The Patient Acceptable Symptom State for Commonly Used Patient-Reported Outcomes After Nonoperative Management of Hip Femoroacetabular Impingement Syndrome

TL;DR

This study identifies symptom improvement thresholds for non-surgical hip treatment outcomes, helping doctors and researchers evaluate patient progress.

Contribution

Establishes Patient Acceptable Symptom State (PASS) values for nonoperative FAIS treatment, previously unknown.

Findings

PASS for iHOT-33 is 50, HOS-ADL is 66, and pain VAS is 36 after nonoperative FAIS treatment.

Older age and higher baseline iHOT-33 scores predict better outcomes.

Radiographic markers and symptom duration did not significantly affect achieving PASS.

Abstract

Patient Acceptable Symptom State (PASS) values for commonly used patient-reported outcome measures are known for operatively treated patients with femoroacetabular impingement syndrome (FAIS) but have not been established for those undergoing nonoperative treatment.

First, to determine the PASS for International Hip Outcome Tool–33 (iHOT-33), Hip Outcome Score–Activities of Daily Living (HOS-ADL), and pain visual analog scale (VAS) in patients with FAIS treated nonoperatively; second, to assess the baseline factors that were associated with achieving PASS.

Cohort study (diagnosis); Level of evidence, 2.

Patients with FAIS who were treated nonoperatively with an expert-validated physical therapy protocol at 2 academic centers were prospectively enrolled. Patients completed the iHOT-33, HOS-ADL, and pain VAS at baseline and 6 months after beginning treatment. Receiver operating characteristic curve analyses were conducted to determine PASS cutoff points. Multivariable regression analyses were performed to determine the association of patient factors, radiographic markers, and disease severity on the likelihood of achieving PASS.

Of the 214 patients enrolled, 121 (57%) were female, and the mean age was 34 years. The median symptom duration before beginning the prescribed physical therapy regimen was 24 months. The mean (SD) iHOT-33 score was 42.9 (16.7) at baseline and 54.2 (22.0) at 6 months. The iHOT-33 score for PASS is 50 (specificity, 91%; sensitivity, 82%; area under the curve [AUC], 0.95). The mean (SD) HOS-ADL was 72.9 (16.0) at baseline and 77.1 (17.1) at 6 months. The HOS-ADL score for PASS is 66 (specificity, 81%; sensitivity, 86%; AUC, 0.90). The mean (SD) pain VAS score was 53.7 (23.1) at baseline and 41.9 (SD25.4) at 6 months. The pain VAS score for PASS is 36 (specificity, 67%; sensitivity, 85%; AUC, 0.87). Patient age was significantly predictive of achieving PASS for iHOT-33 (odds ratio, 1.04; 95% CI, 1.01-1.08). Patients with higher baseline iHOT-33 scores were more likely to achieve PASS for all patient-reported outcome measures (P < .005). Otherwise, patient factors, radiographic markers, and symptom duration were not associated with achieving PASS.

This study determined the PASS values for iHOT-33 (PASS = 50), HOS-ADL (PASS = 66), and pain VAS (PASS = 36) for patients with FAIS treated nonoperatively with an exercise-based, core-focused physical therapy program. These values can be utilized by clinicians in counseling individual patients to anticipated outcomes and by investigators for future nonoperative-focused outcomes research.

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