Hofte- og lyskesmerter hos
yngre fysisk aktive personer
Fagkongres 2015
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
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
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
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
Smerte og funktionsniveau
hos fysiske aktive individer med hofte og lyskesmerter
Kristian Thorborg, Lektor, MSc, PhD, Specialist i Idrætsfysioterapi
Emner i dag
1) Selvrapporteret smerte og funktion
2) Muskelstyrkemålinger omkring hoften
Patient-Reported Outcome (PRO)
“…PRO is any report
coming directly
from patients
about a health
condition and its
treatment….
(FDA, Patrick et al., 2007)
PRO questionnaires
PRO questionnaires
PRO questionnaires
PRO questionnaires
PRO questionnaires
PRO questionnaires
Arthroscopic Centre Amager,
Copenhagen
HAGOS
2013
iHOT-12
iHOT-33
Arthroscopic Centre Amager,
Copenhagen
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)
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)
Artroskopisk Center Amager
(Mokkink et al., 2010)
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)
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
Responsiveness
Interpretability
(Terwee et al, 2007)
Table 3: Included PRO Questionnaires for Patients with Hip and/or Groin Disability
Abbreviation
Full name
Measurement dimension(s)
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
HSAS
IHOT-33
Hip Outcome Score
Hip Sports Activity Score
International Hip Outcome Tool33
ADL, sport
Sport
Symptoms, function, sport,
occupational function, QOL
2
IHOT-12
International Hip Outcome Tool12
Symptoms, Function, sport,
occupational function, QOL
1
mHHS
NAHS
modified Harris Hip Score
Nonarthritic Hip Score
Pain, function, ADL,
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
Arthroskopic Centre Amager,
Copenhagen
ADL, Activities of Daily Living; QOL, Quality Of Life
Nr. of Rating scales
1
1
1
Table 3: Included PRO Questionnaires for Patients with Hip and/or Groin Disability
Abbreviation
Full name
Measurement dimension(s)
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
HSAS
IHOT-33
Hip Outcome Score
Hip Sports Activity Score
International Hip Outcome Tool33
ADL, sport
Sport
Symptoms, function, sport,
occupational function, QOL
2
IHOT-12
International Hip Outcome Tool12
Symptoms, Function, sport,
occupational function, QOL
1
mHHS
NAHS
modified Harris Hip Score
Nonarthritic Hip Score
Pain, function, ADL,
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
Arthroskopic Centre Amager,
Copenhagen
ADL, Activities of Daily Living; QOL, Quality Of Life
Nr. of Rating scales
1
1
1
Table 3: Included PRO Questionnaires for Patients with Hip and/or Groin Disability
Abbreviation
Full name
Measurement dimension(s)
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
HSAS
IHOT-33
Hip Outcome Score
Hip Sports Activity Score
International Hip Outcome Tool33
ADL, sport
Sport
Symptoms, function, sport,
occupational function, QOL
2
IHOT-12
International Hip Outcome Tool12
Symptoms, Function, sport,
occupational function, QOL
1
mHHS
NAHS
modified Harris Hip Score
Nonarthritic Hip Score
Pain, function, ADL,
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
Arthroskopic Centre Amager,
Copenhagen
ADL, Activities of Daily Living; QOL, Quality Of Life
Nr. of Rating scales
1
1
1
Table 3: Included PRO Questionnaires for Patients with Hip and/or Groin Disability
Abbreviation
Full name
Measurement dimension(s)
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
HSAS
IHOT-33
Hip Outcome Score
Hip Sports Activity Score
International Hip Outcome Tool33
ADL, sport
Sport
Symptoms, function, sport,
occupational function, QOL
2
IHOT-12
International Hip Outcome Tool12
Symptoms, Function, sport,
occupational function, QOL
1
mHHS
NAHS
modified Harris Hip Score
Nonarthritic Hip Score
Pain, function, ADL,
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
Arthroskopic Centre Amager,
Copenhagen
ADL, Activities of Daily Living; QOL, Quality Of Life
Nr. of Rating scales
1
1
1
Table 3: Included PRO Questionnaires for Patients with Hip and/or Groin Disability
Abbreviation
Full name
Measurement dimension(s)
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
HSAS
IHOT-33
Hip Outcome Score
Hip Sports Activity Score
International Hip Outcome Tool33
ADL, sport
Sport
Symptoms, function, sport,
occupational function, QOL
2
IHOT-12
International Hip Outcome Tool12
Symptoms, Function, sport,
occupational function, QOL
1
mHHS
NAHS
modified Harris Hip Score
Nonarthritic Hip Score
Pain, function, ADL,
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
Arthroskopic Centre Amager,
Copenhagen
ADL, Activities of Daily Living; QOL, Quality Of Life
Nr. of Rating scales
1
1
1
Table 3: Included PRO Questionnaires for Patients with Hip and/or Groin Disability
Abbreviation
Full name
Measurement dimension(s)
