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Almousa S, Vicenzino B, Mellor R, Grimaldi A, Bennett K, Doyle F, McCarthy GM, McDonough SM, Ryan JM, Lynch K, Sorensen J, French HP. An EDucation and eXercise intervention for gluteal tendinopathy in an Irish setting: a protocol for a feasibility randomised clinical trial (LEAP-Ireland RCT). HRB Open Res 2024; 6:76. [PMID: 39045032 PMCID: PMC11263908 DOI: 10.12688/hrbopenres.13796.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2024] [Indexed: 07/25/2024] Open
Abstract
Background Gluteal tendinopathy (GT) is a degenerative tendon condition characterised by pain over the greater trochanter of the hip. A randomised controlled trial (RCT) in Australia found that 14 sessions of EDucation on load management plus eXercise (EDX) delivered over 8 weeks resulted in greater improvements in global rating of change and pain outcomes at 8 and 52 weeks, compared with corticosteroid injection or 'wait and see'. Typically, 5-6 physiotherapy sessions are provided in public and private physiotherapy settings in Ireland, therefore, the aim of this study is to examine the feasibility of conducting a future definitive RCT to investigate effectiveness of 6 sessions of the EDX programme compared to usual care. Methods We will randomly allocate 64 participants with GT to physiotherapist-administered EDX or usual care. The EDX intervention (EDX-Ireland) will be delivered in 6 sessions over 8 weeks.To determine feasibility of an RCT, we will assess recruitment and retention and outcome measure completion. The health status outcomes to be assessed at baseline, 8 weeks and 3 months include: Global Rating of Change, pain severity, the Victorian Institute of Sport Assessment-Gluteal Questionnaire (VISA-G), the Patient-Specific Functional Scale, the Pain Catastrophizing Scale, Patient Health Questionnaire (PHQ), Pain Self-Efficacy Questionnaire, the EQ-5D-5L, the Central Sensitisation Inventory and hip abductor muscle strength. We will explore acceptability of the EDX-Ireland intervention from the perspective of patients and treatment providers, and the perspective of referrers to the trial. A Study Within A Trial will be also applied to compare recording of exercise adherence using app-based technology to paper diaries. Discussion There is a need to establish effective treatments for GT that potentially can be implemented into existing health systems. The findings of this feasibility trial will inform development of a future definitive RCT. Registration The trial is registered prospectively on ClinicalTrials.gov ( NCT05516563, 27/10/2022).
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Affiliation(s)
- Sania Almousa
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Bill Vicenzino
- School of Health and Rehabilitation Sciences, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Rebecca Mellor
- School of Health and Rehabilitation Sciences, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Alison Grimaldi
- School of Health and Rehabilitation Sciences, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Kathleen Bennett
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Frank Doyle
- Department of Health Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Geraldine M. McCarthy
- Department of Rheumatology, Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - Jennifer M. Ryan
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Jan Sorensen
- Health Outcomes Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Helen P. French
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
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La Touche R, Paris-Alemany A, Pardo-Montero J, Miñambres-Martín D, Mercado-Romero F, de la Rosa-Díaz I, Sorrel MA, Grande-Alonso M. The biobehavioural pain and movement questionnaire (BioPMovQ): development and psychometric validation of a new questionnaire. Front Med (Lausanne) 2024; 11:1358829. [PMID: 38784228 PMCID: PMC11111915 DOI: 10.3389/fmed.2024.1358829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 04/08/2024] [Indexed: 05/25/2024] Open
Abstract
Objective The purpose of this research was to design and psychometrically validate a new instrument (the Biobehavioural Pain and Movement Questionnaire/BioPMovQ), which assesses the relationship between pain and various factors related to motor behaviour from a biobehavioural perspective. Methods A mixed-method design combining a qualitative study with an observational and cross-sectional study was employed to develop (content validity) and psychometrically validate (construct validity, reliability and concurrent/discriminant validity) a new instrument. A total of 200 patients with chronic musculoskeletal pain were recruited. Results According to the exploratory factor analysis, the final version of the BioPMovQ consists of 16 items distributed across 4 subscales (1, disability, 2, self-efficacy for physical activity; 3, movement avoidance behaviours; and 4, self-perceived functional ability), all with an eigen value greater than 1, explaining 55.79% of the variance. The BioPMovQ showed high internal consistency (Cronbach's α = 0.82; McDonald's ω = 0.83). The intraclass correlation coefficient was 0.86 (95% confidence interval 0.76 to 0.91), which was considered to demonstrate excellent test-retest reliability. The standard error of measurement and minimal detectable change were 3.43 and 8.04 points, respectively. No floor or ceiling effects were identified. There was a positive, significant and moderate magnitude correlation with the Graded Chronic Pain Scale (r = 0.54), kinesiophobia (r = 0.60), pain catastrophising (r = 0.44) and chronic pain self-efficacy (r = -0.31). Conclusion The BioPMovQ showed good psychometric properties. Based on the findings of this study, the BioPMovQ can be used in research and clinical practice to assess patients with chronic musculoskeletal pain.
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Affiliation(s)
- Roy La Touche
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios (CSEU) La Salle, Universidad Autónoma de Madrid, Madrid, Spain
- Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Madrid, Spain
- Instituto de Dolor Craneofacial y Neuromusculoesquelético (INDCRAN), Madrid, Spain
- PhD Program in Medicine and Surgery, Doctoral School, Universidad Autónoma de Madrid, Madrid, Spain
| | - Alba Paris-Alemany
- Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Madrid, Spain
- Instituto de Dolor Craneofacial y Neuromusculoesquelético (INDCRAN), Madrid, Spain
- Departamento de Radiología, Rehabilitación y Fisioterapia, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, Spain
| | - Joaquín Pardo-Montero
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios (CSEU) La Salle, Universidad Autónoma de Madrid, Madrid, Spain
- Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Madrid, Spain
- La Paz Hospital Institute for Health Research, IdiPAZ, Madrid, Spain
| | - Diego Miñambres-Martín
- Premium Madrid Global Health Care, Madrid, Spain
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain
| | - Francisco Mercado-Romero
- Cognitive Neuroscience, Pain, and Rehabilitation Research Group (NECODOR), Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
- Department of Psychology, Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
| | - Irene de la Rosa-Díaz
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios (CSEU) La Salle, Universidad Autónoma de Madrid, Madrid, Spain
- Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Madrid, Spain
| | - Miguel A. Sorrel
- Departamento de Psicología Social y Metodología, Universidad Autónoma de Madrid, Madrid, Spain
| | - Mónica Grande-Alonso
- Departamento de Cirugía, Ciencias Médicas y Sociales, Facultad de Medicina, Universidad de Alcalá, Alcalá de Henares, Spain
- Grupo de Investigación Clínico-Docente sobre Ciencias de la Rehabilitación (INDOCLIN), Centro Superior de Estudios Universitarios La Salle, Madrid, Spain
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Nasser A, Grimaldi A. Clinimetrics: The Victorian Institute of Sport Questionnaire - gluteal tendinopathy (VISA-G). J Physiother 2024; 70:153. [PMID: 38453585 DOI: 10.1016/j.jphys.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 02/14/2024] [Indexed: 03/09/2024] Open
Affiliation(s)
| | - Alison Grimaldi
- The University of Queensland, Brisbane, Australia; PhysioTec, Brisbane, Australia
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Fearon AM, Grimaldi A, Mellor R, Nasser AM, Fitzpatrick J, Ladurner A, Vicenzino B. ICON 2020-International Scientific Tendinopathy Symposium Consensus: the development of a core outcome set for gluteal tendinopathy. Br J Sports Med 2024; 58:245-254. [PMID: 38216320 DOI: 10.1136/bjsports-2023-107150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 01/14/2024]
Abstract
Gluteal tendinopathy (GT) is common and can be debilitating and challenging to manage. A lack of condition specific and appropriate outcome measures compromise evidence synthesis for treatment and limits clinical guideline development. Our objective was to develop a core outcome measurement set for GT (COS-GT). Participants were patients with GT and expert health professionals (HPs). A scoping review identified measures used in GT research, which were mapped to the nine International Scientific Tendinopathy Symposium Consensus core domains, and included in two surveys of HPs. The first survey identified the feasible and true measures for each domain. The second survey refined the list which a patient focus group then considered. Meeting online, HPs reached consensus (agreement ≥70%) on the most appropriate COS-GT measures. 34 HPs and seven patients were recruited. 57 measures were mapped to the nine core domains. Six measures did not proceed past survey one. Of those that progressed, none had adequate clinimetric properties for a COS-GT. Thus, participants decided on interim measures: the global rating of change, pain at night, time to pain onset with single limb stance, pain with stair walking, pain self-efficacy and hip abduction strength. HP participants additionally recommended that pain over the last week, the European Quality of Life-5 dimensions-5 levels and the Victorian Institute of Sport Assessment-Gluteal be considered in clinical trials, as they currently provide best easures of the relevant tendinopathy domains. In conclusion this interim COS-GT should guide outcome measure selection in clinical practice and future research trials in patients with GT.
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Affiliation(s)
- Angela M Fearon
- Faculty of Health, University of Canberra Research Institute for Sport and Exercise, Bruce, Australian Capital Territory, Australia
- Trauma and Orthopaedic Research Unit, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Alison Grimaldi
- University of Queensland Physiotherapy, St Lucia, Queensland, Australia
- PhysioTec Physiotherapy, Brisbane, Queensland, Australia
| | - Rebecca Mellor
- University of Queensland Physiotherapy, St Lucia, Queensland, Australia
- Gallipoli Medical Research Foundation, Greenslopes, Queensland, Australia
| | | | - Jane Fitzpatrick
- The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia
- Research Committee, Australasian College of Sport and Exercise Physicians, Melbourne, Victoria, Australia
| | - Andreas Ladurner
- Orthopaedics and Traumatology, Kantonsspital St Gallen, Sankt Gallen, Switzerland
| | - Bill Vicenzino
- Physiotherapy, The University of Queensland, Saint Lucia, Queensland, Australia
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Citaker S, Arikan H, Maras G, Ayas IH, Yazgan-Dagli B. Translation, reliability, and validity of the Turkish version of the Victorian Institute of Sports Assessment For Gluteal Tendinopathy (VISA-G) questionnaire in individuals with greater trochanteric pain syndrome. Physiother Theory Pract 2024; 40:617-624. [PMID: 36170045 DOI: 10.1080/09593985.2022.2127139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 09/13/2022] [Accepted: 09/13/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Greater trochanteric pain syndrome (GTPS) is a common cause of lateral hip pain. OBJECTIVE The objectives of this study were to translate the Victorian Institute of Sports Assessment for Gluteal Tendinopathy (VISA-G) questionnaire into the Turkish language and to examine its reliability and validity. METHODS 108 individuals (45 female, 63 male) participated in the translation and the reliability and validity analysis. The original VISA-G questionnaire was translated into Turkish language using Beaton guidelines. The Turkish version of the VISA-G, Harris Hip Score (HHS), Oswestry Disability Index (ODI), Oxford Hip Score (OHS), and International Physical Activity Questionnaire (IPAQ) were applied to 108 individuals with GTPS for convergent validity. The VISA-G was retested to investigate its reliability after one week. RESULTS The VISA-G had a good correlation with HHS (r = 0.694, p < .001), ODI (r = -0.659, p < .001), OHS (r = 0.678, p < .001), and IPAQ (r = 0.440, p < .001). The reliability and internal consistency were excellent (ICC (2,1) value = 0.943; Cronbach's α = 0.946, respectively). And no floor and ceiling effects were revealed related VISA-G. CONCLUSION The Turkish version of the VISA-G has good validity and excellent reliability. It can be used in clinical and research practices in the Turkish population with GTPS.
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Affiliation(s)
- Seyit Citaker
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Bişkek Street 06490, Cankaya, Turkey
| | - Halime Arikan
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Tokat Gaziosmanpasa University, Taşlıçiftlik Campus, 60250, Turkey
| | - Gokhan Maras
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Bişkek Street 06490, Cankaya, Turkey
| | - Inci-Hazal Ayas
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Bişkek Street 06490, Cankaya, Turkey
| | - Beyza Yazgan-Dagli
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Bişkek Street 06490, Cankaya, Turkey
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Kinsella R, Semciw AI, Hawke LJ, Stoney J, Choong PFM, Dowsey MM. Diagnostic Accuracy of Clinical Tests for Assessing Greater Trochanteric Pain Syndrome: A Systematic Review With Meta-analysis. J Orthop Sports Phys Ther 2024; 54:26-49. [PMID: 37561820 DOI: 10.2519/jospt.2023.11890] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
OBJECTIVE: We aimed to evaluate the accuracy of clinical tests that are used to diagnose greater trochanteric pain syndrome (GTPS) in clinical practice. DESIGN: Diagnostic test accuracy systematic review with meta-analysis. LITERATURE SEARCH: MEDLINE, Embase, CINAHL, AMED, and SPORTDiscus were searched using key words mapped to diagnostic test accuracy for GTPS. STUDY SELECTION CRITERIA: Studies with published or derivable diagnostic accuracy data were included. DATA SYNTHESIS: Risk of bias was assessed using the QUADAS-2 tool, and certainty of evidence, via the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework. MetaDTA "R" random-effects models were used to summarize individual and pooled data including sensitivity, specificity, likelihood ratios, and pretest/posttest probabilities. RESULTS: From a database yield of 858 studies, 23 full texts were assessed. We included 6 studies for review, involving 15 tests and 272 participants (314 hips). Overall certainty of evidence ranged from very low to moderate. Meta-analysis of 6 tests revealed sequenced test clusters able to significantly shift pretest-posttest probability for or against a GTPS diagnosis. In people reporting lateral hip pain, a negative gluteal tendon (GT) palpation test followed by a negative resisted hip abduction test significantly reduced the posttest probability of GTPS from 59% to 14%. In those with a positive GT palpation test followed by a positive resisted hip abduction test, the posttest probability of GTPS significantly shifted from 59% to 96%. CONCLUSION: The value of magnetic resonance imaging for diagnosing GTPS is debated. We have identified a straightforward, clinically useful diagnostic test cluster to help confirm or refute the presence of GTPS in people reporting lateral hip pain. J Orthop Sports Phys Ther 2024;54(1):1-24. Epub 10 August 2023. doi:10.2519/jospt.2023.11890.
