Meta-analysis prediction intervals are under reported in sport and exercise medicine.

AIM: Prediction intervals are a useful measure of uncertainty for meta-analyses that capture the likely effect size of a new (similar) study based on the included studies. In comparison, confidence intervals reflect the uncertainty around the point estimate but provide an incomplete summary of the underlying heterogeneity in the meta-analysis. This study aimed to estimate (i) the proportion of meta-analysis studies that report a prediction interval in sports medicine; and (ii) the proportion of studies with a discrepancy between the reported confidence interval and a calculated prediction interval. METHODS: We screened, at random, 1500 meta-analysis studies published between 2012 and 2022 in highly ranked sports medicine and medical journals. Articles that used a random effect meta-analysis model were included in the study. We randomly selected one meta-analysis from each article to extract data from, which included the number of estimates, the pooled effect, and the confidence and prediction interval. RESULTS: Of the 1500 articles screened, 866 (514 from sports medicine) used a random effect model. The probability of a prediction interval being reported in sports medicine was 1.7% (95% CI = 0.9%, 3.3%). In medicine the probability was 3.9% (95% CI = 2.4%, 6.6%). A prediction interval was able to be calculated for 220 sports medicine studies. For 60% of these studies, there was a discrepancy in study findings between the reported confidence interval and the calculated prediction interval. Prediction intervals were 3.4 times wider than confidence intervals. CONCLUSION: Very few meta-analyses report prediction intervals and hence are prone to missing the impact of between-study heterogeneity on the overall conclusions. The widespread misinterpretation of random effect meta-analyses could mean that potentially harmful treatments, or those lacking a sufficient evidence base, are being used in practice. Authors, reviewers, and editors should be aware of the importance of prediction intervals.

Implementing the 27 PRISMA 2020 Statement items for systematic reviews in the sport and exercise medicine, musculoskeletal rehabilitation and sports science fields: the PERSiST (implementing Prisma in Exercise, Rehabilitation, Sport medicine and SporTs science) guidance.

Poor reporting of medical and healthcare systematic reviews is a problem from which the sports and exercise medicine, musculoskeletal rehabilitation, and sports science fields are not immune. Transparent, accurate and comprehensive systematic review reporting helps researchers replicate methods, readers understand what was done and why, and clinicians and policy-makers implement results in practice. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement and its accompanying Explanation and Elaboration document provide general reporting examples for systematic reviews of healthcare interventions. However, implementation guidance for sport and exercise medicine, musculoskeletal rehabilitation, and sports science does not exist. The Prisma in Exercise, Rehabilitation, Sport medicine and SporTs science (PERSiST) guidance attempts to address this problem. Nineteen content experts collaborated with three methods experts to identify examples of exemplary reporting in systematic reviews in sport and exercise medicine (including physical activity), musculoskeletal rehabilitation (including physiotherapy), and sports science, for each of the PRISMA 2020 Statement items. PERSiST aims to help: (1) systematic reviewers improve the transparency and reporting of systematic reviews and (2) journal editors and peer reviewers make informed decisions about systematic review reporting quality.

Implementation of path analysis and piecewise structural equation modelling to improve the interpretation of key performance indicators in team sports: An example in professional rugby union.

Analysis of key performance indicators (KPIs) in team sports has frequently involved multiple univariate analyses and modelling of direct associations between each KPI and match outcomes. This study aimed to show a more appropriate framework and modelling process to establish causal plausibility for future confirmatory studies. A cross-sectional design was adopted, using 337 team-match observations of Australian Super Rugby performances. A tentative model was developed in consultation with a domain expert (national analyst) and analysed using piecewise structural equation modelling. Model fit was assessed using Fisher's C and the Akaike Information Criterion (AIC). Hypothesised relationships were modelled using linear mixed effects models and unmodelled pathways were investigated using tests of directed separation. The model was an acceptable fit overall, and adjustments were identified in collaboration with the national head analyst, improving the AIC from 127.15 to 120.77 (Fisher's C = 66.78; p = 0.382). Modelling the hierarchical data structure and developing models that contain more logical hypothesised associations (in consultation with domain experts) is a more useful and important step to analyse and interpret effects of KPIs on team performance. This analysis provides support to the plausibility of the causal structure and generation of new and more precise hypotheses.

