Defense Date

2-6-2019

Graduation Date

Spring 5-10-2019

Availability

One-year Embargo

Submission Type

dissertation

Degree Name

PhD

Department

Rehabilitation Science

School

Rangos School of Health Sciences

Committee Chair

RobRoy L. Martin

Committee Member

Amy L. Phelps

Committee Member

Benjamin R. Kivlan

Committee Member

John J. Christoforetti

Keywords

FAI, structural instability, chondrolabral pathologies, single leg squat test, step-down test, visual analog scale, hip outcome score, percent global rating of function, patient satisfaction, hip arthroscopy

Abstract

Purpose: Both the single leg squat test and step-down test assess for deficiencies relating to the hip and surrounding musculoskeletal structures and could be useful in the evaluation of functional movement control for individuals with non-arthritic hip pain. The purpose of this study is to determine if individuals with non-arthritic hip pain that improve functional movement control during the single leg squat test and step-down test have better patient-reported outcomes than those that do not improve, following the implementation of a rehabilitation intervention and a standardized home-exercise program.

Subjects: Forty-six individuals (31 females; 15 males) with a mean age of 30 years (range = 14-61; SD = 12) were included in this retrospective study. These individuals were patients of an orthopaedic surgeon who were clinically diagnosed and conservatively treated for non-arthritic hip pain from chondrolabral lesions caused by FAI, dysplasia and/or structural abnormalities. Participants must have had evaluations for both the initial and follow-up test performance of the single leg squat test and step-down test, following the implementation of a rehabilitation intervention and a standardized home-exercise program.

Materials/Methods: The following information was retrospectively collected from an outcomes registry: age, gender, height, weight, body mass index (BMI), side of involved hip, duration of symptoms, intra-articular diagnosis, current pain level (VAS), hip outcome score for limitations in activities of daily living (HOS-ADL) and sports-related activities (HOS-SRA), percent global rating for activities of daily living (% - ADL) and sports-related activities (% - SRA), the categorical assessment of function, patient satisfaction, the individual’s decision to proceed with surgical intervention or not, and evaluations of test performance for the single leg squat test and step-down test from both the initial and follow-up clinical evaluations. The research data for the current study was de-identified so that subjects could not be identified, directly or through identifiers linked to the subjects. A one-tail, independent t-test and a one-way analysis of covariance (ANCOVA) with a pre-determined alpha set of 0.05 were performed for each continuous patient-reported outcome (VAS, HOS-ADL, HOS-SRA, % - ADL, % - SRA). A Fisher’s exact test with a pre-determined alpha set of 0.05 was performed for each categorical patient-reported outcome (categorical rating of function, patient satisfaction, and choice for surgical intervention or not).

Results: There was a statistically significant difference (p≤.022) between individuals that improved and those that did not improve their functional performance for the following measures: VAS for SLST and SDT, HOS-ADL for the SLST and SDT, HOS-SRA for the SLST and SDT, % - ADL for the SLST and SDT, and % - SRA for the SLST. There was not a statistically significant difference for the % - SRA for the SDT (p=.094). There was a statistically significant relationship (p≤.004) between those individuals that improved and those that did not improve their functional performance for both the SLST and SDT with patient satisfaction and surgery. There was not a statistically significant relationship between those individuals that improved and those that did not improve their functional performance for both the SLST and SDT with their categorical rating of function (p≥.117).

Conclusions: Individuals that improved their functional movement control during performance of the SLST and SDT reported less pain, higher scores for functional ability in their daily and sports-related activities, higher scores for their global rating of functional ability in their daily and sport-related activities, higher patient satisfaction with the prescribed rehabilitation intervention and standardized home-exercise program, and lower rates of surgical intervention, than those that did not improve.

Clinical Relevance: The results of this study suggest that individuals who improved their functional movement control are more likely to report less pain and greater functional ability in their daily and sports-related activities following a prescribed rehabilitation intervention and standardized home-exercise program. A significant number of individuals who improved their functional movement control reported greater satisfaction with the prescribed rehabilitation intervention as well as lower rates of surgical intervention, than those that did not improve. There is potential significance for the routine addition of the SLST and SDT into the clinical assessment of non-arthritic hip pain and dysfunction as measures of function. This study also supports the use of a rehabilitation intervention and a standardized home-exercise program to acutely improve outcomes for those with non-arthritic hip pain.

Language

English

Additional Citations

McGovern RP, Martin RL, Kivlan BR, Christoforetti JJ. Non-Operative Management of Individuals with Non-Arthritic Hip Pain: A Literature Review. Int J Sports Phys Ther. February 2019; 14(1): 135-147.


McGovern RP, Martin RL, Christoforetti JJ, Kivlan BR. Evidence-Based Procedures for Performing the Single Leg Squat and Step-Down Tests in Evaluation of Non-Arthritic Hip Pain: A Literature Review. Int J Sports Phys Ther. June 2018; 13(3): 526-536.


McGovern RP, Christoforetti JJ, Martin RL, Phelps A, Kivlan BR. Evidence for Inter-Rater Reliability and Validity of Functional Performance Testing in the Evaluation of Non-Arthritic Hip Pain. J Athl Train. JAT0033-18R (accepted; pending publication)

Available for download on Sunday, May 10, 2020

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