Evaluation and Standardization of the Hip Examination in Osteoarthritis
Description of Project:
The purpose of this study was to determine which hip examination techniques can be assessed reliably by expert rheumatologists and orthopedic surgeons in persons with painful hip osteoarthritis.
Why Do This Research?
The hip examination is an important component of the assessment of persons with hip osteoarthritis both in a clinical setting and in research. The hip examination can be conducted using different assessments such as examinations for pain on movement, range of motion, muscle strength and gait. In addition, different techniques can be employed for these assessments.
There is little information on how reliable or comparable the findings of a hip examination are among different examiners. If the hip examination is to be used in research studies, it is important to understand which assessments and techniques are most reliable. These reliable assessment techniques can then be incorporated by other researchers or in a clinical setting
Who Was Studied?
Six subjects, age 40-75, with hip pain and with mild to severe hip osteoarthritis on x-ray were included in this study.
How Was It Done?
Each subject was examined by six arthritis specialists (four rheumatologists and two orthopedic surgeons) experienced in the assessment of osteoarthritis. More than 20 hip examination techniques were assessed in this study. Subjects were examined in random order prior to and following standardization of techniques. Standardization of techniques was achieved during a meeting of the six examiners. The standardization meeting entailed the identification of differences in examination findings, the discussion of different examination techniques and the demonstration of examination techniques on a healthy volunteer to clarify the reasons for the differences. This resulted in a standardized way of examining the hip joint. The study was conducted over two days.
What Was Found?
Moderate to very good agreement was present for many hip examinations prior to standardization. Improved reliability was achieved after standardization for many but not all hip assessments. The hip could be examined reliably for pain on movement (log roll test, pain on flexion, pain on external rotation), range of motion in different directions (internal rotation, flexion and flexion contracture), muscle strength of different muscle groups (abduction, adduction, flexion, extension), and leg length measurements. Some examinations were not reliable despite standardization of techniques, including the assessment of gait (walking) and Trendelenburg test for the assessment of hip muscle abduction strength.
Why Is This Relevant To People Living With Arthritis?
A standardized hip examination is important for the accurate and reliable assessment of persons with hip osteoarthritis. The results from this study allow for the selective use of only those hip examination techniques that are of good reliability. These findings are currently being applied in a study that aims to develop a tool for the diagnosis of early hip osteoarthritis. In general, the diagnostic accuracy and evaluation of the progression of osteoarthritis has been enhanced by such standardized assessments both in clinical practice and in a research setting.
Were Consumers Involved?
Consumers were involved as participants in this research study.
Who Helped Pay For The Research?
This study was funded by the Osteoarthritis New Emerging Team grant, which is funded by the Canadian Institutes of Health Research and the Canadian Arthritis Network.
Publications / Presentations
- Results for this study were presented at the Canadian-Mexican Rheumatology Congress, Acapulco, Mexico, February 2006.
- The published abstract of the presentation is available:
- Cibere J, Thorne A, Bellamy N, Chalmers A, Greidanus N, Mahomed N, Trithart S, Combes V, Shojania K, Kopec J, Esdaile JM. Reliability and standardization of the hip examination in osteoarthritis. J Rheumatol 2006;33(2):398.
- The article is in press:
-
Cibere J, Thorne A, Bellamy N, Greidanus N, Chalmers A, Mahomed N, Shojania K, Kopec J, Esdaile JM. Reliability of the hip examination in osteoarthritis: Effect of standardization. Arthritis Rheum 2008;59(3):373-81.
Time Frame:
September 2004 to August 2005.
Funding Agency:
This study is funded by the OA NET grant, which is funded by the CIHR and the Canadian Arthritis Network.
Project Team Members:
Principal Investigator
Jolanda Cibere MD, PhD
Research Scientist, ARC
Co-Investigators
John Esdaile MD, MPH
Scientific Director, ARC
Jacek Kopec MD, PhD
Research Scientist, ARC
Kam Shojania MD
Former Director of Clinical Trials, ARC
Nelson Greidanus MD, MPH, PhD
Research Scientist, ARC
Andrew Chalmers MD,
University of British Columbia
Vancouver, BC, Canada
Nizar Mahomed MD
University of Toronto, ON, Canada
Anona Thorne MSc
Canadian HIV Trials Network
Vancouver, BC, Canada
Nicholas Bellamy MD, MSc
Centre of National Research on Disability and Rehabilitation Medicine (CONROD)
University of Queensland, Brisbane, Australia
Study Coordinators
Sherry Trithart MA
Research Co-ordinator, ARC
Victoria Combes BSc
Research Clerk, ARC
Other Institutions Involved
University of British Columbia
Vancouver, BC Canada
Vancouver Hospital & Health Sciences Centre
Vancouver, BC Canada
University of Toronto
Toronto, ON Canada
Canadian HIV Trials Network
Vancouver, BC Canada
Centre of National Research on Disability and Rehabilitation Medicine (CONROD)
University of Queensland
Brisbane Australia