Analysis of the worst-case scenarios in an elite football team: Towards a better understanding and application.

This study investigated the variability in the worst-case scenario (WCS) and suggested a framework to improve the definition and guide further investigation. Optical tracking data from 26 male players across 38 matches were analysed to determine the WCS for total distance, high-speed running (>5.5 m.s-1) and sprinting (>7.0 m.s-1) using a 3-minute rolling window. Position, total output, previous epoch, match half, time of occurrence, classification of starter vs substitute, and minutes played were modelled as selected contextual factors hypothesized to have associations with the WCS. Linear mixed effects models were used to account for cross-sectional observations and repeated measures. Unexplained variance remained high (total distance R2 = 0.53, high-speed running R2 = 0.53 and sprinting R2 = 0.40). Intra-individual variability was also high (total distance CV = 4.6-8.2%; high-speed CV = 15.6-37.8% and Sprinting CV = 21.1-76.4%). The WCS defined as the maximal physical load in a given time-window, produces unstable metrics lacking context, with high variability. Furthermore, training drills targetting this metric concurrently across players may not have representative designs and may underprepare athletes for complete match demands and multifaceted WCS scenarios. Using WCS as benchmarks (reproducing similar physical activity for training purposes) is conceptually questionable.

Standardised measurement of physical capacity in young and middle-aged active adults with hip-related pain: recommendations from the first International Hip-related Pain Research Network (IHiPRN) meeting, Zurich, 2018.

Hip-related pain can significantly impact quality of life, function, work capacity, physical activity and family life. Standardised measurement methods of physical capacity of relevance to young and middle-aged active adults with hip-related pain are currently not established. The aim of this consensus paper was to provide recommendations for clinical practice and research on standardised measurement methods of physical capacity in young and middle-aged active adults with hip-related pain. Four areas of importance were identified: (1) clinical measures (range of motion, muscle strength, functional impairments), (2) laboratory-based measures (biomechanics and muscle function (muscle activity, size and adiposity)), (3) physical activity, and (4) return to sport/performance. The literature was reviewed, and a summary circulated to the working group to inform discussion at the consensus meeting. The working group developed clinical and research recommendations from the literature review, which were further discussed and modified within the working group at the consensus meeting. These recommendations were then presented to all 38 International Hip-related Pain Research Network (IHiPRN) participants for further discussion, refinement and consensus voting. Therefore, the recommendations voted on were based on a combination of current evidence and expert opinion. The consensus meeting voted on 13 recommendations, six of which were clinically orientated, and seven more research specific. We recommended that clinicians working with young and middle-aged active adults with hip-related pain assess strength using objective methods of measurement, and clinically assess performance of functional tasks, including walking and running. Physical activity should be quantified using both self-reported and objective measures, and patient expectations of recovery should be quantified prior to treatment. It was recommended that return to physical activity (including sport and occupation) be quantified, and sport-specific activities should be assessed prior to return to sport. The IHiPRN participants were uncertain regarding recommendations for range of motion assessment. Research recommendations were that the measurement properties of range of motion, strength and functional performance tests be investigated, reported and improved in both clinical and research settings. Reporting of movement-related parameters (biomechanics and muscle function) should be standardised and the relationship among movement-related parameters, symptoms, function, quality of life, and intra-articular and imaging findings should be investigated. Quantification of return to physical activity (including sport and occupational demands) is required in future research, and the return to sport continuum should be used. Future research is required to determine the best criteria for rehabilitation progression and return to physical activity following hip-related pain management.

Patient-reported outcome measures for hip-related pain: a review of the available evidence and a consensus statement from the International Hip-related Pain Research Network, Zurich 2018.