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ROŠKAR S, ROJC M, PODOVŠOVNIK E, TREBŠE R. Psychometric Characteristics, Cross-Cultural Adaptation and Validation of the Slovenian Version of the Victorian Institute of Sports Assessments for Gluteal Tendinopathy Questionnaire (VISA-G). Zdr Varst 2023; 62:167-172. [PMID: 37799417 PMCID: PMC10549249 DOI: 10.2478/sjph-2023-0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 07/06/2023] [Indexed: 10/07/2023] Open
Abstract
Introduction Greater trochanteric pain syndrome (GTPS) denotes several disorders around the lateral aspect of the hip. GTPS may develop in native hips as well as after total hip arthroplasty (THA). It is estimated that 5-12% of patients suffer from GTPS after primary THA. Despite the prevalence of GTPS, it is hard to diagnose and manage it properly. The VISA-G questionnaire was developed as a patient-reported outcome measurement tool for evaluation of GTPS. The aims of the present study were to evaluate the reliability of the VISA-G Slovenian and its construct and criterion validity. Methods After the finalization of the VISA-G Slovenian translation procedure, 59 patients with a painful trochanteric region planned for THA filled in the VISA-G Slovenian at the hospital on two occasions 5-7 days apart. On the first occasion, each patient also filled in the EQ-5D-5L questionnaire and the Harris Hip Score (HHS) was completed by the physiotherapist. Results The VISA-G Slovenian was found to have a test-retest reliability of ICC 0.977; 95% CI [0.96; 0.986]. Internal consistency was assessed with Cronbach's alpha 0.79. The statistically significant, but low, correlation between the HHS and VISA-G (r=0.48) was obtained. Concurrent validity of the VISA-G with the EQ-5D-5L showed moderate to strong correlations in Mobility, Self-Care, Usual Activities, Pain, EQ-5D-5L Index and EQ VAS, but low correlation in the Anxiety subscale. No floor and ceiling effect were obtained. Conclusions The VISA-G Slovenian has excellent psychometric properties needed to measure gluteal tendinopathy-related disability of patients in Slovenia. Thus, we recommend using the questionnaire for measuring trochanteric hip pain.
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Affiliation(s)
- Samo ROŠKAR
- Valdoltra Orthopaedic Hospital, Jadranska cesta 31, 6280Ankaran, Slovenia
- University of Ljubljana, Faculty of Medicine, Zaloška 9, 1000Ljubljana, Slovenia
| | - Marina ROJC
- Valdoltra Orthopaedic Hospital, Jadranska cesta 31, 6280Ankaran, Slovenia
| | - Eva PODOVŠOVNIK
- Valdoltra Orthopaedic Hospital, Jadranska cesta 31, 6280Ankaran, Slovenia
| | - Rihard TREBŠE
- Valdoltra Orthopaedic Hospital, Jadranska cesta 31, 6280Ankaran, Slovenia
- University of Ljubljana, Faculty of Medicine, Zaloška 9, 1000Ljubljana, Slovenia
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Sveinall H, Wenstad PK, Fearon AM, Skyttemyr G, Thornes E, Skaara HE, Juel NG, Brox JI, Roe C, Johnsen MB. The reliability and validity of the Norwegian version of the Victorian Institute of Sports Assessment for gluteal tendinopathy questionnaire (VISA-G-Norwegian) for patients with greater trochanteric pain syndrome. BMC Musculoskelet Disord 2023; 24:769. [PMID: 37770944 PMCID: PMC10540384 DOI: 10.1186/s12891-023-06901-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 09/20/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Greater Trochanteric Pain Syndrome (GTPS) is a common chronic musculoskeletal condition that may affect physical function, quality of life and sleep. The Victorian Institute of Sport Assessment-Gluteal questionnaire (VISA-G) has been developed as a Patient-Reported Outcome Measurement (PROM) to address pain, everyday activities, physical activities, and difficulty with weight bearing activities. The aim of the study was to test the reliability, validity and floor and ceiling effects of the Norwegian version of the VISA-G (VISA-G-Norwegian) in a population with GTPS in a specialist health care setting. METHODS This psychometric evaluation of the VISA-G-Norwegian questionnaire were conducted with a prospective observational design. The VISA-G was translated into Norwegian following recommended guidelines. A subgroup repeated the VISA-G-Norwegian a week after the initial submission. For the reliability, the Intraclass Correlation Coefficient (ICC2.1), Standard Error of the Measurement (SEM) and the Smallest Detectable Change (SDC95%) were calculated. Internal consistency was measured using a Cronbach´s alpha. Floor and ceiling effects were evaluated, and construct validity was assessed with three a priori hypotheses. RESULTS 78 participants were included in the study of which 47 stable participants undertook the test-retest reliability arm of the study. The ICC2.1 for the total score was 0.85 (95% CI 0.68, 0.92), SEM was 6.6 points and SDC95% 18.4 points. Cronbach`s alpha was 0.77 (95% CI 0.69, 0.84). No floor or ceiling effects were found in the total score, but ceiling effect was found in three of the eight items. For construct validity, one of the three hypotheses were confirmed. VISA-G-Norwegian correlated to the modified Harris Hip Score (mHHS), Oswestry Disability Questionnaire (ODI) and Numeric Pain Rating Scale (NPRS), 0.64, -0.75 and - 0.63 respectively. CONCLUSION The VISA-G-Norwegian has acceptable reliability and validity, despite ceiling effect of individual items. The large SDC95% should be considered when measuring change in similar cohorts with GTPS. For a potential future version, it would be recommended to consider response options for questions with ceiling effect and the comprehensibility of question eight. TRIAL REGISTRATION Registered at ClinicalTrials.gov the 28/02/2020 (NCT04289922).
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Affiliation(s)
- Håkon Sveinall
- Department of Physical Medicine and rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Per Kristian Wenstad
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University, Pilestredet 44, Oslo, 0167, Norway
| | - Angela M Fearon
- University of Canberra Research Institute Sport and Exercise, Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
- Trauma and Orthopedic Research Unit, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | | | | | - Heléne Engberg Skaara
- Department of Physical Medicine and rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Niels Gunnar Juel
- Department of Physical Medicine and rehabilitation, Oslo University Hospital, Oslo, Norway
- Department of General Practice, University of Oslo, Oslo, Norway
| | - Jens Ivar Brox
- Department of Physical Medicine and rehabilitation, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - Cecilie Roe
- Department of Physical Medicine and rehabilitation, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - Marianne Bakke Johnsen
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University, Pilestredet 44, Oslo, 0167, Norway.
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Mediators and Moderators of Education Plus Exercise on Perceived Improvement in Individuals With Gluteal Tendinopathy: An Exploratory Analysis of a 3-Arm Randomized Trial. J Orthop Sports Phys Ther 2022; 52:826-836. [PMID: 36306175 DOI: 10.2519/jospt.2022.11261] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE: To investigate mediators and moderators of effects of an education-plus-exercise program compared to corticosteroid injections or wait and see on perceived improvement in individuals with gluteal tendinopathy. METHODS: Exploratory analysis from a clinical trial (n = 204) comparing education plus exercise, corticosteroid injection, and wait and see on global rating of change at 52 weeks. Potential mediators measured at baseline and 8 weeks were hip active abduction range, abductor muscle torque, pain self-efficacy, pain constancy, and patient-specific function. Potential moderators at baseline were Victorian Institute of Sport Assessment for gluteal tendinopathy, menopausal status, symptom duration, magnetic resonance imaging-determined tendon pathology, and pain catastrophizing. RESULTS: There is evidence from mediation analysis that the beneficial effect of education plus exercise on global rating of change relative to corticosteroid injection or wait and see may be due to changes in patient-specific function (indirect effect relative risk; 95% CI: 1.14 [1.05-1.29], 1.29 [1.12-1.58], respectively), pain constancy (1.12 [1.03-1.27], 1.2 [1.08-1.41]), and pain self-efficacy (1.1 [1.02-1.25], 1.18 [1.04-1.44])-not active hip movement/muscle torque. Moderation analysis did not support our included patient characteristics. CONCLUSION: Education plus exercise is likely to improve global rating of change for persons with gluteal tendinopathy relative to corticosteroid injection and wait and see through improvements in patient-specific function, pain self-efficacy, and reduced pain constancy. We found no evidence of differences in the effect of education plus exercise in patient subgroups based on disability, menopausal status, symptom duration, tendon pathology, or pain catastrophizing. J Orthop Sports Phys Ther 2022;52(12):826-836. Epub: 17 October 2022. doi:10.2519/jospt.2022.11261.
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Plinsinga ML, Boudreau SA, Coombes BK, Mellor R, Hayes S, Vicenzino B. Comparing what the clinician draws on a digital pain map to that of persons who have greater trochanteric pain syndrome. Scand J Pain 2022; 22:506-514. [PMID: 35119798 DOI: 10.1515/sjpain-2021-0135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 01/20/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To assess the agreements and differences in pain drawings (pain area, shape and location) between individuals who have greater trochanteric pain syndrome (GTPS) and their clinician. METHODS In this study, 23 patients with GTPS (21 female, pain duration range 8-24 months) underwent clinical evaluation by a registered physiotherapist. Digital 2d full body pain drawings were independently performed by the clinician during the subjective examination and by the patient following the physical examination. Levels of agreement [LoA] in the pain area were assessed with Bland-Altman plots. Differences in pain drawings were assessed visually by overlaying images, and by quantifying the differences in shape and location with the bounding box, and Jaccard index, respectively. RESULTS Pain areas (/total pixels of the charts) did not differ in size (LoA mean difference less than -0.5%; range -2.35-1.56%) or shape (bounding box p>0.17). However, there was minimal overlap in location (Jaccard index range 0.09-0.18/1 for perfect overlap). CONCLUSIONS Patients and the clinician displayed differences in location of pain areas, but not size or shape, when they independently performed digital pain drawings. The reasons that underlie and the clinical impact of these differences remains unclear.
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Affiliation(s)
- Melanie L Plinsinga
- University of Queensland School of Health and Rehabilitation Sciences: Physiotherapy, The University of Queensland, St Lucia, QLD4102, Australia
- Menzies Health Institute Queensland, Griffith University, Nathan, QLD4111, Australia
| | - Shellie A Boudreau
- Center for Neuroplasticity and Pain (CNAP), SMI®, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Brooke K Coombes
- School of Allied Health Sciences, Nathan Campus, Griffith University, Nathan, QLD4111, Australia
| | - Rebecca Mellor
- University of Queensland School of Health and Rehabilitation Sciences: Physiotherapy, The University of Queensland, St Lucia, QLD4102, Australia
- Gallipoli Medical Research Foundation, Greenslopes Private Hospital, Newdegate Street, Greenslopes, QLD4121, Australia
| | - Sandi Hayes
- Menzies Health Institute Queensland, Griffith University, Nathan, QLD4111, Australia
| | - Bill Vicenzino
- University of Queensland School of Health and Rehabilitation Sciences: Physiotherapy, The University of Queensland, St Lucia, QLD4102, Australia
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Wang Y, Wang K, Qin Y, Wang S, Tan B, Jia L, Jia G, Niu L. The effect of corticosteroid injection in the treatment of greater trochanter pain syndrome: a systematic review and meta-analysis of randomized controlled trials. J Orthop Surg Res 2022; 17:283. [PMID: 35598025 PMCID: PMC9123821 DOI: 10.1186/s13018-022-03175-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 05/09/2022] [Indexed: 11/21/2022] Open
Abstract
Background corticosteroid injection (CSI) has been used to treat greater trochanter pain syndrome (GTPS) for many years. However, so far, the efficacy of CSI in the treatment of GTPS is still controversial. Therefore, the aim of this review is to evaluate the effectiveness of CSI in comparison with sham intervention, nature history, usual care, platelet-rich plasma (PRP), physiotherapy/exercise therapy, dry needling, or other nonsurgical treatment for improvements in pain and function in GTPS. Methods PubMed (Medline), Embase, Cochrane Library were searched from their inception until April 2021. Randomized controlled trails (RCTs) comparing CSI to nonsurgical treatment were included. Data on the effect of CSI on pain and function were extracted and checked by two review authors independently. The treatment effect was analyzed in the short term, medium term, and long term. Results Eight RCTs (764 patients) were included. This review suggests CSI may be superior to usual care and ‘wait and see,’ ESWT, but may not be superior to exercise, PRP, dry needling, and sham intervention in short-term pain or function improvement. In terms of medium-term pain or function improvement, CSI may be superior to usual care and ‘wait and see,’ but may not be superior to PRP. In terms of long-term pain or function improvement, CSI may be inferior to PRP and ESWT, but it may be superior to usual care and ‘wait and see’ at 12 months. Conclusions Due to the small sample size and lack of sufficient clinical studies, current evidence is equivocal regarding the efficacy of CSI in the treatment of GTPS. Considering the limitations, more large-sample and high-quality RCTs are needed to prove the therapeutic effect of CSI on GTPS. Trial registration PROSPERO registration number: CRD42021247991. Registered 09 May 2021. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-022-03175-5.
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Affiliation(s)
- Yule Wang
- Department of Rehabilitation, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Kaijin Wang
- Department of Respiratory Medicine, Jiangjin District Central Hospital, Chongqing, 400010, China
| | - Yiling Qin
- Department of Pediatrics, Angel Maternity Hospital, Chongqing, 400010, China
| | - Sanrong Wang
- Department of Rehabilitation, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Botao Tan
- Department of Rehabilitation, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Lang Jia
- Department of Rehabilitation, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Gongwei Jia
- Department of Rehabilitation, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Lingchuan Niu
- Department of Rehabilitation, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China.
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12
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Høgsholt M, Jørgensen SL, Rolving N, Mechlenburg I, Tønning LU, Bohn MB. Exercise With Low-Loads and Concurrent Partial Blood Flow Restriction Combined With Patient Education in Females Suffering From Gluteal Tendinopathy: A Feasibility Study. Front Sports Act Living 2022; 4:881054. [PMID: 35498515 PMCID: PMC9047753 DOI: 10.3389/fspor.2022.881054] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 03/23/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction To date, there exists no gold standard conservative treatment for lateral hip pain due to tendinopathy of the gluteus medius and/or minimus tendon (GT), a condition often complicated by pain and disability. Higher loads during everyday activities and exercise seems to be contraindicated with GT. The purpose of this study was to evaluate the feasibility of exercise with low-loads concurrent partial blood flow restriction (LL-BFR) and patient education for patients present GT. Methods Recruitment took place at three hospitals in the Central Denmark Region. The intervention consisted of daily sessions for 8 weeks with one weekly supervised session. From week three patients exercised with applied partial blood flow restriction by means of a pneumatic cuff around the proximal thigh of the affected leg. Throughout the intervention patients received patient education on their hip condition. Sociodemographic and clinical variables were collected at baseline. The feasibility of LL-BFR was conducted by adherence to the exercise protocol and drop-out rate. Patient reported outcome measures (The Victorian Institute of Sport Assessment-Gluteal Questionnaire, EuroQol - 5 Dimensions-Visual Analogue Scale, Oxford Hip Score, Copenhagen Hip and Groin Outcome Score), maximal voluntary isometric hip abduction-, hip extension, and knee extension strength (Nm/kg) measured using a handheld dynamometer, and functional capacity tests (30 second chair-stand test and a stair-climb test) was conducted as secondary outcomes. Results Sixteen women with a median (IQR) age of 51 (46–60) years were included. Median (IQR) Body Mass Index was 26.69 (23.59–30.46) kg/m2. Adherence to the total number of training sessions and the LL-BFR was 96.4 and 94.4%, respectively. Two patients dropped out due to (i) illness before initiation of LL-BFR and (ii) pain in the affected leg related to the LL-BFR-exercise. At follow-up both pain levels and patient-reported outcome measures improved. Isometric hip abduction-, hip extension-, and knee extension strength on both legs and functional performance increased. Conclusion: LL-BFR-exercise seems feasible for treatment of GT. At follow-up, a high adherence and low drop-out rate were observed. Further, patients reported clinically relevant reductions in pain, and showed significant increases in isometric hip and knee strength.
