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    • Thoracic Spine >
      • Adam's Forward Bend Test
      • Passive Neck Flexion Test
      • Thoracic Compression Test
      • Thoracic Distraction Test
      • Thoracic Foraminal Closure Test
    • Lumbar Spine/Sacroiliac Joint >
      • Active Sit-Up Test
      • Alternate Gillet Test
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      • Gaenslen Test
      • Gillet Test
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      • Prone Instability Test
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      • SIJ Compression/Distraction Test
      • Slump Test
      • Sphinx Test
      • Spine Rotators & Multifidus Test
      • Squish Test
      • Standing Forward Flexion Test
      • Straight Leg Raise Test
      • Supine to Long Sit Test
    • Shoulder >
      • Active Compression Test
      • Anterior Apprehension
      • Biceps Load Test II
      • Drop Arm Sign
      • External Rotation Lag Sign
      • Hawkins-Kennedy Impingement Sign
      • Horizontal Adduction Test
      • Internal Rotation Lag Sign
      • Jobe Test
      • Ludington's Test
      • Neer Test
      • Painful Arc Sign
      • Pronated Load Test
      • Resisted Supination External Rotation Test
      • Speed's Test
      • Posterior Apprehension
      • Sulcus Sign
      • Thoracic Outlet Tests >
        • Adson's Test
        • Costoclavicular Brace
        • Hyperabduction Test
        • Roos (EAST)
      • Yergason's Test
    • Elbow >
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      • Chair Sign
      • Cozen's Test
      • Elbow Extension Test
      • Medial Epicondylalgia Test
      • Mill's Test
      • Moving Valgus Stress Test
      • Push-up Sign
      • Ulnar Nerve Compression Test
      • Valgus Stress Test
      • Varus Stress Test
    • Wrist/Hand >
      • Allen's Test
      • Carpal Compression Test
      • Finkelstein Test
      • Phalen's Test
      • Reverse Phalen's Test
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      • FAIR Test
      • Fitzgerald's Test
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      • Long-Axis Femoral Distraction Test
      • Noble Compression Test
      • Percussion Test
      • Sign of the Buttock
      • Trendelenburg Test
    • Knee >
      • Anterior Drawer Test
      • Dial Test (Tibial Rotation Test)
      • Joint Line Tenderness
      • Lachman Test
      • McMurray Test
      • Noble Compression Test
      • Pivot-Shift Test
      • Posterior Drawer Test
      • Posterior Sag Sign
      • Quad Active Test
      • Thessaly Test
      • Valgus Stress Test
      • Varus Stress Test
    • Foot/Ankle >
      • Anterior Drawer
      • Calf Squeeze Test
      • External Rotation Test
      • Fracture Screening Tests
      • Impingement Sign
      • Navicular Drop Test
      • Squeeze Test
      • Talar Tilt
      • Tarsal Tunnel Syndrome Test
      • Test for Interdigital Neuroma
      • Windlass Test
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Clinical Practice Guidelines Review: Hip OA Examination and Treatment

11/29/2018

1 Comment

 
The Clinical Practice Guidelines (CPG) have been developed over the last decade with the goal of summarizing best practice methods for various orthopaedic diagnoses. While the utility of CPG's may be debatable, they do an excellent job providing a summary of the evidence for managing the specific conditions. With the hip being the focus of December, I am going to review what the evidence shows for examining a patient with hip osteoarthritis and the appropriate interventions. Before getting started, a quick reminder for the grading system for research: A (strong evidence), B (moderate evidence), C (weak evidence), F (expert opinion).
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Diagnosis (A):
These patients are over the age of 50 and exhibit the following presentation (A-Level Evidence):
-Moderate anterior or lateral hip pain with weight-bearing
-Morning stiffness less than 1 hour after waking
-Hip IR ROM < 24 deg or IR and Flexion < 15 deg compared to nonpainful side
-Increased hip pain associated with passive hip IR
Outcome Measures for Activity Limitation and Participation Restriction (A):
-WOMAC
-HOOS
-LEFS
-HHS
Activity Limitation/Performance  Measures (A):
-6 Minute Walk Test
-30 Second Chair Stand
-Stair Measure
-TUG Test
-Self-Paced Walk
-Timed SLS
-4 Square Step Test
-Step Test
Balance Measures (A):
-TUG Test
-Berg Balance Test
-Timed SLS Test
Physical Impairment Measures (A):
-FABER Test
-Hip PROM
-Hip Strength Testing
As you can see, there are quite a few very reliable methods of diagnosing Hip OA and then tracking progress in function, balance, performance and impairment. It is in no way necessary to perform all of the above tests and measures. What I recommend from these is to identify your patient's goals  and determine what outcome measures and performance measures will best track said progress. It is good to be thorough with the impairment measures in order to track objective changes. Once the patient has been diagnosed with Hip OA, there are several interventions that have shown varying levels of support. 
Interventions:
-Education (B): activity modification, exercise, joint unloading, weight-loss
-Functional Gait and Balance Training (C): gait/balance training and use of assistive device
-Manual Therapy (A): thrust/non-thrust manipulation and STM and coupled with exercise
-Flexibility/Strengthening/Endurance Exercises (A)
-Modalities (B): US to ant/lat/post hip and coupled with exercises and heat
-Bracing (F): should only be tried if exercise/manual therapy fail
-Weight Loss (C)
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As you can see, the typical trend for PT continues with treatment for this diagnosis: manual therapy and exercise have high level evidence. While education has moderate evidence, it would be interesting to see the benefit of education that was more focused on pain science, graded exposure, and cognitive behavioral therapy. These topics are more pertinent today given the findings of pain science research, especially given how frequently people have "Hip OA" and don't have any pain. Additionally, it was surprising to see that ultrasound had moderate evidence. Even so, I would recommend more focus be placed on exercise, education and manual therapy for these patients. 