Hip-related pain is a well-recognised complaint among active young and middle-aged active adults. People experiencing hip-related disorders commonly report pain and reduced functional capacity, including difficulties in executing activities of daily living. Patient-reported outcome measures (PROMs) are essential to accurately examine and compare the effects of different treatments on disability in those with hip pain. In November 2018, 38 researchers and clinicians working in the field of hip-related pain met in Zurich, Switzerland for the first International Hip-related Pain Research Network meeting. Prior to the meeting, evidence summaries were developed relating to four prioritised themes. This paper discusses the available evidence and consensus process from which recommendations were made regarding the appropriate use of PROMs to assess disability in young and middle-aged active adults with hip-related pain. Our process to gain consensus had five steps: (1) systematic review of systematic reviews; (2) preliminary discussion within the working group; (3) update of the more recent high-quality systematic review and examination of the psychometric properties of PROMs according to established guidelines; (4) formulation of the recommendations considering the limitations of the PROMs derived from the examination of their quality; and (5) voting and consensus. Out of 102 articles retrieved, 6 systematic reviews were selected and assessed for quality according to AMSTAR 2 (A MeaSurement Tool to Assess systematic Reviews). Two showed moderate quality. We then updated the most recent review. The updated literature search resulted in 10 additional studies that were included in the qualitative synthesis. The recommendations based on evidence summary and PROMs limitations were presented at the consensus meeting. The group makes the following recommendations: (1) the Hip and Groin Outcome Score (HAGOS) and the International Hip Outcome Tool (iHOT) instruments (long and reduced versions) are the most appropriate PROMs to use in young and middle-aged active adults with hip-related pain; (2) more research is needed into the utility of the HAGOS and the iHOT instruments in a non-surgical treatment context; and (3) generic quality of life measures such as the EuroQoL-5 Dimension Questionnaire and the Short Form Health Survey-36 may add value for researchers and clinicians in this field. We conclude that as none of the instruments shows acceptable quality across various psychometric properties, more methods studies are needed to further evaluate the validity of these PROMS-the HAGOS and iHOT-as well as the other (currently not recommended) PROMS.

Physiotherapist-led treatment for young to middle-aged active adults with hip-related pain: consensus recommendations from the International Hip-related Pain Research Network, Zurich 2018.

The 1st International Hip-related Pain Research Network meeting discussed four prioritised themes concerning hip-related pain in young to middle-aged adults: (1) diagnosis and classification of hip-related pain; (2) patient-reported outcome measures for hip-related pain; (3) measurement of physical capacity for hip-related pain; (4) physiotherapist-led treatment for hip-related pain. Thirty-eight expert researchers and clinicians working in the field of hip-related pain attended the meeting. This manuscript relates to the theme of physiotherapist-led treatments for hip-related pain. A systematic review on the efficacy of physiotherapist-led interventions for hip-related pain (published separately) was conducted and found that strong evidence for physiotherapist-led treatments was lacking. Prior to the meeting, draft consensus recommendations for consideration in the meeting were also developed based on the systematic review. The draft consensus recommendations were presented to all of the meeting participants via email, at least 1 week prior to the meeting. At the meeting, these recommendations were discussed, revised and voted on. Six recommendations for clinical practice and five recommendations for research were included and all gained consensus. Recommendations for clinical practice were that (i) Exercise-based treatments are recommended for people with hip-related pain. (ii) Exercise-based treatment should be at least 3 months duration. (iii) Physiotherapist-led rehabilitation after hip surgery should be undertaken. (iv) Patient-reported outcome measures, measures of physical impairment and measures of psychosocial factors should be used to monitor response to treatment. (v) Physical activity (that may include sport) is recommended for people with hip-related pain. (vi) Clinicians should discuss patient expectations, use shared-decision making and provide education. Recommendations for research were (i) Reporting of exercise programmes: Exercise descriptors such as load magnitude, number of repetitions and sets, duration of whole programme, duration of contractile element of exercise, duration of one repetition, time under tension, rest between repetitions, range of motion through which the exercise is performed, and rest between exercise sessions should be reported. (ii) Research should investigate the optimal frequency, intensity, time, type, volume and progression of exercise therapy. (iii) Research should examine the effect of patient education in people with hip-related pain. (iv) Research should investigate the effect of other treatments used in people with hip-related pain (for example: manual therapy, medications, injections). (v) Research should examine the impact of comorbidities and social determinants on treatment effectiveness in people with hip-related pain. Clinicians and researchers working with young to middle-aged active adults with hip-related pain may use these consensus recommendations to guide, develop, test and implement individualised, evidence-based physiotherapist-led rehabilitation programmes.