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Affiliation(s)
- Mathias Høgsholt
- Department of Occupational and Physical Therapy, Horsens Regional Hospital, Horsens, Denmark
| | - Stian Langgård Jørgensen
- Department of Occupational and Physical Therapy, Horsens Regional Hospital, Horsens, Denmark
- H-HIP, Department of Orthopedic Surgery, Horsens Regional Hospital, Horsens, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Nanna Rolving
- Center of Rehabilitation Research, DEFACTUM, Central Denmark Region, Aarhus, Denmark
- Department of Physical and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Inger Mechlenburg
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Lisa Urup Tønning
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Marie Bagger Bohn
- H-HIP, Department of Orthopedic Surgery, Horsens Regional Hospital, Horsens, Denmark
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13
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Nasser AM, Fearon AM, Grimaldi A, Vicenzino B, Mellor R, Spencer T, Semciw AI. Outcome measures in the management of gluteal tendinopathy: a systematic review of their measurement properties. Br J Sports Med 2022; 56:877-887. [PMID: 35396205 DOI: 10.1136/bjsports-2021-104548] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Evaluate properties of outcome measures for gluteal tendinopathy. DESIGN Multistage scoping/systematic review. DATA SOURCES Cochrane, PubMed, Embase, Scopus, Web of Science, PEDro, CINAHL, SPORTDISCUS were searched (December 2021) to identify measures used to evaluate gluteal tendinopathy. Measures were mapped to the core health domains for tendinopathy. Medline, CINAHL, Embase and PubMed were searched (December 2021) for studies evaluating measurement properties of gluteal tendinopathy outcome measures captured in the initial search. Both reviews included studies that evaluated a treatment in participants with gluteal tendinopathy, diagnosed by a professional. Consensus-based-Standards for the Selection of Health Instruments methodology were followed-including bias assessment and synthesis of findings. RESULTS Six studies reported on the Victorian Institute of Sport Assessment-Gluteal Tendinopathy (VISA-G). One study reported on the Hip Outcome Score (HOS)-activities of daily living (ADL) and Sport.The VISA-G had moderate-quality evidence of sufficient construct validity (known group) and responsiveness (pre-post intervention), low-quality evidence of sufficient reliability, measurement error, comprehensibility and insufficient construct validity (convergent), and very low-quality evidence of sufficient comprehensiveness, relevance and responsiveness (comparison with other outcome measures).Both the HOS(ADL) and HOS(Sport) had very low-quality evidence of sufficient reliability, relevance and insufficient construct validity and comprehensiveness. The HOS(ADL) had very low-quality evidence of sufficient comprehensibility and insufficient measurement error. The HOS(Sport) had very low quality evidence of inconsistent comprehensibility and sufficient measurement error. CONCLUSION Rigorously validated outcome measures for gluteal tendinopathy are lacking. The VISA-G is the preferred available option to capture the disability associated with gluteal tendinopathy.
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Affiliation(s)
- Anthony M Nasser
- School of Allied Health, La Trobe University, Melbourne, Victoria, Australia .,Graduate School of Health, University of Technology, Sydney, New South Wales, Australia
| | - Angela M Fearon
- Discipline of Physiotherapy, Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia.,Trauma and Orthopaedic Research Unit, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Alison Grimaldi
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Bill Vicenzino
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Rebecca Mellor
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Trevor Spencer
- Discipline of Physiotherapy, Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia.,Trauma and Orthopaedic Research Unit, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Adam Ivan Semciw
- School of Allied Health, La Trobe University, Melbourne, Victoria, Australia.,Allied Health, Northern Health, Melbourne, Victoria, Australia
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14
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Cowan RM, Ganderton CL, Cook J, Semciw AI, Long DM, Pizzari T. Does Menopausal Hormone Therapy, Exercise, or Both Improve Pain and Function in Postmenopausal Women With Greater Trochanteric Pain Syndrome? A 2 × 2 Factorial Randomized Clinical Trial. Am J Sports Med 2022; 50:515-525. [PMID: 34898293 DOI: 10.1177/03635465211061142] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Greater trochanteric pain syndrome (GTPS) is a debilitating chronic condition, most prevalent in postmenopausal women. A positive association between high estrogen levels and tendon health may exist, and postmenopausal women have reduced estrogen. Menopausal hormone therapy (MHT) may reduce the incidence of tendon abnormality, particularly when combined with exercise. PURPOSE To determine the effect of MHT and exercise on tendon pain and function in postmenopausal women with GTPS. STUDY DESIGN Randomized controlled clinical trial; Level of evidence, 1. METHODS Postmenopausal women (N = 132; n = 12, lost to follow-up) with GTPS were randomized into MHT and placebo transdermal cream groups combined with tendon-specific or sham exercise. All groups received education about avoiding gluteal tendon compression and load management throughout 12 weeks of intervention. The primary outcome was the Victorian Institute of Sport Assessment for gluteal tendinopathy (VISA-G), and secondary outcomes were measured at baseline and at 12 and 52 weeks. The Global Rating of Change was assessed at 12 and 52 weeks. A linear mixed-effects model was used to assess differences. Body mass index (BMI) was included as a covariate. RESULTS All participant groups improved over time (baseline vs 12 weeks, P < .001; baseline vs 52 weeks, P < .001). There was no difference among exercise groups measured by all outcomes (VISA-G: baseline, P = .97, mean difference [MD] = 0.10; 12 weeks, P = .49, MD = 2.15; 52 weeks, P = .32, MD = -3.08). There was a significant interaction effect between cream and BMI; therefore, the population was stratified by BMI levels (<25, <30, ≥30). The MHT groups (with exercise and education) had significantly better VISA-G outcomes (baseline, P = .04, MD = -11.20, 95% CI = -21.70 to -0.70; 12 weeks, P < .001, MD = -20.72, 95% CI = -31.22 to -10.22; 52 weeks, P = .002, MD = -16.71, 95% CI = -27.21 to -6.22) and secondary measure scores as compared with placebo at all time points when BMI was <25. CONCLUSION MHT or placebo combined with tendon-specific or sham exercise plus education reduced pain and increased function for this population. For women with a BMI <25, MHT with any exercise plus education was better than placebo. A targeted exercise or sham exercise strategy is effective when prescribed with education about avoiding gluteal tendon compression and load management. REGISTRATION ACTRN12614001157662 (Australian New Zealand Clinical Trials Registry).
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Affiliation(s)
- Rachael Mary Cowan
- Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, La Trobe University, Melbourne, Victoria, Australia.,Olympic Park Sports Medicine Centre, Victoria, Australia
| | - Charlotte Louise Ganderton
- Department of Nursing and Allied Health, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, Australia
| | - Jillianne Cook
- Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, La Trobe University, Melbourne, Victoria, Australia
| | - Adam Ivan Semciw
- Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, La Trobe University, Melbourne, Victoria, Australia.,Allied Health Research, Northern Health, Epping, Australia
| | - David Michel Long
- Olympic Park Sports Medicine Centre, Victoria, Australia.,School of Medicine, Deakin University, Geelong, Australia
| | - Tania Pizzari
- Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, La Trobe University, Melbourne, Victoria, Australia
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15
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Wheeler PC, Dudson C, Calver R, Goodall D, Gregory KM, Singh H, Boyd KT. Three Sessions of Radial Extracorporeal Shockwave Therapy Gives No Additional Benefit Over "Minimal-Dose" Radial Extracorporeal Shockwave Therapy for Patients With Chronic Greater Trochanteric Pain Syndrome: A Double-Blinded, Randomized, Controlled Trial. Clin J Sport Med 2022; 32:e7-e18. [PMID: 33512943 DOI: 10.1097/jsm.0000000000000880] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 07/03/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the outcomes following 3 weekly sessions of radial extracorporeal shockwave therapy (rESWT) in patients with chronic greater trochanteric pain syndrome (GTPS) presenting to an NHS Sports Medicine Clinic in the United Kingdom. DESIGN Double-blinded randomized controlled trial. SETTING A single NHS Sports Medicine Clinic, in the United Kingdom. PATIENTS One hundred twenty patients in an NHS Sports Medicine clinic presenting with symptoms of GTPS who had failed to improve with a minimum of 3 months of rehabilitation were enrolled in the study and randomized equally to the intervention and treatment groups. Mean age was 60.6 ± 11.5 years; 82% were female, and the mean duration of symptoms was 45.4 ± 33.4 months (range, 6 months to 30 years). INTERVENTIONS Participants were randomized to receive either 3 sessions of ESWT at either the "recommended"/"maximally comfortably tolerated" dose or at "minimal dose." All patients received a structured home exercise program involving flexibility, strength, and balance exercises. MAIN OUTCOME MEASURES Follow-up was at 6 weeks, 3 months, and 6 months. Outcome measures included local hip pain, validated hip PROMs (Oxford hip score, non-arthritic hip score, Victorian Institute of Sport assessment questionnaire), and wider measures of function including sleep (Pittsburgh sleep quality index) and mood (hospital anxiety and depression scale). RESULTS Results were available for 98% of patients at the 6-month period. There were statistically significant within-group improvements in pain, local function, and sleep seen in both groups. However, fewer benefits were seen in other outcome measures, including activity or mood. CONCLUSION There were no time × group interaction effects seen between the groups at any time point, indicating that in the 3 sessions, the "recommended-dose" rESWT had no measurable benefit compared with "minimal dose" rESWT in this group of patients with GTPS. The underlying reason remains unclear; it may be that rESWT is ineffective in the treatment of patients with chronic GTPS, that "minimal dose" rESWT is sufficient for a therapeutic effect, or that a greater number of treatment sessions are required for maximal benefit. These issues need to be considered in further research.
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Affiliation(s)
- Patrick C Wheeler
- Department of Sport and Exercise Medicine, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
- National Centre of Sport and Exercise Medicine, Loughborough, United Kingdom ; and
| | - Chloe Dudson
- Department of Sport and Exercise Medicine, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Rachel Calver
- Department of Sport and Exercise Medicine, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Duncan Goodall
- Department of Sport and Exercise Medicine, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
- DMRC Stanford Hall, Leicestershire, United Kingdom
| | - Kim M Gregory
- Department of Sport and Exercise Medicine, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
- National Centre of Sport and Exercise Medicine, Loughborough, United Kingdom ; and
| | - Harjinder Singh
- Department of Sport and Exercise Medicine, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
- National Centre of Sport and Exercise Medicine, Loughborough, United Kingdom ; and
| | - Kevin T Boyd
- Department of Sport and Exercise Medicine, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
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16
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Bicket L, Cooke J, Knott I, Fearon A. The natural history of greater trochanteric pain syndrome: an 11-year follow-up study. BMC Musculoskelet Disord 2021; 22:1048. [PMID: 34930192 PMCID: PMC8691027 DOI: 10.1186/s12891-021-04935-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 12/03/2021] [Indexed: 12/04/2022] Open
Abstract
Background Greater trochanteric pain syndrome (GTPS) is a musculoskeletal condition which can cause disability and reduce quality of life. However, limited evidence is available on the long-term outcomes of people with GTPS. Our aims were to determine the long-term prevalence of GTPS; to calculate the proportion of people with GTPS who had developed hip osteoarthritis (OA); and to determine the level of function and quality of life, 11-years after initial GTPS diagnosis. Methods A prospective 11-year natural history study. Two groups [GTPS group (n = 24), asymptomatic control (ASC) group (n = 20)] were evaluated at baseline, 12-months and 11-years. At 11-years all participants completed the modified Harris Hip Score (mHHS), Oswestry Disability Index (ODI) and Assessment of Quality-of-Life questionnaire. At 11-year follow-up 20/24 GTPS and 19/20 ASC participants were clinically assessed for GTPS and hip OA, completed the 10 metre-walk-test, timed up and go, and hip abduction and external rotation strength testing. Results At 11-year follow-up 45.0% of GTPS participants had GTPS compared to 5.3% of ASC participants (p = 0.008), OR [95% CI]: 10.19 [1.95, 104.3], and 35.0% of GTPS participants were clinically diagnosed with hip OA compared to none of the ASC participants (p = 0.002), OR [95% CI]: 21.6, [2.3, 2898.0]. GTPS participants reported more pain and disability than ASC participants via the ODI, mean difference [95% CI]: 6.1 [0.7, 11.6] but not the modified Harris Hip Score, mean difference [95% CI]: -3.3 [-10.3, 3.7]. Both groups had similar levels of quality of life and measures of function. Conclusions GTPS is a chronic condition: people with GTPS at baseline had twice the odds of being clinically diagnosed with GTPS or hip OA than the control group at 11-years. Further, there appears to be a temporal relationship between GTPS and the development of hip OA. This finding highlights the need to identify effective treatments that address the underlying impairments associated with GTPS. Pain and function results varied depending on the assessment tools used. Between group differences in quality of life seen at baseline are not found at the 11-year follow-up. The small sample size means the results must be considered with caution. Level of Evidence Level II Natural history Study. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04935-w.
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Affiliation(s)
- Luke Bicket
- Faculty of Health, University of Canberra, 11 Kirinari St, Bruce, ACT, 2617, Australia
| | - Julie Cooke
- Faculty of Health, University of Canberra, 11 Kirinari St, Bruce, ACT, 2617, Australia.,Research Institute for Sport and Exercise, University of Canberra, 11 Kirinari St, Bruce, ACT, 2617, Australia
| | - Isaac Knott
- Canberra Health Services, 20 Guraguma St, Bruce, 2617, Australia
| | - Angie Fearon
- Faculty of Health, University of Canberra, 11 Kirinari St, Bruce, ACT, 2617, Australia. .,Research Institute for Sport and Exercise, University of Canberra, 11 Kirinari St, Bruce, ACT, 2617, Australia. .,Trauma and Orthopaedic Research Centre at the Canberra Hospital, Garren, ACT, 2606, Australia.
