How Comprehensive and Efficient are Patient Reported Outcomes for Femoroacetabular Impingement?

Abstract

Objectives:Increasing emphasis is placed on patient reported outcomes following common orthopedic procedures as a measure of quality and patient satisfaction. When considering patient reported outcome (PRO) utilization in patients with hip pain secondary to femoroacetabular impingement, several different PRO exist with varying levels of utilization and accuracy. Understanding which disease-specific PRO may be most efficiently administered in patients with femoroacetabular impingement, particularly those undergoing arthroscopic hip procedures, may assist in promoting increased patient and physician adoption of these useful scores. Using a novel assessment criterion, this study assessed all commonly used PRO in hip arthroscopy literature. We hypothesize that surveys with fewer numbers of questions may remain comparable (with regards to comprehensiveness) to longer surveys.Methods:Commonly utilized PRO in hip arthroscopy literature were analyzed with regards to number of survey components, comprehensiveness, and efficiency. Comprehensiveness (maximum score 13) was scored as the total number of pain (at rest/baseline, at night, during activities of daily living, during sport, during work, and mechanical symptoms) and functional (range of motion, ability to perform ADL, sport, work, ability to sit, and pre-injury level of function) metrics included, along with inclusion of quality of life/satisfaction metrics. Efficiency was calculated as comprehensiveness divided by number of survey components.Results:Thirteen different PRO were studied. Number of components ranged from 1 (UCLA Activity Score) - 40 (HOOS). Only the iHOT-33 included all six pain components, while only the iHOT-33 and HOS PRO contained all six functional components. Seven PRO included a quality of life/satisfaction component. The most comprehensive scores were the iHOT-33 (score = 13) and HAGOS (score = 10), and the least comprehensive score was the UCLA (score = 2). The most efficient PROs were the UCLA, MHHS, and EQ-5D scores. The least efficient scores were the HOS and SF-36 scores.Conclusion:Many commonly utilized PRO for FAI are lacking in comprehensiveness and efficiency. Continued critical assessment of PRO quality may help practitioners identify the most comprehensive and efficient PRO to incorporate into daily clinical practice.Figure 1:Bar Graph of Comprehensiveness Scores with Overlying Line Graph of Efficiency Scores on Secondary Axis