Consensus recommendations on the classification, definition and diagnostic criteria of hip-related pain in young and middle-aged active adults from the International Hip-related Pain Research Network, Zurich 2018.

There is no agreement on how to classify, define or diagnose hip-related pain-a common cause of hip and groin pain in young and middle-aged active adults. This complicates the work of clinicians and researchers. The International Hip-related Pain Research Network consensus group met in November 2018 in Zurich aiming to make recommendations on how to classify, define and diagnose hip disease in young and middle-aged active adults with hip-related pain as the main symptom. Prior to the meeting we performed a scoping review of electronic databases in June 2018 to determine the definition, epidemiology and diagnosis of hip conditions in young and middle-aged active adults presenting with hip-related pain. We developed and presented evidence-based statements for these to a panel of 37 experts for discussion and consensus agreement. Both non-musculoskeletal and serious hip pathological conditions (eg, tumours, infections, stress fractures, slipped capital femoral epiphysis), as well as competing musculoskeletal conditions (eg, lumbar spine) should be excluded when diagnosing hip-related pain in young and middle-aged active adults. The most common hip conditions in young and middle-aged active adults presenting with hip-related pain are: (1) femoroacetabular impingement (FAI) syndrome, (2) acetabular dysplasia and/or hip instability and (3) other conditions without a distinct osseous morphology (labral, chondral and/or ligamentum teres conditions), and that these terms are used in research and clinical practice. Clinical examination and diagnostic imaging have limited diagnostic utility; a comprehensive approach is therefore essential. A negative flexion-adduction-internal rotation test helps rule out hip-related pain although its clinical utility is limited. Anteroposterior pelvis and lateral femoral head-neck radiographs are the initial diagnostic imaging of choice-advanced imaging should be performed only when requiring additional detail of bony or soft-tissue morphology (eg, for definitive diagnosis, research setting or when planning surgery). We recommend clear, detailed and consistent methodology of bony morphology outcome measures (definition, measurement and statistical reporting) in research. Future research on conditions with hip-related pain as the main symptom should include high-quality prospective studies on aetiology and prognosis. The most common hip conditions in active adults presenting with hip-related pain are: (1) FAI syndrome, (2) acetabular dysplasia and/or hip instability and (3) other conditions without distinct osseous morphology including labral, chondral and/or ligamentum teres conditions. The last category should not be confused with the incidental imaging findings of labral, chondral and/or ligamentum teres pathology in asymptomatic people. Future research should refine our current recommendations by determining the clinical utility of clinical examination and diagnostic imaging in prospective studies.

The Association Between Comorbidity and the Risks and Early Benefits of Total Hip Arthroplasty for Hip Osteoarthritis.

BACKGROUND: The changing demographics of our society will lead to an increasing number of patients presenting for orthopedic surgery with increasing comorbidity. We investigated the association between comorbidity and both the risks (complications) and benefits (improved function) of total hip arthroplasty (THA) for primary hip osteoarthritis, whilst controlling for potential confounders including age. METHODS: One thousand five hundred and eighty-four patients (67.1 ± 10.6 years; 54% men) in our tertiary care orthopedic hospital completed the Oxford Hip Score before and 12 months after THA. Comorbidity was assessed using the American Society of Anesthesiologists (ASA) grade and Charlson Comorbidity Index (CCI). Details regarding perioperative complications (hospital stay plus 18 days after discharge; mean 27 ± 3 days) were extracted from the clinic information system and graded for severity. RESULTS: For ASA1, 2, and ≥3, respectively, there were 3.1%, 3.0%, and 6.6% surgical/orthopedic complications; 3.7%, 12.5%, and 27.4% general medical complications; and 6.7%, 14.5%, and 29.8% complications of either type. ASA was associated with complication severity (P < .001). In multiple regression, increasing ASA grade (OR 1.74; 95% CI, 1.33-2.29) and age (OR 1.06; 95% CI, 1.05-1.08), both showed an independent association with increased risk of a complication; CCI explained no further significant variance. CCI, but not age, was associated with the 12-month Oxford Hip Score (beta coefficient, -0.742; 95% CI, -1.130 to -0.355; P = .002) while ASA grade explained no further variance. CONCLUSION: Greater comorbidity was associated with increased odds of a complication and (independently) slightly worse patient-rated outcome 12 months after THA. Comorbidity indices can be easily obtained for all surgical patients and may assist with preoperative counseling regarding individual risks and benefits of THA.