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17
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Migliorini F, Kader N, Eschweiler J, Tingart M, Maffulli N. Platelet-rich plasma versus steroids injections for greater trochanter pain syndrome: a systematic review and meta-analysis. Br Med Bull 2021; 139:86-99. [PMID: 34405857 DOI: 10.1093/bmb/ldab018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 07/17/2021] [Accepted: 07/20/2021] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Greater trochanter pain syndrome (GTPS) is characterized by a persistent and debilitating pain around the greater trochanter. GTPS can be caused by a combination of gluteus medius or minimus tendinopathy, snapping hip or trochanteric bursitis. SOURCE OF DATA Recent published literatures identified from PubMed, EMBASE, Google Scholar, Scopus. AREAS OF AGREEMENT Platelet rich plasma (PRP) and corticosteroids (CCS) injections are useful options to manage symptoms of GTPS. AREAS OF CONTROVERSY Whether PRP leads to superior outcomes compared to CCS injections is unclear. GROWING POINTS A systematic review and meta-analysis comparing PRP versus CCS in the management of GTPS was conducted. AREAS TIMELY FOR DEVELOPING RESEARCH PRP injections are more effective than CCS at approximately 2 years follow-up.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopedic, Trauma, and Reconstructive Surgery, RWTH University Hospital of Aachen, 52074 Aachen, Germany
| | - Nardeen Kader
- Department of Orthopedics, South West London Elective Orthopaedic Centre (SWLEOC), Dorking Rd, Epsom KT18 7EG, UK
| | - Jörg Eschweiler
- Department of Orthopedic, Trauma, and Reconstructive Surgery, RWTH University Hospital of Aachen, 52074 Aachen, Germany
| | - Markus Tingart
- Department of Orthopedic, Trauma, and Reconstructive Surgery, RWTH University Hospital of Aachen, 52074 Aachen, Germany
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi (SA), Italy.,School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Thornburrow Drive, 01782 Stoke on Trent, UK.,Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London E1 4DG, UK
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18
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Korakakis V, Whiteley R, Kotsifaki A, Stefanakis M, Sotiralis Y, Thorborg K. A systematic review evaluating the clinimetric properties of the Victorian Institute of Sport Assessment (VISA) questionnaires for lower limb tendinopathy shows moderate to high-quality evidence for sufficient reliability, validity and responsiveness-part II. Knee Surg Sports Traumatol Arthrosc 2021; 29:2765-2788. [PMID: 33860806 PMCID: PMC8384816 DOI: 10.1007/s00167-021-06557-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/26/2021] [Indexed: 12/28/2022]
Abstract
PURPOSE The evaluation of measurement properties such as reliability, measurement error, construct validity, and responsiveness provides information on the quality of the scale as a whole, rather than on an item level. We aimed to synthesize the measurement properties referring to reliability, measurement error, construct validity, and responsiveness of the Victorian Institute of Sport Assessment questionnaires (Achilles tendon-VISA-A, greater trochanteric pain syndrome-VISA-G, proximal hamstring tendinopathy-VISA-H, patellar tendon-VISA-P). METHODS A systematic review was conducted according to Consensus-based Standards for the Selection of Health Measurement Instruments methodology (COSMIN). PubMed, Cochrane, CINAHL, EMBASE, Web of Science, SportsDiscus, grey literature, and reference lists were searched. Studies assessing the measurement properties concerning reliability, validity, and responsiveness of the VISA questionnaires in patients with lower limb tendinopathies were included. Two reviewers assessed the methodological quality of studies assessing reliability, validity, and responsiveness using the COSMIN guidelines and the evidence for these measurement properties. A modified Grading of Recommendations Assessment Development and Evaluation (GRADE) approach was applied to the evidence synthesis. RESULTS There is moderate-quality evidence for sufficient VISA-A, VISA-G, and VISA-P reliability. There is moderate-quality evidence for sufficient VISA-G and VISA-P measurement error, and high-quality evidence for sufficient construct validity for all the VISA questionnaires. Furthermore, high-quality evidence exists with regard to VISA-A for sufficient responsiveness in patients with insertional Achilles tendinopathy following conservative interventions. CONCLUSIONS Sufficient reliability, measurement error, construct validity and responsiveness were found for the VISA questionnaires with variable quality of evidence except for VISA-A which displayed insufficient measurement error. LEVEL OF EVIDENCE IV. REGISTRATION DETAILS Prospero (CRD42018107671); PROSPERO reference-CRD42019126595.
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Affiliation(s)
- Vasileios Korakakis
- Aspetar Orthopaedic and Sports Medicine Hospital, 29222, Doha, Qatar.
- Hellenic Orthopaedic Manipulative Therapy Diploma (HOMTD), Athens, Greece.
| | - Rod Whiteley
- Aspetar Orthopaedic and Sports Medicine Hospital, 29222, Doha, Qatar
| | - Argyro Kotsifaki
- Aspetar Orthopaedic and Sports Medicine Hospital, 29222, Doha, Qatar
| | - Manos Stefanakis
- School of Science, Program of Physiotherapy, University of Nicosia, Nicosia, Cyprus
| | - Yiannis Sotiralis
- Hellenic Orthopaedic Manipulative Therapy Diploma (HOMTD), Athens, Greece
| | - Kristian Thorborg
- Department of Orthopaedic Surgery, Sports Orthopedic Research Center-Copenhagen (SORC-C), Amager-Hvidovre Hospital, Faculty of Health Sciences, Copenhagen University, Copenhagen, Denmark
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19
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Korakakis V, Kotsifaki A, Stefanakis M, Sotiralis Y, Whiteley R, Thorborg K. Evaluating lower limb tendinopathy with Victorian Institute of Sport Assessment (VISA) questionnaires: a systematic review shows very-low-quality evidence for their content and structural validity-part I. Knee Surg Sports Traumatol Arthrosc 2021; 29:2749-2764. [PMID: 34019117 PMCID: PMC8384789 DOI: 10.1007/s00167-021-06598-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 04/26/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE The Victorian Institute of Sport Assessment (Achilles tendon-VISA-A, greater trochanteric pain syndrome-VISA-G, proximal hamstring tendinopathy-VISA-H, patellar tendon-VISA-P) questionnaires are widely used in research and clinical practice; however, no systematic reviews have formally evaluated their content, structural, and cross-cultural validity evidence. The measurement properties referring to content, structural and cross-cultural validity of the VISA questionnaires were appraised and synthesized. METHODS The systematic review was conducted according to Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) methodology. PubMed, Cochrane, CINAHL, EMBASE, Web of Science, SportsDiscus, grey literature, and reference lists were searched. Development studies and cross-cultural adaptations (12 languages) assessing content or structural validity of the VISA questionnaires were included and two reviewers assessed their methodological quality. Evidence for content (relevance, comprehensiveness, and comprehensibility), structural, and cross-cultural validity was synthesized. A modified Grading of Recommendations Assessment Development and Evaluation (GRADE) approach was applied to evidence synthesis. RESULTS The VISA-A presented very-low-quality evidence of sufficient relevance, insufficient comprehensiveness, and inconsistent comprehensibility. VISA-G displayed moderate-quality evidence for sufficient comprehensibility and very-low-quality evidence of sufficient relevance and comprehensiveness. The VISA-P presented very-low-quality evidence of sufficient relevance, insufficient comprehensiveness, and inconsistent comprehensibility, while VISA-H presented very-low evidence of insufficient content validity. VISA-A displayed low-quality evidence for structural validity concerning unidimensionality and internal structure, while VISA-H presented low-quality evidence of insufficient unidimensionality. The structural validity of VISA-G and VISA-P were indeterminate and inconsistent, respectively. Internal consistency for VISA-G, VISA-H, and VISA-P was indeterminate. No studies evaluated cross-cultural validity, while measurement invariance across sexes was assessed in one study. CONCLUSIONS Only very-low-quality evidence exists for the content and structural validity of VISA questionnaires when assessing the severity of symptoms and disability in patients with lower limb tendinopathies. LEVEL OF EVIDENCE IV. REGISTRATION PROSPERO reference-CRD42019126595.
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Affiliation(s)
- Vasileios Korakakis
- Aspetar, Orthopaedic and Sports Medicine Hospital, PO 29222, Doha, Qatar.
- Hellenic Orthopaedic Manipulative Therapy Diploma (HOMTD), Athens, Greece.
| | - Argyro Kotsifaki
- Aspetar, Orthopaedic and Sports Medicine Hospital, PO 29222, Doha, Qatar
| | - Manos Stefanakis
- School of Science, Program of Physiotherapy, University of Nicosia, Nicosia, Cyprus
| | - Yiannis Sotiralis
- Hellenic Orthopaedic Manipulative Therapy Diploma (HOMTD), Athens, Greece
| | - Rod Whiteley
- Aspetar, Orthopaedic and Sports Medicine Hospital, PO 29222, Doha, Qatar
| | - Kristian Thorborg
- Department of Orthopaedic Surgery, Sports Orthopedic Research Center-Copenhagen (SORC-C), Amager-Hvidovre Hospital, Faculty of Health Sciences, Copenhagen University, Copenhagen, Denmark
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Escriche-Escuder A, Cuesta-Vargas AI, Casaña J. Effect of a common exercise programme with an individualised progression criterion based on the measurement of neuromuscular capacity versus current best practice for lower limb tendinopathies (MaLaGa trial): a protocol for a randomised clinical trial. BMJ Open 2021; 11:e046729. [PMID: 34404699 PMCID: PMC8372811 DOI: 10.1136/bmjopen-2020-046729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION High-load resistance training has shown positive effects in pain and function in lower limb tendinopathies. However, some authors suggest that current exercise programmes produce an increase in tolerance to load and exercise in general but without fixing some existing issues in tendinopathy. This may indicate the need to include training aspects not currently taken into account in the current programmes. The main objective of this study will be to compare the effect of a common exercise protocol for the three predominant lower limb tendinopathies (Achilles, patellar and gluteal), based on an individualised control of the dose and training of specific aspects of the neuromuscular system versus the current best practice for each location. METHODS AND ANALYSIS This study will be conducted among people with mid-portion Achilles, patellar or gluteal tendinopathy. The participants allocated to the experimental group will perform a 14-week innovative common therapeutic exercise programme. Participants allocated to the control group will carry out a 14-week exercise programme based on the best current practice for each of the studied locations. The Victorian Institute of Sports Assessment questionnaire will be considered the primary outcome. Pain, central sensitisation, fear avoidance behaviour, quality of life, treatment satisfaction, lower-limb strength and function, and high-density electromyography profile will be evaluated as secondary outcomes. Outcomes will be assessed at baseline, 7 weeks, after the intervention (week 14), 26 weeks and 52 weeks. ETHICS AND DISSEMINATION The study has been approved by the Portal de Ética de la Investigación Biomédica de Andalucía Ethics Committee (1221-N-19). All participants will be informed about the purpose and content of the study and written informed consent will be completed. The results of this study will be published in a peer-reviewed journal and will be disseminated electronically and in print. TRIAL REGISTRATION NUMBER NCT03853122; Pre-results.
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Affiliation(s)
- Adrian Escriche-Escuder
- Department of Physiotherapy, University of Malaga, Malaga, Spain
- Grupo Clinimetría (F-14), Instituto de Investigación Biomédica de Málaga (IBIMA), Malaga, Spain
| | - Antonio I Cuesta-Vargas
- Department of Physiotherapy, University of Malaga, Malaga, Spain
- Grupo Clinimetría (F-14), Instituto de Investigación Biomédica de Málaga (IBIMA), Malaga, Spain
- Health, Queensland University Technology, Brisbane, Queensland, Australia
| | - Jose Casaña
- Department of Physiotherapy, University of Valencia, Valencia, Spain
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Kay J, Memon M, Lindner D, Randelli F, Ayeni OR. Arthroscopic management of greater trochanter pain syndrome and abductor tears has demonstrated promising results in terms of improvement in pain scores and functional outcomes: a scoping review. Knee Surg Sports Traumatol Arthrosc 2021; 29:2401-2407. [PMID: 33044606 DOI: 10.1007/s00167-020-06322-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 10/02/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Greater trochanteric pain syndrome (GTPS) refers to the constellation of signs and symptoms related to pain in the trochanteric region and has recently replaced the previously ubiquitous term of 'greater trochanteric bursitis'. GTPS is common, particularly in women 50-79 years of age, and the understanding and management of GTPS have expanded considerably in recent years to include management with arthroscopic and endoscopic techniques in recalcitrant cases. The purpose of this scoping literature review was to summarize the current evidence on arthroscopic management of GTPS including sources of evidence, key concepts, and gaps in the literature. METHODS A thorough electronic database search included studies published from 2009 to June 14, 2020. A total of 52 peer-reviewed articles were identified within the literature on arthroscopic or endoscopic management of GTPS. RESULTS Of the 52 identified papers, 12 were technique descriptions, 10 papers were review articles, and 30 papers were original clinical papers. Of the 30 clinical papers, 24 (80%) were of level IV evidence, 5 (17%) were of level III evidence, and 1 (3%) was level II evidence. Among the 30 clinical studies, 988 patients were included with 761 (77%) female. Indications for surgical management included a failed trial of conservative management in all 30 studies, typically after a period of 3-6 months. Surgical management consisted of arthroscopic/endoscopic abductor tendon repair in 16 (53%) studies, arthroscopic/endoscopic bursectomy and iliotibial band release in 12 (40%) studies, and arthroscopic/endoscopic gluteal tendon contracture release in 2 (7%) studies. CONCLUSION Overall, results following arthroscopic management of GTPS and abductor tears have been promising, including significantly improved pain scores and functional outcomes at final post-operative assessment. These studies support continued use and investigation of arthroscopic management strategies of GTPS and pave the way to conduct larger prospective studies to confirm these results in the future. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Jeffrey Kay
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 1200 Main St. W. HSC 4E15, Hamilton, ON, L8N 3Z5, Canada
| | - Muzammil Memon
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 1200 Main St. W. HSC 4E15, Hamilton, ON, L8N 3Z5, Canada
| | - Dror Lindner
- Department of Orthopaedic Surgery, Yitzhak Shamir Medical Center, Zriffin, Israel
- Tel Aviv University, Tel Aviv, Israel
| | - Filippo Randelli
- Hip Department (CAD), Gaetano Pini, CTO Orthopedic Institute, University of Milan, Milan, Italy
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 1200 Main St. W. HSC 4E15, Hamilton, ON, L8N 3Z5, Canada.
