A patient walks into your clinic complaining of hip pain. The referral from the orthopedist says “hip OA,” but how can you be sure that the symptoms that your patient is complaining of are truly arthritic in nature? With the help of clinical prediction rules (CPRs), you can help improve your ability to accurately diagnose the patient, which will allow for you to improve your treatment outcomes.
In 2008, Sutlive et al published a report regarding the diagnoses hip osteoarthritis in patients with unilateral hip pain. Using diagnostic evidence of osteoarthritis on X-ray as the reference standard, five predictors were found to help in the diagnosis of hip osteoarthritis:
- Self-reported squatting as an aggravating factor
- Scour test with adduction causing groin or lateral pain
- Active hip flexion causing lateral pain
- Active hip extension causing hip pain
- Passive hip internal rotation less than or equal to 25°
If 4/5 of the above predictors were present, a positive likelihood ratio of 24.3 was found (a post test probability of 91%). What’s great about this CPR is how quick it is to run through the five predictors, and once you do, you can provide your patient with a more evidence based clinical diagnosis.
So now that you feel confident with your diagnosis, how do you treat your patient? I personally tend to utilize a lot of joint manipulation/mobilization techniques with these patients, and the research supports this type of plan of care. Hoeksma et al published a paper in 2004 comparing manual therapy to exercise in the treatment of patients with hip osteoarthritis. The findings showed a significantly higher success rate after 5 weeks of treatment in the manual therapy group compared to the exercise group. Now this does not mean that you should completely neglect the use of therapeutic exercises when treating patients with hip OA, but more importantly, should reinforce the significance of using manual therapy with this population (aka if you are not doing hip mobilizations for your patients, you should!).
Both of these articles are great ways to not only improve your own clinical skills, but to educate your patient as well. If you are able to confidently tell your patient what you believe is causing their symptoms, and more importantly that you can improve them, their trust in you as their physical therapist will grow exponentially.
Tim Reynolds, PT, DPT, OCS, CSCS 