Measurement properties of PROMIS short forms for pain and function in orthopedic foot and ankle surgery patients.

PURPOSE: To examine the measurement properties of the German PROMIS short forms for pain intensity (PAIN), pain interference (PI) and physical function (PF) in orthopedic foot and ankle surgery patients. METHODS: Patient-rated outcomes were collected from consecutive patients of our foot and ankle registry before and 6 months after surgery. Measurement properties were tested according to the COnsensus-based Standards for the selection of health status Measurement Instruments (COSMIN). The German Foot Function Index (FFI-D) served as a legacy measure. RESULTS: 748 patients were included in our cross-sectional sample. Longitudinal and test-retest data were available for 202 and 65 patients, respectively. Construct validity of all short forms was good. All Cronbach's α and intraclass correlation coefficients were > 0.7. The smallest detectable change (SDC) was highest for PF (8.9) and lowest for PI (6.5). Minimal important change was 4 to 5 points and thus smaller than SDC for all instruments. We observed a baseline ceiling effect for PF. PI showed insufficiently correlated change scores with FFI-D disability change scores, and therefore failed the responsiveness testing. CONCLUSION: Our study showed some adequate psychometric properties, but also certain aspects regarding interpretability and responsiveness that researchers must be aware of when using PROMIS short forms of pain and function in foot and ankle surgery patients.

EUROSPINE 2017 FULL PAPER AWARD: Time to remove our rose-tinted spectacles: a candid appraisal of the relative success of surgery in over 4500 patients with degenerative disorders of the lumbar spine, hip or knee.

PURPOSE: Studies comparing the outcome of spine surgery with that of large-joint replacement report equivocal findings. The patient-reported outcome measures (PROMs) used in such studies are typically generic and may not be sufficiently sensitive to the successes/failures of treatment. This study compared different indices of "success" in patients undergoing surgery for degenerative disorders of the lumbar spine, hip, or knee, using a validated, multidimensional, and joint-specific PROM. METHODS: Preoperatively and 12 months postoperatively, 4594 patients (3937 lumbar spine, 368 hip, 269 knee) undergoing first-time surgery completed a PROM that included the Core Outcome Measures Index (COMI) for the affected joint. The latter comprises a set of single items on pain, function, symptom-specific well-being, quality of life, and disability-all in relation to the specified joint problem. Other single-item ratings of treatment success were made 12 months postoperatively. RESULTS: In multiple regression analyses, controlling for confounders, the mean improvement in COMI at 12 months was greatest for the hip patients and lowest for those with degenerative spinal deformity (= the statistical reference group) (p < 0.05). Compared with spinal deformity, the odds of achieving "success" were: higher for hip (OR 4.6; 95% CI 2.5-8.5) and knee (OR 4.0; 95% CI 2.1-7.7) (no difference between spine subgroups) for "satisfaction with care"; higher for hip (OR 16.9; 95% CI 7.3-39.6), knee (OR 6.3; 95% CI 3.4-11.6), degenerative spondylolisthesis (OR 1.6; 95% CI 1.2-2.2), and herniated disc (OR 1.7; 95% CI 1.2-2.4) for "global treatment outcome"; and higher for hip (OR 13.8; 95% CI 8.8-21.6), knee (OR 5.3; 95% CI 3.6-7.8), degenerative spondylolisthesis (OR 1.6; 95% CI 1.3-2.1), and herniated disc (1.5; 95% CI 1.1-2.0) for "patient-acceptable symptom state". Patient-rated complications were the greatest in degenerative spinal deformity (29%) and the lowest in hip (18%). CONCLUSIONS: The current study is the largest of its kind and the first to use a common, but joint-specific instrument to report patient-reported outcomes after surgery for degenerative disorders of the spine, hip, or knee. The findings provide a sobering account of the significantly poorer outcomes after spine surgery compared with large-joint replacement. Further work is required to hone the indications and patient selection criteria for spine surgery. The data should be used to lobby research funding-bodies, governmental agencies, industry, and charitable foundations to invest more in spine research/registries, in the hope of ultimately improving spine outcomes. These slides can be retrieved under Electronic Supplementary Material.