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Plinsinga ML, Coombes BK, Mellor R, Vicenzino B. Individuals with Persistent Greater Trochanteric Pain Syndrome Exhibit Impaired Pain Modulation, as well as Poorer Physical and Psychological Health, Compared with Pain-Free Individuals: A Cross-Sectional Study. PAIN MEDICINE 2021; 21:2964-2974. [PMID: 32232468 DOI: 10.1093/pm/pnaa047] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To compare physical, sensory, and psychosocial factors between individuals with greater trochanteric pain syndrome and controls and to explore factors associated with pain and disability. DESIGN Cross-sectional study. SETTING General community. SUBJECTS Patients with persistent, clinically diagnosed greater trochanteric pain syndrome and healthy controls. METHODS Participants completed tests of thermal and pressure pain threshold, conditioned pain modulation, temporal summation, muscle strength, physical function, physical activity, psychological factors, and health-related quality of life. Standardized mean differences between groups were calculated, and multiple linear regression identified factors associated with pain and disability. RESULTS Forty patients (95% female, average [SD] age = 51 [9] years) and 58 controls (95% female, average [SD] age = 53 [11] years) were included. Heat pain threshold, temporal summation, and pain catastrophizing were not different between groups. Compared with controls, patients displayed significantly poorer quality of life (standardized mean difference = -2.66), lower pressure pain threshold locally (-1.47, remotely = -0.57), poorer health status (-1.22), impaired physical function (range = 0.64-1.20), less conditioned pain modulation (-1.01), weaker hip abductor/extensor strength (-1.01 and -0.59), higher depression (0.72) and anxiety (0.61) levels, lower cold pain threshold locally (-0.47, remotely = -0.39), and less time spent in (vigorous) physical activity (range = -0.43 to -0.39). Twenty-six percent of pain and disability was explained by depression, hip abductor strength, and time to complete stairs. CONCLUSIONS Patients with greater trochanteric pain syndrome exhibited poorer health-related quality of life, physical impairments, widespread hyperalgesia, and greater psychological distress than healthy controls. Physical and psychological factors were associated with pain and disability.
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Affiliation(s)
- Melanie Louise Plinsinga
- Department of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Brooke Kaye Coombes
- Department of Physiotherapy, School of Allied Health Sciences, Griffith University, Brisbane, QLD, Australia
| | - Rebecca Mellor
- Department of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Bill Vicenzino
- Department of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
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Translation, cross-cultural adaptation and validation of the Brazilian Portuguese version of the Victorian Institute of Sports Assessment for Gluteal Tendinopathy patient reported-outcome measure (VISA-G.BR). Musculoskelet Sci Pract 2021; 52:102341. [PMID: 33581429 DOI: 10.1016/j.msksp.2021.102341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 01/28/2021] [Accepted: 02/02/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Different outcome measures can be used to assess pain and disability in individuals with Greater Trochanteric Pain Syndrome (GTPS), including the Victorian Institute of Sports Assessment for Gluteal Tendinopathy (VISA-G), Oswestry Disability Index (ODI), Patient Specific Functional Scale (PSFS) and Global Perceived Effect (GPE). OBJECTIVE To translate, cross-culturally adapt and validate VISA-G to Brazilian Portuguese and to evaluate the measurement properties of the VISA-G.BR, ODI, GPE, and PSFS in individuals with GTPS. DESIGN This is a longitudinal clinimetric study. METHODS Sixty-eight individuals with GTPS participated in this study. The questionnaires VISA-G.BR, ODI, PSFS, and GPE were administered to participants at the initial assessment, 24-48 h and 30 days after the initial assessment. Internal consistency and construct validity for the VISA-G.BR were assessed. Reliability, agreement, ceiling and floor effect, and responsiveness were described for all instruments. RESULTS The Cronbach Alpha for internal consistency value for VISA-G.BR was 0.65. The construct validity analysis showed a strong correlation value between ODI and VISA-G.BR (r = -0.77). The agreement analysis performed for all questionnaires showed standard error of measurement values ranging from 0.64 (PSFS) to 4.2 (VISA-G.BR). GPE scale had a floor effect. The responsiveness analysis performed for all questionnaires showed low values of effect size ranging from -0.07 to 0.3. CONCLUSION The VISA-G.BR is a valid and reliable instrument to assess the disability of individuals with GTPS. The ODI and PSFS instruments can also be used in the evaluation of this population.
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Korakakis V, Whiteley R, Kotsifaki A, Thorborg K. Tendinopathy VISAs have expired-is it time for outcome renewals? Knee Surg Sports Traumatol Arthrosc 2021; 29:2745-2748. [PMID: 33970294 PMCID: PMC8384781 DOI: 10.1007/s00167-021-06596-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 04/26/2021] [Indexed: 11/21/2022]
Affiliation(s)
| | - Rod Whiteley
- grid.415515.10000 0004 0368 4372Aspetar Orthopaedic and Sports Medicine Hospital, PO 29222, Doha, Qatar
| | - Argyro Kotsifaki
- grid.415515.10000 0004 0368 4372Aspetar Orthopaedic and Sports Medicine Hospital, PO 29222, Doha, Qatar
| | - Kristian Thorborg
- grid.5254.60000 0001 0674 042XDepartment of Orthopaedic Surgery, Sports Orthopedic Research Center – Copenhagen (SORC-C), Amager-Hvidovre Hospital, Faculty of Health Sciences, Copenhagen University, Copenhagen, Denmark
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Evidenced-Based Management of Greater Trochanteric Pain Syndrome. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2020. [DOI: 10.1007/s40141-020-00294-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Girgis B, Duarte JA. Physical therapy for tendinopathy: An umbrella review of systematic reviews and meta-analyses. Phys Ther Sport 2020; 46:30-46. [PMID: 32877858 DOI: 10.1016/j.ptsp.2020.08.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/01/2020] [Accepted: 08/04/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To summarize evidence in the last decade regarding the efficacy of physical therapy interventions to treat tendinopathy, as a single disease entity, as determined in systematic reviews (SRs) and/or meta-analyses (MAs). METHODS Electronic search of PubMed, PEDro, and Scopus database was performed from year 2010 to January 2020. The methodological quality of the identified studies was assessed using the AMSTAR 2 tool. Studies scoring 9 points or higher were further analyzed using GRADE principles. RESULTS 40 SRs and/or MAs were included in qualitative synthesis, whereas only 5 MAs were included in quantitative synthesis. Low-level laser therapy (LLLT) intervention showed a pooled improvement in pain reduction of 1.53 cm; 95% CI, [1.14, 1.91] (I2 = 1.9%, p = 0.361) on visual analogue scale, and grip strength of 9.59 kg; 95% CI, [5.90, 13.27]. CONCLUSIONS Moderate-quality evidence may support these following interventions: LLLT revealed a statistically and potentially clinically significant improvement in pain and function on the short-term. Extracorporeal shockwave therapy showed a statistically significant enhancement in pain and function at all follow-up durations; however, its clinical significance was undetermined. Eccentric exercise was supported by qualitative evidence only. Caution is advised when interpreting results due to possible pathological differences in tendinopathy at each region.
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Affiliation(s)
- Beshoy Girgis
- CIAFEL, Faculty of Sport, University of Porto, R. Dr. Plácido Costa, 91, 4200-450, Porto, Portugal.
| | - José Alberto Duarte
- CIAFEL, Faculty of Sport, University of Porto, R. Dr. Plácido Costa, 91, 4200-450, Porto, Portugal.
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Minetto MA, Busso C, Giannini A, Meiburger K, Massazza G, Maffulli N. Cross-cultural adaptation and validation of the Victorian Institute of Sports Assessment for gluteal tendinopathy questionnaire in Italian and investigation of the association between tendinopathy-related disability and pain. Eur J Phys Rehabil Med 2020; 56:764-770. [PMID: 32638573 DOI: 10.23736/s1973-9087.20.06209-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The Victorian Institute of Sports Assessment for gluteal tendinopathy (VISA-G) questionnaire has recently been proposed as a condition-specific patient reported outcome measurement tool to assess the tendinopathy-related disability. AIM The aim was to evaluate the reliability of the Italian version of the VISA-G questionnaire and its construct validity and to investigate the association between tendinopathy-related disability and pain. DESIGN It consists in a cross-sectional study. SETTING The location of the study was a university laboratory. POPULATION We evaluated patients with gluteal tendinopathy (N.=38) and healthy controls (N.=38). METHODS Subjects were asked to fill the VISA-G questionnaire twice to evaluate its reliability. The construct validity was evaluated by comparing the VISA score with the Oswestry Disability Index score. Moreover, pain intensity, extent and location were also investigated. RESULTS The VISA-G scores showed non-significant changes in the median values and the values of intraclass correlation coefficient showed very high correlation between the first and second administration (ICC>0.90 in both populations). No significant correlations were found between VISA-G score and either pain extent (R=-0.05, P=0.76), or resting pain intensity (R=-0.13, P=0.45), or palpation pain intensity (R= 0.01, P=0.97). Conversely, a high (and significant) negative correlation was obtained between VISA-G score and Oswestry Disability Index score (R=-0.80, P<0.0001). CONCLUSIONS These results indicated that the VISA-G Italian version presents excellent test-retest reliability. CLINICAL REHABILITATION IMPACT The evaluation of gluteal tendinopathy-related disability through VISA-G can be useful for the prognostic assessment and/or follow-up of tendinopathy patients in combination with the pain drawing assessment of pain extent.
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Affiliation(s)
- Marco A Minetto
- Division of Physical Medicine and Rehabilitation, Department of Surgical Sciences, University of Turin, Turin, Italy -
| | - Chiara Busso
- Division of Physical Medicine and Rehabilitation, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Alessandro Giannini
- Division of Physical Medicine and Rehabilitation, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Kristen Meiburger
- BioLab, Department of Electronics and Telecommunications, Polytechnic of Turin, Turin, Italy
| | - Giuseppe Massazza
- Division of Physical Medicine and Rehabilitation, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, School of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy.,Center for Sports and Exercise Medicine, Bart's and London School of Medicine and Dentistry, Queen Mary University, London, UK.,School of Pharmacy and Bioengineering, School of Medicine, Keele University, Stoke on Trent, UK
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Beaudart C, Gillier M, Bornheim S, Van Beveren J, Bruyère O, Kaux JF. French Translation and Validation of the Victorian Institute of Sports Assessment for Gluteal Tendinopathy Questionnaire. PM R 2020; 13:137-143. [PMID: 32323468 DOI: 10.1002/pmrj.12391] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 04/01/2020] [Accepted: 04/13/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Developed in 2015, the Victorian Institute for Sport Assessment for Gluteal Tendinopathy (VISA-G) is the first patient-reported outcome measure tool specifically designed to measure the severity of disability associated with greater trochanteric pain syndrome. There is currently no French version of the VISA-G questionnaire. OBJECTIVE To translate the VISA-G questionnaire into French (VISA-GF) and to test its psychometric performances. DESIGN Cross-sectional study, validation study. SETTING Clinics in Liège, Belgium and in France. PATIENTS Participants with greater trochanteric pain syndrome and control asymptomatic participants. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES French translation of the VISA-G and psychometric performances of the questionnaire tested using internal consistency, construct validity and test-retest reliability with a 7-day interval. RESULTS The eight items of the VISA-G questionnaire were translated without any difficulties. The psychometric validation study included 106 participants (median age 53 [58-64] years old, 65 women [61.3%]). The questionnaire discriminates well between pathologic (n = 52) and asymptomatic participants (n = 54). Moreover, we found a good internal consistency and excellent test-retest reliability for the VISA-GF questionnaire. We also confirmed the construct validity and did not find any floor or ceiling effects. CONCLUSIONS The VISA-GF has been shown to be a valid and reliable way to measure the severity of disability associated with greater trochanteric pain syndrome in French-speaking participants.
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Affiliation(s)
- Charlotte Beaudart
- World Health Organization Collaborating Center for Public Health Aspects of Musculoskeletal Health and Ageing, Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - Mario Gillier
- Department of Rehabilitation and Sports Sciences, University of Liège, Liège, Belgium
| | - Stephen Bornheim
- Department of Rehabilitation and Sports Sciences, University of Liège, Liège, Belgium
| | | | - Olivier Bruyère
- World Health Organization Collaborating Center for Public Health Aspects of Musculoskeletal Health and Ageing, Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - Jean-François Kaux
- Department of Rehabilitation and Sports Sciences, University of Liège, Liège, Belgium.,Department of Physical Medicine and Sports Traumatology, SportS2, FIFA Medical Centre of Excellence, IOC Research Centre for Prevention of Injury and Protection of Athlete Health, FIMS collaborative Center of Sports Medicine, University and University Hospital of Liège, Liège, Belgium
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Common Musculoskeletal Disorders in the Elderly: The Star Triad. J Clin Med 2020; 9:jcm9041216. [PMID: 32340331 PMCID: PMC7231138 DOI: 10.3390/jcm9041216] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 04/09/2020] [Accepted: 04/22/2020] [Indexed: 12/15/2022] Open
Abstract
Musculoskeletal disorders are debilitating conditions that significantly impair the state of health, especially in elderly subjects. A pathological triad of inter-related disorders that are highly prevalent in the elderly consists of the following main “components”: sarcopenia, tendinopathies, and arthritis. The aim of this review is to critically appraise the literature relative to the different disorders of this triad, in order to highlight the pathophysiological common denominator and propose strategies for personalized clinical management of patients presenting with this combination of musculoskeletal disorders. Their pathophysiological common denominator is represented by progressive loss of (focal or generalized) neuromuscular performance with a risk of adverse outcomes such as pain, mobility disorders, increased risk of falls and fractures, and impaired ability or disability to perform activities of daily living. The precise management of these disorders requires not only the use of available tools and recently proposed operational definitions, but also the development of new tools and approaches for prediction, diagnosis, monitoring, and prognosis of the three disorders and their combination.
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Jorgensen JE, Fearon AM, Mølgaard CM, Kristinsson J, Andreasen J. Translation, validation and test-retest reliability of the VISA-G patient-reported outcome tool into Danish (VISA-G.DK). PeerJ 2020; 8:e8724. [PMID: 32181058 PMCID: PMC7060749 DOI: 10.7717/peerj.8724] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 02/10/2020] [Indexed: 11/20/2022] Open
Abstract
The Victorian Institute of Sport Assessment (VISA) questionnaire model is based on item response theory using a graded response (responses reflect increasing difficulty). The purpose of the VISA-G is to monitor patient outcomes and evaluate treatment strategies for people with greater trochanteric pain syndrome (GTPS). The primary aim of the current study was to translate and culturally adapt the VISA-G into a Danish context (DK) through forward and back translation and cognitive interviews. The second aim was to establish test-retest reliability and face validity of the VISA-G into a Danish context (DK). No major disagreements were observed between the original and translated versions of the questionnaire. A total of 58 heterogenous asymptomatic, and 49 symptomatic respondents (response rate: 92% and 78% respectively) completed the VISA-G.DK twice, 1 week apart. The VISA-G.DK had excellent internal consistency (Cronbach's alpha: asymptomatic = 0.86; symptomatic = 0.98). The test-retest reliability was excellent for the total score: ICC: 0.961 (95% CI [0.933-0.978]). Standard Error Measurement was calculated to be 0.6. Bland-Altman plots showed no significant or relevant differences from test to retest in the total score with mean differences below 1 (0.61). The minimal detectable change was 3.17 for both groups. The VISA-G.DK was found to be valid, reliable and acceptable for use in the Danish population.