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
HSAS
IHOT-33
Hip Outcome Score
Hip Sports Activity Score
International Hip Outcome Tool33
ADL, sport
Sport
Symptoms, function, sport,
occupational function, QOL
2
IHOT-12
International Hip Outcome Tool12
Symptoms, Function, sport,
occupational function, QOL
1
mHHS
NAHS
modified Harris Hip Score
Nonarthritic Hip Score
Pain, function, ADL,
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
Arthroskopic Centre Amager,
Copenhagen
ADL, Activities of Daily Living; QOL, Quality Of Life
Nr. of Rating scales
1
1
1
Table 3: Included PRO Questionnaires for Patients with Hip and/or Groin Disability
Abbreviation
Full name
Measurement dimension(s)
HAGOS
23 % poor methodology ratings
HOOS
Hip Disability and Osteoarthritis
Outcome Score
HOS
HSAS
Hip Outcome
ADL, sport
46
% poorScore
methodology ratings
IHOT-33
46 % poor methodology ratings
IHOT-12
31 % 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
Pain, symptoms, ADL,
sport/recreational function, QOL
Arthroskopic Centre Amager,
Copenhagen
ADL, Activities of Daily Living; QOL, Quality Of Life
Nr. of Rating scales
5
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)
(6/8)
HOS followed
(five positive scores out of eight relevant scores)
(5/8)
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)
(6/8)
HOS followed
(five positive scores out of eight relevant scores)
(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)
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.
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.
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.
For more information
concerning HAGOS
www.koos.nu/
Arthroscopic Centre Amager,
Copenhagen
Ongoing translations and
cross-cultural validations of HAGOS
www.koos.nu/
Arthroscopic Centre Amager,
Copenhagen
(Thorborg et al., 2013)
Arthroscopic Centre Amager,
Copenhagen
(Thorborg et al., unpublished data)
Adductor-related groin pain
Adductor-related groin pain
FAI/ hip dysplasia
Strength measurements
in groin pain
Many different hip-adduction strength tests exist today
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
Weak
Intermediate
Strong
Intra-tester
Kappa = 0.58-0.72
Inter-tester
Kappa = 0-0.22
(Hölmich et al., 2004)
Arthroscopic Centre Amager,
Copenhagen
Manual muscle testing (0-5)
0/5
1/5
2/5
3/5
4/5
5/5
-
no contraction
muscle flicker, but no movement
movement possible, but not against gravity
movement possible against gravity, but not against resistance
movement possible against some resistance
normal strength
Arthroscopic Centre Amager,
Copenhagen
Manual muscle testing (0-5)
Fails to identify
”50% strength deficits”
(Beasley, 1956)
Arthroscopic Centre Amager,
Copenhagen
Publications (2010-14)
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. 2013 May 22;6(1):205. [Epub
ahead of print]
8: 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. 2011 Dec;21(6):e215-21.
2: Thorborg K, Bandholm T, Hölmich P. Men are stronger than
women-also in the hip. J Sci Med Sport. 2013 Sep;16(5):E1-3.
9: 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. 2011
Jan;39(1):121-6.
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. 2012 Dec;22(6):e140-6.
5: 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. 2013 Mar;21(3):550-5.
6: 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. 2012 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. 2013 Aug;23(4):487-93.
10: 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. 2010 Oct;20 Suppl 2:70-7.
11: 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. 2011 Jan;45(1):10-3.
12: 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. 2010 Jun;20(3):493-501.
13: 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. 2014
Feb;9(1):68-75.
Eccentric strength deficits
(Jakobsen et al., 2013)
Arthroscopic Centre Amager,
Copenhagen
Eccentric hip abduction
(Ramskov et al. 2014)
Arthroscopic Centre Amager,
Copenhagen
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
Hip adduction strength deficit
(Soccer players with adductor related groin pain)
(Thorborg et al., 2014)
Hip adduction strength deficit
(Soccer players with adductor related groin pain)
(Thorborg et al., 2014)
Hip adduction strength deficit
(Soccer players with adductor related groin pain)
20 % reduced
(Thorborg et al., 2014)
Aspetar - Andrea Mosler
Arthroscopic Centre Amager,
Copenhagen
The acute adductor injury
(Thorborg et al., 2013)
The acute adductor injurymechanism of injury?
Arthroscopic Centre Amager,
Copenhagen
2 weeks
Adductor rupture 1
Adductor rupture 2
Hip adduction strength
Arthroscopic Centre Amager,
Copenhagen
Aspetar Sports Medicine Journal
Aspetar Sports Medicine Journal
Hofte- og lyskesmerter hos
yngre fysisk aktive personer
Fagkongres 2015
Workshop i morgen
Fagkongres 2015
Anamnese
Klinik
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