Quantification of energy expenditure of recreational football.

There is a strong relationship between low physical activity level and cardiovascular diseases (CVD). The popularity of football may be used to promote physical activity and previous evidence has shown it is effective to decrease the risk of CVD. However, the energy expenditure (EE) of recreational football is not well known but it is crucial to develop preventive health programmes. Fifteen sedentary middle-aged male participants were involved (mean ± SDs; age 43.9 ± 3.1 years, weight 83.0 ± 13.6 kg, height 174.9 ± 6.8 cm). EE was estimated from the heart rate (HR)-VO2 relation during 1-h 5-a-side matches (futsal). Participants covered 3412 ± 381 m in 52 ± 2 min, at an average HR of 85 ± 2% of maximum HR. Estimated EE during a recreational futsal match was 634 ± 92 kcal. One futsal recreational match corresponds to about 50% of American College of Sport Medicine recommended physical activity quantity per week. Based on this estimation: once, twice and 3 sessions per week are equivalent to 50% (634 kcal), 100% (1268 kcal) and 150% (1902 kcal), respectively, of EE suggested in international guidelines. This EE estimation may have important implications for designing recreational football training protocols in health programmes and dose response studies.

Clinical improvement and satisfaction after total joint replacement: a prospective 12-month evaluation on the patients' perspective.

PURPOSE: To determine short-term improvements, satisfaction rates and the patient acceptable symptom state (PASS) after total joint replacement (TJR) for different patient-reported outcome measures (PROMs). METHODS: This prospective cohort study included 426 consecutive patients undergoing total hip (n = 193) or knee arthroplasty (n = 233). The following PROMs were completed before TJR, and at 3, 6 and 12 months after surgery, respectively: WOMAC, Oxford Hip or Knee Score, Lower Extremity Functional Scale, University of California at Los Angeles (UCLA) activity scale and EuroQol-5 dimension (EQ-5D). Satisfaction rates and the PASS thresholds were also assessed. RESULTS: THA patients improved quicker and achieved higher outcome scores than TKA patients. Comorbidities according to the Sangha score were moderately correlated with all PROM values in an inverse direction at all time points (r = -0.27 to -0.47, p < 0.01) in both groups. Satisfaction with the result of surgery improved over time. At 12 months, more than 90 % of the patients were satisfied or very satisfied with the achieved result. The THA group showed a higher proportion of very satisfied patients than the TKA group at all time points. PASS thresholds increased over time for all PROMs except for the UCLA and the EQ-5D in TKA patients. CONCLUSIONS: More than 90 % of the patients will be satisfied 1 year after TJR. THA patients recover faster than TKA patients, i.e., they achieve higher PROM values at earlier follow-up time points. Cutoff values defining a successful result in terms of the PASS could be defined for all PROMs at different time points and can serve as reference for future studies and patient-oriented follow-ups.

The German Lower Extremity Functional Scale (LEFS) is reliable, valid and responsive in patients undergoing hip or knee replacement.

PURPOSE: To determine the measurement properties of a German version of the Lower Extremity Functional Scale (LEFS) in patients with hip or knee osteoarthritis undergoing total joint replacement (TJR). METHODS: This prospective cohort study included 486 consecutive patients. The LEFS and other self-reported outcome measures were administered at different time points and several classical measurement properties were determined. RESULTS: The German LEFS was highly reliable (ICC 0.98) and internally consistent (CA 0.95). Construct validity was proven by large to very large correlations (r = 0.52-0.91) with all other instruments in the expected directions. Factor analysis using a polychoric correlation matrix revealed two factors at baseline and 6 months explaining about 70% of the total variance. There were no floor or ceiling effects for the total score, but significant floor effects for the single items 16-19 at baseline. The LEFS was highly responsive at 6 months. CONCLUSIONS: The German LEFS proved to be a reliable, valid and responsive tool for the self-assessment of patients undergoing total hip or knee replacement. Nevertheless, the questionnaire seems to summarize more than one construct as highlighted by the factor analysis. Further research seems therefore warranted.