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Affiliation(s)
- Jens Erik Jorgensen
- Sofiendal Aalborg Sundhedsteam, Physiotherapy Private Practice, Aalborg, Denmark
| | - Angela M. Fearon
- University of Canberra Hospital, Research Institute for Sport and Exercise, Faculty of Health University of Canberra, Bruce, ACT, Australia
| | - Carsten M. Mølgaard
- Aalborg University Hospital, Department of Physiotherapy and Occupational Therapy, Aalborg, Denmark
- Aalborg University Hospital, Department of Orthopaedic Surgery, Aalborg, Denmark
| | - Jens Kristinsson
- Aalborg University Hospital, Department of Orthopaedic Surgery, Aalborg, Denmark
| | - Jane Andreasen
- Aalborg University Hospital, Department of Physiotherapy and Occupational Therapy, Aalborg, Denmark
- Public Health and Epidemiology Group, Aalborg University, The Faculty of Medicine, Department of Health Science and Technology, Aalborg, Denmark
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Ebert JR, Brogan K, Janes GC. A Prospective 2-Year Clinical Evaluation of Augmented Hip Abductor Tendon Repair. Orthop J Sports Med 2020; 8:2325967119897881. [PMID: 32030347 PMCID: PMC6977235 DOI: 10.1177/2325967119897881] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 12/03/2019] [Indexed: 11/17/2022] Open
Abstract
Background: Hip abductor tendon (HAT) tearing is commonly implicated in greater trochanteric pain syndrome. Studies reporting surgical outcomes are often on small cohorts and with limited information on functional improvement. Purpose: To report the 2-year clinical and functional outcomes in a series of patients undergoing HAT repair augmented with a ligament augmentation and reconstruction system (LARS) ligament. Study Design: Case series; Level of evidence, 4. Methods: Between October 2012 and December 2016, a total of 142 patients with symptomatic HAT tears underwent open bursectomy, V-Y lengthening, and reattachment of the tendon with suture anchors augmented with a LARS ligament. This included 132 women (93%) with a mean age of 64.3 years (range, 43-84 years), a mean body mass index of 28.2 kg/m2 (range, 20.0-41.3 kg/m2), and an average duration of symptoms of 4.0 years (range, 6 months-20 years). Following surgery, patients underwent a graduated rehabilitation program consisting of hydrotherapy and land-based exercises. Patient-reported outcome measures (PROMs) were evaluated preoperatively and at 3, 6, 12, and 24 months postoperatively with the Harris Hip Score, Oxford Hip Score, 12-item Short Form Health Survey, and visual analog scale (VAS) for pain. Hip range of motion, hip abduction strength, 30-s single-leg stance (SLS), and 6-minute walk test (6MWT) capacity were evaluated. Patient satisfaction and perceived global rating of change were evaluated postsurgery. Analysis of variance was employed to evaluate clinical improvement over time. Results: A significant improvement (P < .05) was demonstrated up to 24 months in all PROMs and clinical scores, including hip range of motion in all planes, hip abductor strength limb symmetry indices (mean ± SD; presurgery, 90.1% ± 42.5%; 24 months, 102.6% ± 15.0%), and the 6MWT (presurgery, 421.8 ± 91.9 m; 24 months, 509.7 ± 105.1 m). Furthermore, several variables, including pain (VAS and pain scores during the 6MWT and 30-s SLS) and patient-perceived improvement (global rating of change), continued to improve from 12 to 24 months. At 24 months, 95.7% of patients were satisfied with their surgical outcome (excluding 3 patients who underwent reoperation within the 24-month period). There was a 5.6% (n = 8) failure rate over the study period. Conclusion: HAT repair augmented with a synthetic ligament demonstrated significantly improved clinical and functional outcomes, high levels of patient satisfaction, and a relatively low failure rate up to 24 months postsurgery. Registration: ACTRN12616001655437 (Australian New Zealand Clinical Trials Registry).
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Affiliation(s)
- Jay R Ebert
- School of Human Sciences (Exercise and Sport Science), University of Western Australia, Crawley, Australia.,HFRC Rehabilitation Clinic, Nedlands, Australia
| | - Kit Brogan
- Perth Orthopaedic and Sports Medicine Centre, West Perth, Australia
| | - Gregory C Janes
- Perth Orthopaedic and Sports Medicine Centre, West Perth, Australia
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Cowan RM, Semciw AI, Pizzari T, Cook J, Rixon MK, Gupta G, Plass LM, Ganderton CL. Muscle Size and Quality of the Gluteal Muscles and Tensor Fasciae Latae in Women with Greater Trochanteric Pain Syndrome. Clin Anat 2019; 33:1082-1090. [DOI: 10.1002/ca.23510] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 09/24/2019] [Accepted: 10/27/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Rachael Mary Cowan
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University Victoria Australia
| | - Adam Ivan Semciw
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University Victoria Australia
| | - Tania Pizzari
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University Victoria Australia
| | - Jill Cook
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University Victoria Australia
| | - Melissa Kate Rixon
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University Victoria Australia
| | | | - Lindsey Marie Plass
- The University of Chicago Medicine, Department of Therapy Services Illinois United States of America
| | - Charlotte Louise Ganderton
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University Victoria Australia
- Department of Health Professions, Swinburne University of Technology Victoria Australia
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Plinsinga ML, Ross MH, Coombes BK, Vicenzino B. Physical findings differ between individuals with greater trochanteric pain syndrome and healthy controls: A systematic review with meta-analysis. Musculoskelet Sci Pract 2019; 43:83-90. [PMID: 31369906 DOI: 10.1016/j.msksp.2019.07.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 06/13/2019] [Accepted: 07/24/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Understanding of the biopsychosocial characteristics of greater trochanteric pain syndrome (GTPS), a prevalent lower limb tendinopathy, is currently lacking. OBJECTIVES To quantify differences in participant characteristics between individuals with GTPS and healthy control participants. DESIGN Systematic review of original studies with meta-analyses where appropriate. METHODS A comprehensive electronic search was undertaken in Pubmed, EMBASE, Web of Science and CINAHL for terms referring to GTPS. Studies that provided comparison of individuals with clinically characterized GTPS with healthy controls were included. Study quality was rated with the Joanna Briggs Institute Critical Appraisal Checklist for Cross Sectional Studies. Standardized mean differences were calculated and supported by narrative synthesis or meta-analyses where appropriate. Certainty of evidence was assessed based on the GRADE guidelines. RESULTS The search revealed 2798 studies, of which 13 studies from five research groups were included. There were 229 participants with at least three months duration of GTPS and 193 control participants. Individuals with GTPS displayed larger greater trochanteric width, greater body mass index, lower hip abductor muscle strength, higher hip abductor muscle activity, altered single leg loading and gait parameters including shorter step length and velocity. No studies investigating psychological features or sensory perception were identified. Quality of life was investigated in a single study. CONCLUSIONS Compared to healthy controls, participants with GTPS are more overweight, have poorer hip abductor muscle function and altered gait parameters. Overall quality of evidence across studies was very low based on GRADE guidelines.
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Affiliation(s)
- Melanie Louise Plinsinga
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, 4072, Australia
| | - Megan Heather Ross
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, 4072, Australia
| | - Brooke Kaye Coombes
- School of Biomedical Sciences, The University of Queensland, Brisbane, QLD, 4072, Australia
| | - Bill Vicenzino
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, 4072, Australia.
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French HP, Jong CC, McCallan M. Do features of central sensitisation exist in Greater Trochanteric Pain Syndrome (GTPS)? A case control study. Musculoskelet Sci Pract 2019; 43:6-11. [PMID: 31153026 DOI: 10.1016/j.msksp.2019.05.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 04/17/2019] [Accepted: 05/13/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Greater Trochanteric Pain Syndrome (GTPS), which is commonly due to Gluteal Tendinopathy, refers to pain over the lateral hip that can become persistent and disabling. Central nervous sensitisation has been implicated in upper limb tendinopathy, but no studies have investigated if it plays a role in GTPS. OBJECTIVES To investigate if features of central sensitisation were present in people with GTPS. METHODS Eighteen people with GTPS were matched with 18 healthy controls in this cross-sectional study. The VISA-G and Central Sensitisation Inventory (CSI) self-report questionnaires were completed and pressure pain detection thresholds (PPDTs) at local and remote sites were measured in all participants. Data were analysed for between-group differences using Mann-Whitney U tests. Correlation between CSI and PPDTs were assessed using Pearson correlation co-efficients. RESULTS PPDT values were lower at local (symptomatic greater trochanter) and remote sites in the GTPS group, indicative of central sensitisation, resulting in statistically significant between-group differences. 44.4% of the GTPS group were classified as having symptoms of central sensitisation, based on the CSI. CONCLUSION There is preliminary evidence of central sensitisation in people with GTPS. Results need to be validated using other objective quantitative sensory testing measures in larger samples.
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Affiliation(s)
- Helen P French
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin 2, Ireland.
| | - Chie Chian Jong
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Mary McCallan
- Physiotherapy Department, Connolly Hospital, Dublin 15, Ireland
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Ebert JR, Fearon AM, Smith A, Janes GC. Responsiveness of the Victorian Institute for Sport Assessment for Gluteal Tendinopathy (VISA-G), modified Harris hip and Oxford hip scores in patients undergoing hip abductor tendon repair. Musculoskelet Sci Pract 2019; 43:1-5. [PMID: 31129382 DOI: 10.1016/j.msksp.2019.05.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 05/01/2019] [Accepted: 05/13/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND A lack of consensus exists on which patient-reported outcome measures (PROMs) best evaluate change following hip abductor tendon (HAT) repair. OBJECTIVES To compare the responsiveness of the Victorian Institute for Sport Assessment for Gluteal Tendinopathy (VISA-G), Oxford Hip (OHS) and modified Harris Hip (mHHS) scores in patients undergoing HAT repair. STUDY DESIGN Prospective case series. METHODS 56 patients underwent HAT repair and were evaluated pre-surgery and 3, 6 and 12 months post-operatively using the VISA-G, OHS, mHHS and a Global Rating of Change (GRC) scale. Internal and external responsiveness, the minimal clinically important change (MIC) and the presence of ceiling effects were evaluated. The extent to which VISA-G change was associated with mHHS and OHS change was investigated, as was the extent to which PROM changes were discriminatory for GRC improvement. RESULTS All PROMs demonstrated large standardized effect sizes (>1), with the VISA-G demonstrating responsiveness similar to the mHHS and OHS. At 12 months, the GRC correlated similarly with VISA-G (0.42, 95% CI: 0.17-0.61), mHHS (0.44, 95% CI: 0.17-0.61) and OHS (0.53, 95% CI: 0.31-0.70) changes. Using a GRC anchor of ≥4, an MIC of 29/100, 29/91 (32/100) and 16/48 (33/100) was observed for the VISA-G, mHHS and OHS, respectively. At 12 months ceiling effects existed for the mHHS (18/56, 32.1%) and OHS (13/56, 23.2%), but not VISA-G (1/56, 1.8%). CONCLUSION The VISA-G demonstrated acceptable responsiveness and was more resistant to ceiling effects, though demonstrated similar change scores and correlations with perceived improvement to the mHHS and OHS. CLINICAL TRIAL REGISTRATION This research trial is registered in the Australian New Zealand Clinical Trials Registry (ACTRN12616001655437).
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Affiliation(s)
- Jay R Ebert
- School of Human Sciences (Exercise and Sport Science), University of Western Australia, Crawley, Perth, Western Australia, 6009, Australia; HFRC Rehabilitation Clinic, 117 Stirling Highway, Nedlands, Western Australia, 6009, Australia.
| | - Angela M Fearon
- UCRISE, Faculty of Health, University of Canberra, ACT, 2617, Australia
| | - Anne Smith
- The School of Physiotherapy and Curtin Health Innovation Research Institute, Curtin University, Bentley, Perth, Western Australia, 6102, Australia
| | - Gregory C Janes
- Perth Orthopaedic and Sports Medicine Centre, 31 Outram Street, West Perth, Western Australia, 6005, Australia
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French HP, Grimaldi A, Woodley SJ, O'Connor L, Fearon A. An international survey of current physiotherapy practice in diagnosis and knowledge translation of greater trochanteric pain syndrome (GTPS). Musculoskelet Sci Pract 2019; 43:122-126. [PMID: 31285186 DOI: 10.1016/j.msksp.2019.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 06/19/2019] [Accepted: 06/24/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate how physiotherapists across three countries (Australia, New Zealand (NZ) and Ireland) diagnose greater trochanteric pain syndrome (GTPS) using clinical tests and imaging findings, and how physiotherapists update their knowledge regarding GTPS. DESIGN Cross-sectional observational study of physiotherapists. METHODS An online survey was distributed to registered physiotherapists in Australia, NZ and Ireland. Ordinal and nominal data were analysed using frequency counts or mean ranks; medians and interquartile ranges were calculated for numerical data. Comparisons between the three countries were made using Chi-squared analyses for nominal/ordinal data and Kruskal Wallis tests for numerical data. Statistical significance was set at p < 0.05. RESULTS/FINDINGS Valid responses were received from 361 physiotherapists; 61% were female and 79.8% worked in private practice. Most respondents were very confident in diagnosing GTPS (67.9%) and incorporated a range of symptoms and tests, including validated tests, in their diagnosis. However, many physiotherapists were not commonly using some available validated diagnostic tests (e.g. FABER and FADER-R). Approximately 30% of physiotherapists used imaging to inform assessment, with ultrasound being most preferred. Physiotherapists rated hands-on experience as most valuable for updating their knowledge of GTPS, followed by courses. CONCLUSION While most clinicians appear to be using current evidence in their assessment of patients with GTPS, a proportion use suboptimal methods and/or a limited range of diagnostic tests, suggesting that despite their confidence in diagnosis, further knowledge translation may be required. Future research should determine the best methods of facilitating knowledge acquisition and translation of research into practice.
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Affiliation(s)
- H P French
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - A Grimaldi
- Physiotec Physiotherapy, Brisbane, Australia; School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia.
| | - S J Woodley
- Department of Anatomy, School of Biomedical Sciences, University of Otago, New Zealand.
| | - L O'Connor
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - A Fearon
- UCRISE, Faculty of Health, University of Canberra, Australia.
