality Of Life Arthroskopic Centre Amager, Copenhagen
26 Table 3: Included PRO Questionnaires for Patients with Hip and/or Groin Disability Abbreviation Full name Measurement dimension(s) Nr. of Rating scales HAGOS Hip And Groin Outcome Score Symptoms, pain, ADL, sport/recreational function, participation physical activity, QOL 6 HOOS Hip Disability and Osteoarthritis Outcome Score Pain, symptoms, ADL, sport/recreational function, QOL 5 HOS Hip Outcome Score ADL, sport 2 HSAS Hip Sports Activity Score Sport 1 IHOT-33 IHOT-12 International Hip Outcome Tool- 33 International Hip Outcome Tool- 12 Symptoms, function, sport, occupational function, QOL Symptoms, Function, sport, occupational function, QOL mhhs modified Harris Hip Score Pain, function, ADL, 1 NAHS Nonarthritic Hip Score Pain, symptoms, ADL, activities SUSHI Super Simple Hip Score General, pain, limitations, activity 1 WOMAC-12 and McMaster Universities Osteoarthritis index 12 Pain, ADL/physical function 1 ADL, Activities of Daily Living; QOL, Quality Of Life Arthroskopic Centre Amager, Copenhagen
27 Table 3: Included PRO Questionnaires for Patients with Hip and/or Groin Disability Abbreviation Full name Measurement dimension(s) Nr. of Rating scales HAGOS Hip And Groin Outcome Score Symptoms, pain, ADL, sport/recreational function, participation physical activity, QOL 6 HOOS Hip Disability and Osteoarthritis Outcome Score Pain, symptoms, ADL, sport/recreational function, QOL 5 HOS Hip Outcome Score ADL, sport 2 HSAS Hip Sports Activity Score Sport 1 IHOT-33 IHOT-12 International Hip Outcome Tool- 33 International Hip Outcome Tool- 12 Symptoms, function, sport, occupational function, QOL Symptoms, Function, sport, occupational function, QOL mhhs modified Harris Hip Score Pain, function, ADL, 1 NAHS Nonarthritic Hip Score Pain, symptoms, ADL, activities SUSHI Super Simple Hip Score General, pain, limitations, activity 1 WOMAC-12 and McMaster Universities Osteoarthritis index 12 Pain, ADL/physical function 1 ADL, Activities of Daily Living; QOL, Quality Of Life Arthroskopic Centre Amager, Copenhagen
28 Table 3: Included PRO Questionnaires for Patients with Hip and/or Groin Disability Abbreviation Full name Measurement dimension(s) Nr. of Rating scales HAGOS 23 % poor methodology ratings HOOS Hip Disability and Osteoarthritis Outcome Score Pain, symptoms, ADL, sport/recreational function, QOL 5 HOS 46 Hip Outcome % poor Score methodology ratings ADL, sport HSAS IHOT % poor methodology ratings IHOT % poor methodology ratings mhhs NAHS Nonarthritic Hip Score Pain, symptoms, ADL, activities 1 SUSHI Super Simple Hip Score General, pain, limitations, activity 1 WOMAC-12 and McMaster Universities Osteoarthritis index 12 Pain, ADL/physical function 1 ADL, Activities of Daily Living; QOL, Quality Of Life Arthroskopic Centre Amager, Copenhagen
29 Criteria List (Terwee) for Rating the Measurement Properties of Patient-Reported Outcome Questionnaires HAGOS, IHOT-33 and IHOT-12 received the best ratings concerning their clinimetric properties (six positive scores out of eight relevant scores) HOS followed (five positive scores out of eight relevant scores) (6/8) (5/8)
30 Criteria List (Terwee) for Rating the Measurement Properties of Patient-Reported Outcome Questionnaires HAGOS, IHOT-33 and IHOT-12 received the best ratings concerning their clinimetric properties (six positive scores out of eight relevant scores) HOS followed (five positive scores out of eight relevant scores) (6/8) (5/8) Then HOOS and mhhs and NAHS followed (four positive scores out of eight relevant scores) (4/8) Last came HSAS and SUSHI. WOMAC-12 ( 2 positive scores out of eight relevant scores) ( 2/8)
31 Conclusion HAGOS, HOS, IHOT-12 and IHOT-33 can be recommended for the assessment of young to middle-aged adults with pain related to the hip joint, undergoing non-surgical treatment or hip-arthroscopy. HAGOS is the only PRO also aimed for young to middle-aged adults presenting with groin pain and can be recommended for use in this population.
32 Conclusion HAGOS, HOS, IHOT-12 and IHOT-33 can be recommended for the assessment of young to middle-aged adults with pain related to the hip joint, undergoing non-surgical treatment or hip-arthroscopy. HAGOS is the only PRO also aimed for young to middle-aged adults presenting with groin pain and can be recommended for use in this population.
33 Conclusion HAGOS, HOS, IHOT-12 and IHOT-33 can be recommended for the assessment of young to middle-aged adults with pain related to the hip joint, undergoing non-surgical treatment or hip-arthroscopy. HAGOS is the only PRO also aimed for young to middle-aged adults presenting with groin pain and can be recommended for use in this population.