Women demonstrate more pain and worse function before THA but comparable results 12 months after surgery.

BACKGROUND: Many studies report differences in patient-reported outcome measures (PROMs) for men and women undergoing total hip arthroplasty (THA). Few studies have evaluated whether these are explained by corresponding differences in important preoperative factors. QUESTIONS/PURPOSES: (1) Are there differences between men and women in PROM scores preoperatively and 12 months after THA? (2) Do baseline differences in comorbidity, age, body mass index (BMI), and mental health status explain these differences in PROM scores? METHODS: Preoperatively, 300 patients completed the Oxford Hip Score (OHS), WOMAC, and SF-12; 261 (86%) of them (129 women, 64 ± 11 years; 132 men, 66 ± 10 years) completed the same questionnaires 12 months postoperatively and also rated the acceptability of their current symptoms and change in general health. RESULTS: Preoperatively, women showed worse scores than men in the OHS (-1.9; 95% confidence interval, -3.6 to -0.3) and WOMAC (-6.3; -10.9 to -1.7). At 12 months postoperatively, the absolute scores for all PROMs were not significantly different. After controlling for BMI, age, comorbidity, SF-12 mental health scores, and sociodemographic characteristics, the baseline differences remained. CONCLUSIONS: Surgeons may be more reluctant to operate on women than men because they perceive that, because of their worse baseline status, women are likely to have worse outcomes; however, given that we found no evidence for differences in patient-reported outcomes at 12 months, these suspicions would appear to be unfounded. Women and men can be expected to benefit to a similar extent from THA. LEVEL OF EVIDENCE: Level III, therapeutic study.

Validation of the Core Outcome Measures Index in Patients With Femoroacetabular Impingement.

PURPOSE: To evaluate a short, hip-oriented outcome instrument, based on the Core Outcome Measures Index (COMI), in patients undergoing surgery for femoroacetabular impingement (FAI). METHODS: The following full-length questionnaires were completed preoperatively and at 6 and 12 months postoperatively by 159 consecutive FAI patients: Hip Outcome Score (HOS); Oxford Hip Score; Western Ontario and McMaster Universities Arthritis Index; Short Form 12 Health Survey; World Health Organization Quality of Life questionnaire, short version; and EuroQol-Five Dimensional index. The scores for the 6 hip-oriented Core Outcome Measures Index (COMI-Hip) items-addressing pain, function, symptom-specific well-being, quality of life, and disability-were extracted from established full-length questionnaires, and their performance as an index was compared with that of the full-length instruments. RESULTS: Scores for the single items of the COMI-Hip questionnaire correlated well with the scores for the corresponding full-length instruments from which they were extracted (r = -0.89 to -0.62, P < .001). The COMI-Hip sum score also correlated well with the Oxford Hip Score and the Western Ontario and McMaster Universities Arthritis Index pain and function scores (r = -0.85 to -0.70, P < .001), as well as with the HOS (r = -0.72 to -0.60, P < .001), an instrument specifically developed for assessing FAI patients. Internal responsiveness (Cohen d for effect size) of the COMI-Hip sum score from preoperatively to 12 months postoperatively was similar to that of the HOS activities-of-daily living subscale (d = -0.76 and d = -0.68, respectively; P < .001). Significant correlations were found between the change scores of the COMI-Hip sum score and those of the HOS activities-of-daily living and sport subscales at 6 months (r = -0.62 and r = -0.60, respectively; P < .001) and 12 months (r = -0.69 and r = -0.61, respectively; P < .001), showing the external responsiveness of the COMI-Hip. CONCLUSIONS: The COMI-Hip is a simple yet valid and responsive outcome instrument for the efficient assessment of patients undergoing surgery for FAI. It performs at least as well as the current reference instrument for FAI, the HOS, and can therefore be considered a potentially valuable instrument for routine use in both research and clinical practice. LEVEL OF EVIDENCE: Level II, development of diagnostic criteria based on consecutive patients (with universally applied reference gold standard).