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Clifford C, Paul L, Syme G, Millar NL. Isometric versus isotonic exercise for greater trochanteric pain syndrome: a randomised controlled pilot study. BMJ Open Sport Exerc Med 2019; 5:e000558. [PMID: 31673402 PMCID: PMC6797310 DOI: 10.1136/bmjsem-2019-000558] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2019] [Indexed: 12/18/2022] Open
Abstract
Objectives Greater trochanteric pain syndrome (GTPS) is a common cause of lateral hip pain. Limited evidence exists for the effectiveness of exercise for GTPS. This study aimed to compare the effectiveness of isometric and isotonic exercise for individuals with GTPS. Methods This randomised controlled pilot trial recruited 30 participants with GTPS. Both programmes consisted of daily, progressive home exercise for 12 weeks with 8 individual physiotherapy sessions over the trial period. The primary outcome measure was the Victorian Institute of Sport Assessment-Gluteal (VISA-G) and secondary outcome measures included the Numeric Pain Rating Scale (0–10) and an 11-point Global Rating of Change Scale. Outcome measures were assessed at baseline, 4 and 12 weeks. Results Twenty-three participants completed the trial. After 12 weeks, mean VISA-G scores improved in both groups; 55–65 in the isometric group and 62–72 in the isotonic group. 55% of the isometric group and 58% of the isotonic group achieved a reduction in pain of at least 2 points (minimally clinically important difference (MCID)) on the Numeric Pain Rating Scale. 64% of the isometric group and 75% of the isotonic group had improved by at least 2 points (MCID) on the Global Rating of Change Scale. Conclusion Isometric and isotonic exercise programmes appear to be effective for individuals with GTPS and should be considered in the loading management of patients with this condition.
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Affiliation(s)
- Christopher Clifford
- Department of Physiotherapy, NHS Greater Glasgow and Clyde, Glasgow, UK.,Institute of Infection, Immunity and Inflammation, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Lorna Paul
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Grant Syme
- Department of Physiotherapy, NHS Fife, Kirkcaldy, UK
| | - Neal L Millar
- Institute of Infection, Immunity and Inflammation, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
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French HP, Woodley SJ, Fearon A, O'Connor L, Grimaldi A. Physiotherapy management of greater trochanteric pain syndrome (GTPS): an international survey of current physiotherapy practice. Physiotherapy 2019; 109:111-120. [PMID: 31493863 DOI: 10.1016/j.physio.2019.05.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVES This study aimed to establish and compare current physiotherapy management of GTPS in Australia, New Zealand (NZ) and Ireland. DESIGN Cross-sectional observational survey of physiotherapists. METHODS An online survey was distributed to registered musculoskeletal physiotherapists in Australia, NZ and Ireland. Ordinal and nominal data were analysed using frequency counts or mean ranks; median and interquartile ranges were calculated for numerical data. Inter-country comparisons were made using Chi-squared analyses for nominal/ordinal data and Kruskal-Wallis tests for numerical data. Statistical significance was set at P<0.05. RESULTS/FINDINGS Valid responses were received from 361 physiotherapists, 61% were female and 80% worked in private practice. Overall, consistency in treatment of GTPS was observed across the three countries. All physiotherapists used education and exercise (most commonly strengthening and neuromuscular control) primarily targeting the gluteal muscles. Other interventions included massage (90%), stretching (53%), range of motion (40%), thermal modalities (50%), taping (38%) and electrotherapy (25%), whilst 40% commonly recommended up to 2 to 3 corticosteroid injections per patient/per annum. Physiotherapists used pain severity scales as their primary outcome measure (79%). Single leg stance was the most common physical measure used (68%), and global rating scores or standardised physical measures were less commonly used. CONCLUSION This international survey established the physiotherapy management of GTPS. Education used in conjunction with exercise is in line with current evidence, but a proportion of clinicians use adjunct treatments without clear rationale or supporting evidence. Results indicate the need to further define optimal management of GTPS using robust methodologies such as randomised controlled trials.
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Affiliation(s)
| | - S J Woodley
- Department of Anatomy, School of Biomedical Sciences, University of Otago, New Zealand.
| | - A Fearon
- UCRISE, Faculty of Health, University of Canberra, Australia.
| | | | - A Grimaldi
- Physiotec Physiotherapy, Brisbane, Australia; School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia.
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Does Dynamic Tape change the walking biomechanics of women with greater trochanteric pain syndrome? A blinded randomised controlled crossover trial. Gait Posture 2019; 70:275-283. [PMID: 30921578 DOI: 10.1016/j.gaitpost.2019.02.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 01/27/2019] [Accepted: 02/26/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVES There is considerable debate among clinicians as to whether sports tape can provide mechanical support and pain relief. People with greater trochanteric pain syndrome (GTPS) have increased adduction moment, adduction angle and pelvic obliquity, likely contributing to the continuation of the pathology. We aimed to see if Dynamic Tape® could control these movements and reduce pain. METHODS Fifty women with GTPS participated in a three-dimensional gait analysis. Each participant performed three walking trials: baseline, and two subsequent trials, with active and sham applications of Dynamic Tape. The order of active and sham taping was randomised. Differences in kinetic and kinematic data were analysed using mixed model linear regressions for each condition. Pain scores were obtained before and immediately after walking trials. RESULTS Hip adduction moment was reduced at first peak by both active (p < 0.001) and sham tape (p = 0.028), with no between group difference; at second peak by the active taping (p < 0.001), with a between-group difference (p < 0.001). Adduction angle was reduced at first peak by both active (p < 0.001) and sham taping (p = 0.026), with the active taping producing a larger effect (p = 0.004); at mid-stance by active taping (p = 0.003), with a between-group difference (p = 0.002); there was no reduction at second peak. Internal rotation was reduced at the first (p < 0.001) and second peaks (p < 0.001), and mid-stance by the active taping alone (p < 0.001). Pelvic obliquity was reduced at the first peak (p = 0.019), mid-stance (p < 0.001) and second peak (p < 0.001) by the active tape, with a between-group difference at mid-stance (p = 0.03). Both the active and sham taping resulted in a clinically meaningful pain reduction. CONCLUSION Dynamic Tape produced a mechanical effect and a meaningful reduction in pain in women with GTPS. The extent that placebo or somatosensory input may have had on these results is not clear. CLINICAL TRIAL REGISTRATION NUMBER ACTRN12617001611314.
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Carlisi E, Cecini M, Di Natali G, Manzoni F, Tinelli C, Lisi C. Focused extracorporeal shock wave therapy for greater trochanteric pain syndrome with gluteal tendinopathy: a randomized controlled trial. Clin Rehabil 2018; 33:670-680. [PMID: 30585498 DOI: 10.1177/0269215518819255] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVES: To investigate if focused extracorporeal shock wave therapy (f-ESWT) is an effective treatment in a population affected by greater trochanteric pain syndrome (GTPS). DESIGN: Randomized controlled trial, with blind outcome assessors. SETTING: Outpatients, University Hospital. SUBJECTS: A total of 50 patients affected by GTPS with gluteal tendinopathy. INTERVENTIONS: The study group was assigned to receive f-ESWT, the control group received ultrasound therapy (UST). MAIN MEASURES: We assessed hip pain and lower limb function by means of a numeric rating scale (p-NRS) and the Lower Extremity Functional Scale (LEFS scale), respectively. The first follow-up evaluation (2M-FUP) was performed two months after the first treatment session, the second (6M-FUP) was carried out six months later. RESULTS: The mean age of the population was 61.24 (9.26) years. A marked prevalence of the female sex was recorded (44 subjects, 86%). The statistical analysis showed a significant pain reduction over time for the study group and the control group, the f-ESWT proving to be significantly more effective than UST ( P < 0.05) at the 2M-FUP (2.08 vs 3.36) and at the 6M-FUP (0.79 vs 2.03). A marked improvement of the LEFS total score was observed in both groups as well, but we found no statistical differences in the comparisons between groups. CONCLUSION: Our findings support the hypothesis that f-ESWT is effective in reducing pain, both in the short-term and in the mid-term perspective. We also observed a functional improvement in the affected lower limb, but, in this case, f-ESWT showed not to be superior to UST.
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Affiliation(s)
- Ettore Carlisi
- 1 Rehabilitation Unit, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Miriam Cecini
- 1 Rehabilitation Unit, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy.,4 Istituti Clinici Scientifici Maugeri, Pavia, Italy
| | - Giuseppe Di Natali
- 1 Rehabilitation Unit, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Federica Manzoni
- 2 Clinical Epidemiology and Biometric Unit, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.,3 Biostatistics and Clinical Epidemiology Unit, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Carmine Tinelli
- 2 Clinical Epidemiology and Biometric Unit, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Claudio Lisi
- 1 Rehabilitation Unit, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
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Mellor R, Bennell K, Grimaldi A, Nicolson P, Kasza J, Hodges P, Wajswelner H, Vicenzino B. Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial. Br J Sports Med 2018; 52:1464-1472. [PMID: 30385462 DOI: 10.1136/bjsports-2018-k1662rep] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To compare the effects of a programme of load management education plus exercise, corticosteroid injection use, and no treatment on pain and global improvement in individuals with gluteal tendinopathy. DESIGN Prospective, three arm, single blinded, randomised clinical trial. SETTING Brisbane and Melbourne, Australia. PARTICIPANTS Individuals aged 35-70 years, with lateral hip pain for more than 3 months, at least 4/10 on the pain numerical rating scale, and gluteal tendinopathy confirmed by clinical diagnosis and MRI; and with no corticosteroid injection use in previous 12 months, current physiotherapy, total hip replacement, or neurological conditions. INTERVENTIONS A physiotherapy led education and exercise programme of 14 sessions over 8 weeks (EDX; n=69), one corticosteroid injection (CSI; n=66), and a wait and see approach (WS; n=69). MAIN OUTCOMES Primary outcomes were patient reported global rating of change in hip condition (on an 11 point scale, dichotomised to success and non-success) and pain intensity in the past week (0=no pain, 10=worst pain) at 8 weeks, with longer term follow-up at 52 weeks. RESULTS Of 204 randomised participants (including 167 women; mean age 54.8 years (SD 8.8)), 189 (92.6%) completed 52 week follow-up. Success on the global rating of change was reported at 8 weeks by 51/66 EDX, 38/65 CSI, and 20/68 WS participants. EDX and CSI had better global improvement scores than WS (risk difference 49.1% (95% CI 34.6% to 63.5%), number needed to treat 2.0 (95% CI 1.6 to 2.9); 29.2% (13.2% to 45.2%), 3.4 (2.2 to 7.6); respectively). EDX had better global improvement scores than CSI (19.9% (4.7% to 35.0%); 5.0 (2.9 to 21.1)). At 8 weeks, reported pain on the numerical rating scale was mean score 1.5 (SD 1.5) for EDX, 2.7 (2.4) for CSI, and 3.8 (2.0) for WS. EDX and CSI participants reported less pain than WS (mean difference -2.2 (95% CI -2.89 to -1.54); -1.2 (-1.85 to -0.50); respectively), and EDX participants reported less pain than CSI (-1.04 (-1.72 to -0.37)). Success on the global rating of change was reported at 52 weeks by 51/65 EDX, 36/63 CSI, and 31/60 WS participants; EDX was better than CSI (20.4% (4.9% to 35.9%); 4.9 (2.8 to 20.6)) and WS (26.8% (11.3% to 42.3%); 3.7 (2.4 to 8.8)). Reported pain at 52 weeks was 2.1 (2.2) for EDX, 2.3 (1.9) for CSI, and 3.2 (2.6) for WS; EDX did not differ from CSI (-0.26 (-1.06 to 0.55)), but both treatments did better than WS (1.13 (-1.93 to -0.33); 0.87 (-1.68 to -0.07); respectively). CONCLUSIONS For gluteal tendinopathy, education plus exercise and corticosteroid injection use resulted in higher rates of patient reported global improvement and lower pain intensity than no treatment at eight weeks. Education plus exercise performed better than corticosteroid injection use. At 52 week follow-up, education plus exercise led to better global improvement than corticosteroid injection use, but no difference in pain intensity. These results support EDX as an effective management approach for gluteal tendinopathy. TRIAL REGISTRATION NUMBER Prospectively registered at the Australian New Zealand Clinical Trials Registry (ACTRN12612001126808).
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Affiliation(s)
- Rebecca Mellor
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Kim Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Carlton, Victoria, Australia
| | | | - Philippa Nicolson
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Carlton, Victoria, Australia
| | - Jessica Kasza
- Epidemiology and Preventive Medicine, Alfred Centre, Monash University, Melbourne, Victoria, Australia
| | - Paul Hodges
- Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, University of Queensland, National Health and Medical Research Council (NHMRC), Brisbane, Queensland, Australia
| | - Henry Wajswelner
- Discipline of Physiotherapy, School of Allied Health, LaTrobe University, Bundoora, Victoria, Australia
| | - Bill Vicenzino
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
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Mellor R, Bennell K, Grimaldi A, Nicolson P, Kasza J, Hodges P, Wajswelner H, Vicenzino B. Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial. BMJ 2018; 361:k1662. [PMID: 29720374 PMCID: PMC5930290 DOI: 10.1136/bmj.k1662] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To compare the effects of a programme of load management education plus exercise, corticosteroid injection use, and no treatment on pain and global improvement in individuals with gluteal tendinopathy. DESIGN Prospective, three arm, single blinded, randomised clinical trial. SETTING Brisbane and Melbourne, Australia. PARTICIPANTS Individuals aged 35-70 years, with lateral hip pain for more than three months, at least 4/10 on the pain numerical rating scale, and gluteal tendinopathy confirmed by clinical diagnosis and magnetic resonance imaging; and with no corticosteroid injection use in previous 12 months, current physiotherapy, total hip replacement, or neurological conditions. INTERVENTIONS A physiotherapy led education and exercise programme of 14 sessions over eight weeks (EDX; n=69), one corticosteroid injection (CSI; n=66), and a wait and see approach (WS; n=69). MAIN OUTCOMES Primary outcomes were patient reported global rating of change in hip condition (on an 11 point scale, dichotomised to success and non-success) and pain intensity in the past week (0=no pain, 10=worst pain) at eight weeks, with longer term follow-up at 52 weeks. RESULTS Of 204 randomised participants (including 167 women; mean age 54.8 years (standard deviation 8.8)), 189 (92.6%) completed 52 week follow-up. Success on the global rating of change was reported at eight weeks by 51/66 EDX, 38/65 CSI, and 20/68 WS participants. EDX and CSI had better global improvement scores than WS (risk difference 49.1% (95% confidence interval 34.6% to 63.5%), number needed to treat 2.0 (95% confidence interval 1.6 to 2.9); 29.2% (13.2% to 45.2%), 3.4 (2.2 to 7.6); respectively). EDX had better global improvement scores than CSI (19.9% (4.7% to 35.0%); 5.0 (2.9 to 21.1)). At eight weeks, reported pain on the numerical rating scale was mean score 1.5 (standard deviation 1.5) for EDX, 2.7 (2.4) for CSI, and 3.8 (2.0) for WS. EDX and CSI participants reported less pain than WS (mean difference -2.2 (95% confidence interval -2.89 to -1.54); -1.2 (-1.85 to -0.50); respectively), and EDX participants reported less pain than CSI (-1.04 (-1.72 to -0.37)). Success on the global rating of change was reported at 52 weeks by 51/65 EDX, 36/63 CSI, and 31/60 WS participants; EDX was better than CSI (20.4% (4.9% to 35.9%); 4.9 (2.8 to 20.6)) and WS (26.8% (11.3% to 42.3%); 3.7 (2.4 to 8.8)). Reported pain at 52 weeks was 2.1 (2.2) for EDX, 2.3 (1.9) for CSI, and 3.2 (2.6) for WS; EDX did not differ from CSI (-0.26 (-1.06 to 0.55)), but both treatments did better than WS (1.13 (-1.93 to -0.33); 0.87 (-1.68 to -0.07); respectively). CONCLUSIONS For gluteal tendinopathy, education plus exercise and corticosteroid injection use resulted in higher rates of patient reported global improvement and lower pain intensity than no treatment at eight weeks. Education plus exercise performed better than corticosteroid injection use. At 52 week follow-up, education plus exercise led to better global improvement than corticosteroid injection use, but no difference in pain intensity. These results support EDX as an effective management approach for gluteal tendinopathy. TRIAL REGISTRATION Prospectively registered at the Australian New Zealand Clinical Trials Registry (ACTRN12612001126808).
