Purpose: To evaluate the benefits of standardization on the reliability of the physical examination of the hip by rheumatologists and orthopaedic surgeons

Methods: Six subjects with mild to severe hip osteoarthritis (OA) were examined by 6 examiners (4 rheumatologists, 2 orthopedic surgeons) experienced in the assessment of hip OA using a 6x6 Latin square design. Subjects were examined, followed by a standardization meeting and, a day later, by post-standardization examinations. 33 hip examination maneuvers were evaluated, including range of motion, pain, tenderness, muscle strength, leg length and gait. The order of examinations was randomized for each examiner. For dichotomous signs, agreement was calculated as the prevalence-adjusted bias-adjusted kappa (PABAK). Ordinal and continuous variables were analyzed by ANOVA, using the proportion of variance due to rheumatologists to calculate a reliability coefficient (Rc).

Results: Subjects’ mean age was 61 years (range 49–65), mean BMI was 24 (range 21–30), mean WOMAC pain on walking was 52 mm (range 21–81mm). 23/33 (70%) hip examinations were reliable after standardization. Two new items resulted from the standardization meeting. Pre-/post-standardization reliability for select hip examinations using PABAK were as follows: Gait 0.06/0.52; pain on internal rotation 0.60/0.52; pain on external rotation 0.24/0.72; pain on flexion 0.46/0.82; Patrick test for hip pain 0.78/0.80; Thomas test 0.60/0.88; Trendelenburg test 0.36/0.06. Pre-/post-standardization reliability for select hip examinations using Rc were as follows: hip flexion strength 0.83/0.95; hip abduction strength 0.90/0.86; hip adduction strength 0.87/0.86; ROM internal rotation (supine) 0.87/0.94; ROM external rotation (supine) 0.87/0.80.

Conclusions: Moderate to very good agreement was present for many hip examinations prior to standardization. Improved reliability was achieved after standardization for many but not all hip assessments. This will be important for improved outcome studies of early hip OA.

Purpose: To evaluate the effect of outpatient physiotherapy versus a self-adminstered home exercise program on recovery following primary total hip arthroplasty.

Methods: Subjects awaiting primary total hip arthroplasty consented to participate in this prospective randomized clinical trial. Patients were assigned to participate in either an outpatient physiotherapy program or self-administered/self-directed home exercise program following discharge home from hospital. Multiple longitudinal measures were performed to adequately assess recovery over time. Primary outcome for comparison was WOMAC function at 4 months postoperatively, additional outcomes of timed-up-and-go, SF-36, HUI3, FSI. Primary outcome was evaluated using repeated measures analyses and regression models for longitudinal data.

Results: 100 patients were randomized to their respective interventions. The two cohorts were similar with regards to baseline characteristics of age, gender, and pre-op quality of life measures (p> .05). At 4 months post-op both groups demonstrated significant change from baseline function and were similar with regards to recovery and rate of recovery (p> .05).

Conclusions: While all patients demonstrated excellent recovery, patients receiving self-adminstered home exercise program did not demonstrate inferior outcome at the interval(s) assessed. Self-adminstered home exercise program may be an effective alternative rehabilitation program where physiotherapy services are limited or in specific subgroups of patients.

Funding : Educational Grant from the Canadian Orthopaedic Foundation