Validity of retrospective patient reported assessment of pre-surgical hip pain and disability following hip arthroscopy

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Wain, Matthew Joel Thomas
Author ORCID Profiles (clickable)
Master of Osteopathy
Unitec Institute of Technology
Bacon, Catherine
Furness, James
Masters Thesis
Ngā Upoko Tukutuku (Māori subject headings)
Auckland (N.Z.)
New Zealand
hip arthroscopy patients
hip arthroscopy
Patient Reported Outcome Measures (PROMs)
hip surgery
osteopathic medicine
Wain, M. J. T. (2021). Validity of retrospective patient reported assessment of pre-surgical hip pain and disability following hip arthroscopy. (Unpublished document submitted in partial fulfilment of the requirements for the degree of Master of Osteopathy). Unitec Institute of Technology, New Zealand. Retrieved from
PURPOSE: The purpose of this study was to assess the validity of pre-surgery PROMS completed retrospectively 6 and 24 months after hip arthroscopy compared with prospective completion. Validity was judged in relation to preoperative test-retest reliability. METHODS: Three separate groups of hip arthroscopy patients were recruited. In two retrospective groups, patients who had undergone a hip arthroscopy and had completed preoperative PROM questionnaires were contacted 6 or 24 months after surgery and asked to recall their preoperative state. In a third test-retest group, patients completed prospective PROMs twice prior to surgery, 2–8 weeks apart. PROMs included Non-Arthritic Hip Score (NAH), Hip Disability and Osteoarthritis Outcome score (HOOS), International Hip Outcome Tool (IHOT- 12), and Visual Analogue Scale (VAS) for Medical Care, Feeling and Pain. RESULTS: In the 6-month, 24-month and test-retest groups, patient sample sizes were 52, 40 and 61, respectively. Retrospective 6- and 24-month and test-retest PROMs demonstrated ‘moderate’ to ‘very large’ correlations (ICC=0.42–0.79), except for 6-month VAS-Medical- Care and VAS-Feeling (‘small’) and 24-month VAS-Feeling (‘trivial’). PROMs for the 24- month group reduced, from prospective to retrospective, for NAH-Total (MD -4.10 [-7.93–- 0.27; (95%CI)]; p=0.03), HOOS Symptoms (-8.21 [-13.44–-2.97]; p=0.003), HOOS-Daily- Living (-7.53 [-12.71–-2.36]; p=0.005), HOOS-Sports (-6.49 [-12.97–0.00]; p=0.05), and HOOS-Short-Form (-5.16 [-9.83–-0.49]; p=0.03). Similar non-significant reductions were observed for 6-month retrospective PROMs, except for VAS-Feeling which increased retrospectively (7.47 [0.13–14.81]; p=0.05). Three test-retest PROMs also showed statistically significant reduction, with worse outcomes approaching surgery: HOOS-Daily- Living (-.3.87 [-7.73–0.00]; p=0.05), HOOS-Short-Form (-4.49 [-8.41–-0.53]; p=0.03), and IHOT-12-Total (-4.91 [-8.7–-1.23]; p=0.01). CONCLUSION: Correlations for retrospective versus prospective PROM scores spanned a similar range to test-retest correlations. Therefore, PROM scores relating to pre-surgery condition, but completed 6 or 24 months after surgery, showed agreement with PROM scores completed before surgery which were consistent with the day-to-day variability expected before surgery. This consistency supports the use of retrospective PROMs completed up to 2 years after hip arthroscopy.
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