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Affiliation(s)
- Rebecca Mellor
- School of Health and Rehabilitation Sciences, University of Queensland, QLD 4072, Australia
| | - Kim Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Carlton, VIC, Australia
| | | | - Philippa Nicolson
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Carlton, VIC, Australia
| | - Jessica Kasza
- Epidemiology and Preventive Medicine, Alfred Centre, Monash University, Melbourne, VIC, Australia
| | - Paul Hodges
- National Health and Medical Research Council (NHMRC), Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, University of Queensland, QLD, Australia
| | - Henry Wajswelner
- Discipline of Physiotherapy, School of Allied Health, LaTrobe University, Bundoora, VIC, Australia
| | - Bill Vicenzino
- School of Health and Rehabilitation Sciences, University of Queensland, QLD 4072, Australia
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Ganderton C, Semciw A, Cook J, Moreira E, Pizzari T. Gluteal Loading Versus Sham Exercises to Improve Pain and Dysfunction in Postmenopausal Women with Greater Trochanteric Pain Syndrome: A Randomized Controlled Trial. J Womens Health (Larchmt) 2018; 27:815-829. [PMID: 29715073 DOI: 10.1089/jwh.2017.6729] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES The aim of the current study was to determine the effects of education with targeted or sham exercise on pain and function in postmenopausal women with greater trochanteric pain syndrome (GTPS). BACKGROUND Conservative management of GTPS is poorly described, and to date, there have been no studies on education with exercise as an intervention for GTPS. Ninety-four postmenopausal women with GTPS were recruited to participate in this study. MATERIALS AND METHODS Participants were randomized to receive one of two 12-week exercise programs (GLoBE vs. sham). Participants received education on avoiding tendon compression with appropriate activity modification. The Victorian Institute of Sport Assessment-Gluteal tendon (VISA-G) was examined at baseline, 12, and 52 weeks. Secondary outcomes included hip pain and function questionnaires (Hip dysfunction and Osteoarthritis Outcome Score (HOOS), Oxford Hip Score (OHS), and Lateral Hip Pain questionnaire), a global rating of change in symptom questionnaire, and a quality of life measure (Assessment of Quality of Life [AQoL]-8D). Differences between groups were analyzed using intention to treat with analysis of covariance, per-protocol analysis, and responder analysis. RESULTS Responders to the GLoBE intervention had significantly better VISA-G, HOOS, OHS, and lateral hip pain questionnaire scores compared to responders in the sham group. However, intention to treat analyses showed no between-group differences for the GLoBE intervention and sham exercise groups. Significant improvement in VISA-G score was found for both programs at 12- and 52-weeks time points (p < 0.001). CONCLUSION Lack of treatment effect was found with the addition of an exercise program to a comprehensive education on GTPS management. The improved outcomes of the responders in the GLoBE group indicate that there may be a subgroup of patients with a GTPS diagnosis that benefit from a GLoBE intervention program.
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Affiliation(s)
- Charlotte Ganderton
- 1 School of Allied Health, College of Science, Health and Engineering, La Trobe University , Bundoora, Australia
| | - Adam Semciw
- 1 School of Allied Health, College of Science, Health and Engineering, La Trobe University , Bundoora, Australia .,2 School of Health and Rehabilitation Sciences, University of Queensland , Queensland, Australia
| | - Jill Cook
- 1 School of Allied Health, College of Science, Health and Engineering, La Trobe University , Bundoora, Australia
| | - Euler Moreira
- 3 Faculty of Medicine, Federal University of Minas Gerais , Minas Gerais, Brazil
| | - Tania Pizzari
- 1 School of Allied Health, College of Science, Health and Engineering, La Trobe University , Bundoora, Australia
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Plinsinga M, Coombes B, Mellor R, Nicolson P, Grimaldi A, Hodges P, Bennell K, Vicenzino B. Psychological factors not strength deficits are associated with severity of gluteal tendinopathy: A cross-sectional study. Eur J Pain 2018; 22:1124-1133. [DOI: 10.1002/ejp.1199] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2018] [Indexed: 01/12/2023]
Affiliation(s)
- M.L. Plinsinga
- School of Health and Rehabilitation Sciences; The University of Queensland; Brisbane Qld Australia
| | - B.K. Coombes
- School of Biomedical Sciences; The University of Queensland; Brisbane Qld Australia
| | - R. Mellor
- School of Health and Rehabilitation Sciences; The University of Queensland; Brisbane Qld Australia
| | - P. Nicolson
- Centre for Health, Exercise and Sports Medicine; Department of Physiotherapy; University of Melbourne; Carlton Vic. Australia
| | - A. Grimaldi
- School of Health and Rehabilitation Sciences; The University of Queensland; Brisbane Qld Australia
- Physiotec; Tarragindi Qld Australia
| | - P. Hodges
- NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury and Health; School of Health and Rehabilitation Sciences; The University of Queensland; Brisbane Qld Australia
| | - K. Bennell
- Centre for Health, Exercise and Sports Medicine; Department of Physiotherapy; University of Melbourne; Carlton Vic. Australia
| | - B. Vicenzino
- School of Health and Rehabilitation Sciences; The University of Queensland; Brisbane Qld Australia
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Ebert JR, Bucher TA, Mullan CJ, Janes GC. Clinical and functional outcomes after augmented hip abductor tendon repair. Hip Int 2018; 28:74-83. [PMID: 28967055 PMCID: PMC6159837 DOI: 10.5301/hipint.5000525] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 09/21/2017] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Hip abductor tendon (HAT) tearing is commonly implicated in greater trochanteric pain syndrome. Surgical studies are often reported in small cohorts and with limited information on functional improvement. This study reports the clinical and functional outcomes after HAT repair. METHODS 112 patients with symptomatic HAT tears, diagnosed via magnetic resonance imaging, underwent open bursectomy, V-Y lengthening of the iliotibial band, debridement of the diseased tendon, decortication of the trochanteric foot-plate and reattachment of the tendon with suture anchors, augmented with a LARS ligament through a trans-osseous tunnel. Patients were evaluated pre-surgery and at 3, 6 and 12 months post-surgery using the Harris (HHS) and Oxford (OHS) Hip Scores, SF-12, hip range of motion, 6-minute walk and 30-second single leg stance tests. Maximal isometric hip abduction strength (HAS) was assessed and limb symmetry indices (LSIs) were calculated between the operated and non-operated limbs. Patient satisfaction and perceived global rating of change (GRC) was evaluated. Analysis of variance evaluated improvement over time. RESULTS There was a significant improvement (p<0.05) in all clinical and functional measures. HAS significantly improved over time (p<0.002) and all LSIs were >85% at 12 months. At 12 months, a mean GRC score of 3.5 (range -1 to 5) was reported, while 96% of patients were satisfied with their surgical outcome. There was a 2.7% (n = 3) failure rate at 12 months. CONCLUSIONS HAT reconstruction, augmented with a synthetic ligament, demonstrated significantly improved clinical and functional outcomes, high levels of patient satisfaction and a low failure rate to 12 months post-surgery.
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Affiliation(s)
- Jay R. Ebert
- School of Human Sciences, University of Western Australia, Perth - Australia
| | - Thomas A. Bucher
- Orthopaedic Department, Fremantle Hospital, Fremantle - Australia
| | - Conor J. Mullan
- Orthopaedic Department, Royal Victoria Hospital, Belfast - UK
| | - Gregory C. Janes
- Perth Orthopaedic and Sports Medicine Centre, West Perth - Australia
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Ganderton C, Semciw A, Cook J, Pizzari T. Demystifying the Clinical Diagnosis of Greater Trochanteric Pain Syndrome in Women. J Womens Health (Larchmt) 2017; 26:633-643. [DOI: 10.1089/jwh.2016.5889] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Charlotte Ganderton
- Department of Rehabilitation, Nutrition, and Sport, College of Science Health and Engineering, School of Allied Health, La Trobe University, Bundoora, Victoria, Australia
| | - Adam Semciw
- Department of Rehabilitation, Nutrition, and Sport, College of Science Health and Engineering, School of Allied Health, La Trobe University, Bundoora, Victoria, Australia
- Department of Physiotherapy, The University of Queensland, St Lucia, Queensland, Australia
| | - Jill Cook
- Department of Rehabilitation, Nutrition, and Sport, College of Science Health and Engineering, School of Allied Health, La Trobe University, Bundoora, Victoria, Australia
| | - Tania Pizzari
- Department of Rehabilitation, Nutrition, and Sport, College of Science Health and Engineering, School of Allied Health, La Trobe University, Bundoora, Victoria, Australia
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Ganderton C, Pizzari T, Harle T, Cook J, Semciw A. A comparison of gluteus medius, gluteus minimus and tensor facia latae muscle activation during gait in post-menopausal women with and without greater trochanteric pain syndrome. J Electromyogr Kinesiol 2017; 33:39-47. [DOI: 10.1016/j.jelekin.2017.01.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 01/10/2017] [Accepted: 01/13/2017] [Indexed: 10/20/2022] Open
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Barratt PA, Brookes N, Newson A. Conservative treatments for greater trochanteric pain syndrome: a systematic review. Br J Sports Med 2016; 51:97-104. [DOI: 10.1136/bjsports-2015-095858] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2016] [Indexed: 01/15/2023]
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Pelvic Rotation in Femoroacetabular Impingement Is Decreased Compared to Other Symptomatic Hip Conditions. J Orthop Sports Phys Ther 2016; 46:957-964. [PMID: 27686413 DOI: 10.2519/jospt.2016.6713] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Cross-sectional, case-control design. Background Pelvic movement has been considered a possible discriminating parameter associated with femoroacetabular impingement (FAI) symptom onset. Decreased pelvic rotation has been found during squatting in people with FAI when compared to people with healthy hips. However, it is possible that changes in pelvic movement may occur in other hip conditions because of pain and may not be specific to FAI. Objectives To compare sagittal pelvic rotation during hip flexion and in sitting between people with FAI and people with other symptomatic hip conditions. Methods Thirty people with symptomatic FAI, 30 people with other symptomatic hip conditions, and 20 people with healthy hips participated in the study. Sagittal pelvic rotation was calculated based on measures of pelvic alignment in standing, hip flexion to 45° and 90°, and sitting. Results There were significant differences in sagittal pelvic rotation among the 3 groups in all conditions (P<.05). Post hoc analyses revealed that participants in the symptomatic FAI group had less pelvic rotation during hip flexion to 45° and 90° compared to participants in the other symptomatic hip conditions group and the hip-healthy group (mean difference, 1.2°-1.9°). In sitting, participants in the other symptomatic hip conditions group had less posterior pelvic rotation compared to those in the hip-healthy group (mean difference, 3.9°). Conclusion People with symptomatic FAI have less posterior pelvic rotation during hip flexion when compared to people with other symptomatic hip conditions and those with healthy hips. Level of Evidence Diagnosis, level 4. J Orthop Sports Phys Ther 2016;46(11):957-964. Epub 29 Sep 2016. doi:10.2519/jospt.2016.6713.
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Ganderton C, Semciw A, Cook J, Pizzari T. Does menopausal hormone therapy (MHT), exercise or a combination of both, improve pain and function in post-menopausal women with greater trochanteric pain syndrome (GTPS)? A randomised controlled trial. BMC Womens Health 2016; 16:32. [PMID: 27312538 PMCID: PMC4910216 DOI: 10.1186/s12905-016-0311-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 06/08/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Greater trochanteric pain syndrome (GTPS) is pathology in the gluteus medius and minimus tendons and trochanteric bursa that causes debilitating tendon pain and dysfunction, particularly in post-menopausal women. Limited evidence in clinical studies suggests hormone changes after menopause may have a negative effect on tendon. This protocol describes a randomised controlled trial comparing the effectiveness of menopausal hormone therapy (MHT) and exercise therapy in reducing pain and dysfunction associated with GTPS in post-menopausal women. METHOD One hundred and sixteen post-menopausal women will be recruited and randomised to receive one of two exercise programs (sham or targeted intervention exercise) and transdermal creams (MHT cream containing oestradiol 50mcg and norethisterone acetate 140mcg or placebo cream). Interventions will be 12-weeks in duration and outcomes will be examined at baseline, 12-weeks and 52-weeks. The primary outcome measure will be the VISA-G questionnaire and secondary outcomes measures will include three hip pain and function questionnaires (Hip dysfunction and Osteoarthritis Outcome Score, Oxford Hip Score, Lateral Hip Pain questionnaire), a global change in symptom questionnaire (using a 15-point Likert scale) and a quality of life measure (AQoL-8D questionnaire). Data will be analysed using the intention to treat principle. DISCUSSION This study is the first randomised controlled trial to compare the effectiveness of menopausal hormone therapy therapy alone, and with the combination of exercise therapy, to treat pain and dysfunction associated with GTPS. This study has been pragmatically designed to ensure that the interventions in this study can be integrated into policy and clinical practice if found to be effective in the treatment of GTPS in post-menopausal women. If successful, there is potential for this treatment regimen to be explored in future studies of other persistent tendon conditions in the post-menopausal population. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12614001157662 Registered 31 October 2014.
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Affiliation(s)
- Charlotte Ganderton
- />School of Allied Health (Physiotherapy), College of Science, Health and Engineering, La Trobe University, Bundoora, VIC 3086 Australia
| | - Adam Semciw
- />School of Health and Rehabilitation Sciences, University of Queensland, St. Lucia, QLD 4072 Australia
| | - Jill Cook
- />School of Allied Health (Physiotherapy), College of Science, Health and Engineering, La Trobe University, Bundoora, VIC 3086 Australia
| | - Tania Pizzari
- />School of Allied Health (Physiotherapy), College of Science, Health and Engineering, La Trobe University, Bundoora, VIC 3086 Australia
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