34 For more information concerning HAGOS Arthroscopic Centre Amager, Copenhagen
35 Ongoing translations and cross-cultural validations of HAGOS Arthroscopic Centre Amager, Copenhagen
36 Arthroscopic Centre Amager, Copenhagen (Thorborg et al., 2013)
37 (Thorborg et al., unpublished data)
38
39 Adductor-related groin pain
40 Adductor-related groin pain FAI/ hip dysplasia
41 Strength measurements in groin pain
42 Many different hip-adduction strength tests exist today
43 Assessment of muscle strength is an important part of the clinical examination of patients with hip and groin pain (Hölmich et al., 2004) Arthroscopic Centre Amager, Copenhagen
44 Weak Intermediate Strong Intra-tester Kappa = Inter-tester Kappa = (Hölmich et al., 2004) Arthroscopic Centre Amager, Copenhagen
45 Manual muscle testing (0-5) 0/5 - no contraction 1/5 - muscle flicker, but no movement 2/5 - movement possible, but not against gravity 3/5 - movement possible against gravity, but not against resistance 4/5 - movement possible against some resistance 5/5 - normal strength Arthroscopic Centre Amager, Copenhagen
46 Manual muscle testing (0-5) Fails to identify 50% strength deficits (Beasley, 1956) Arthroscopic Centre Amager, Copenhagen
47 Publications ( ) 1: Thorborg K, Petersen J, Nielsen MB, Hölmich P. Clinical recovery of two hip adductor longus ruptures: a case-report of a soccer player. BMC Res Notes May 22;6(1):205. [Epub ahead of print] 2: Thorborg K, Bandholm T, Hölmich P. Men are stronger than women-also in the hip. J Sci Med Sport Sep;16(5):E1-3. 3: Jacobsen JS, Thorborg K, Søballe K, Ulrich-Vinther M. Eccentric hip abductor weakness in patients with symptomatic external snapping hip. Scand J Med Sci Sports Dec;22(6):e : Thorborg K, Bandholm T, Hölmich P. Hip- and knee-strength assessments using a hand-held dynamometer with external belt fixation are inter-tester reliable. Knee Surg Sports Traumatol Arthrosc Mar;21(3): : Jensen J, Hölmich P, Bandholm T, Zebis MK, Andersen LL, Thorborg K. Eccentric strengthening effect of hip-adductor training with elastic bands in soccer players: a randomised controlled trial. Br J Sports Med Jul 4.[Epub ahead of print] 7 : Thorborg K, Bandholm T, Schick M, Jensen J, Hölmich P. Hip strength assessment using handheld dynamometry is subject to ntertester bias when testers are ofdifferent sex and strength. Scand J Med Sci Sports Aug;23(4): : Bandholm T, Thorborg K, Andersson E, Larsen T, Toftdahl M, Bencke J, Hölmich P. Increased external hip-rotation strength relates to reduced dynamic knee control in females: paradox or adaptation? Scand J Med Sci Sports Dec;21(6):e : Thorborg K, Serner A, Petersen J, Madsen TM, Magnusson P, Hölmich P. Hip adduction and abduction strength profiles in elite soccer players: implications for clinical evaluation of hip adductor muscle recovery afterinjury. Am J Sports Med Jan;39(1): : Thorborg K, Bandholm T, Petersen J, Weeke KM, Weinold C, Andersen B, Serner A, Magnusson SP, Hölmich P. Hip abduction strength training in the clinical setting: with or without external loading? Scand J Med Sci Sports Oct;20 Suppl 2: : Thorborg K, Couppé C, Petersen J, Magnusson SP, Hölmich P. Eccentric hip adduction and abduction strength in elite soccer players and matched controls: a cross-sectional study. Br J Sports Med Jan;45(1): : Thorborg K, Petersen J, Magnusson SP, Hölmich P. Clinical assessment of hip strength using a hand-held dynamometer is reliable. Scand J Med Sci Sports Jun;20(3): : Ramskov D, Pedersen MB, Kastrup K, Lønbro S, Jacobsen JS, Thorborg K, Nielsen RO, Rasmussen S. Normative values of eccentric hip abduction strength in novice runners: an equation adjusting for age and gender. Int J Sports Phys Ther Feb;9(1):68-75.
48 Eccentric strength deficits (Jakobsen et al., 2013) Arthroscopic Centre Amager, Copenhagen
49 Eccentric hip abduction (Ramskov et al. 2014) Arthroscopic Centre Amager, Copenhagen
50 Eccentric hip adduction strength testing Test-retest variation Mean of 2 rep with 5 % force-plateau ICC= 0.91 SEM%= 7% (Thorborg et al., 2011) No systematic variation Arthroscopic Centre Amager, Copenhagen
51
52 Hip adduction strength deficit (Soccer players with adductor related groin pain) (Thorborg et al., 2014)
53 Hip adduction strength deficit (Soccer players with adductor related groin pain) (Thorborg et al., 2014)
54 Hip adduction strength deficit (Soccer players with adductor related groin pain) 20 % reduced (Thorborg et al., 2014)
55 Aspetar - Andrea Mosler Arthroscopic Centre Amager, Copenhagen
56 The acute adductor injury (Thorborg et al., 2013)
57 The acute adductor injury- mechanism of injury? Arthroscopic Centre Amager, Copenhagen
58 2 weeks Adductor rupture 1 Adductor rupture 2
59 Hip adduction strength Arthroscopic Centre Amager, Copenhagen
60 Aspetar Sports Medicine Journal
61 Aspetar Sports Medicine Journal
62 Hofte- og lyskesmerter hos yngre fysisk aktive personer Fagkongres 2015
63 Workshop i morgen Fagkongres 2015
64 Anamnese Klinik Billeder
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