As a whole, I think that the development of CPG's will help to improve the standard of care. There is far too much varied care due to misdiagnosis. That being said, patients don't present "standardized" and we are moving away from pathoanatomical diagnoses as well. Hip osteoarthritis is so common in people that it is almost surprising that it even has its own CPG. There are so many factors that go into a patient's pain and disability experience: financial situation, relationship stress, past experiences, fear, and more. No two patients present the same. I recommend take the recommendations from the CPG into consideration, but don't hesitate to modify your plan of care based on the patient presentation.

​-Dr. Chris Fox, PT, DPT, OCS

Check out our Insider Access Page! Learn from residency-trained, board-certified orthopaedic & sports physical therapists.

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​With Insider Access, you gain access to advanced manual assessment and treatment techniques, exercise progressions, sports specific content, and more. Our goal is to facilitate your clinical and professional growth!
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  • Home
  • About Us
  • TSPT Academy
  • Resources
    • Newsletter
    • Orthopedic Blog
    • Featured Articles
    • Research Articles
    • Residency Corner
  • Special Tests
    • Cervical Spine >
      • Alar Ligament Test
      • Bakody's Sign
      • Cervical Distraction Test
      • Cervical Rotation Lateral Flexion Test
      • Craniocervical Flexion Test (CCFT)
      • Deep Neck Flexor Endurance Test
      • Posterior-Anterior Segmental Mobility
      • Segmental Mobility
      • Sharp-Purser Test
      • Spurling's Maneuver
      • Transverse Ligament Test
      • ULNT - Median
      • ULNT - Radial
      • ULNT - Ulnar
      • Vertebral Artery Test
    • Thoracic Spine >
      • Adam's Forward Bend Test
      • Passive Neck Flexion Test
      • Thoracic Compression Test
      • Thoracic Distraction Test
      • Thoracic Foraminal Closure Test
    • Lumbar Spine/Sacroiliac Joint >
      • Active Sit-Up Test
      • Alternate Gillet Test
      • Crossed Straight Leg Raise Test
      • Extensor Endurance Test
      • FABER Test
      • Fortin's Sign
      • Gaenslen Test
      • Gillet Test
      • Gower's Sign
      • Lumbar Quadrant Test
      • POSH Test
      • Posteroanterior Mobility
      • Prone Knee Bend Test
      • Prone Instability Test
      • Resisted Abduction Test
      • Sacral Clearing Test
      • Seated Forward Flexion Test
      • SIJ Compression/Distraction Test
      • Slump Test
      • Sphinx Test
      • Spine Rotators & Multifidus Test
      • Squish Test
      • Standing Forward Flexion Test
      • Straight Leg Raise Test
      • Supine to Long Sit Test
    • Shoulder >
      • Active Compression Test
      • Anterior Apprehension
      • Biceps Load Test II
      • Drop Arm Sign
      • External Rotation Lag Sign
      • Hawkins-Kennedy Impingement Sign
      • Horizontal Adduction Test
      • Internal Rotation Lag Sign
      • Jobe Test
      • Ludington's Test
      • Neer Test
      • Painful Arc Sign
      • Pronated Load Test
      • Resisted Supination External Rotation Test
      • Speed's Test
      • Posterior Apprehension
      • Sulcus Sign
      • Thoracic Outlet Tests >
        • Adson's Test
        • Costoclavicular Brace
        • Hyperabduction Test
        • Roos (EAST)
      • Yergason's Test
    • Elbow >
      • Biceps Squeeze Test
      • Chair Sign
      • Cozen's Test
      • Elbow Extension Test
      • Medial Epicondylalgia Test
      • Mill's Test
      • Moving Valgus Stress Test
      • Push-up Sign
      • Ulnar Nerve Compression Test
      • Valgus Stress Test
      • Varus Stress Test
    • Wrist/Hand >
      • Allen's Test
      • Carpal Compression Test
      • Finkelstein Test
      • Phalen's Test
      • Reverse Phalen's Test
    • Hip >
      • Craig's Test
      • Dial Test
      • FABER Test
      • FAIR Test
      • Fitzgerald's Test
      • Hip Quadrant Test
      • Hop Test
      • Labral Anterior Impingement Test
      • Labral Posterior Impingement Test
      • Long-Axis Femoral Distraction Test
      • Noble Compression Test
      • Percussion Test
      • Sign of the Buttock
      • Trendelenburg Test
    • Knee >
      • Anterior Drawer Test
      • Dial Test (Tibial Rotation Test)
      • Joint Line Tenderness
      • Lachman Test
      • McMurray Test
      • Noble Compression Test
      • Pivot-Shift Test
      • Posterior Drawer Test
      • Posterior Sag Sign
      • Quad Active Test
      • Thessaly Test
      • Valgus Stress Test
      • Varus Stress Test
    • Foot/Ankle >
      • Anterior Drawer
      • Calf Squeeze Test
      • External Rotation Test
      • Fracture Screening Tests
      • Impingement Sign
      • Navicular Drop Test
      • Squeeze Test
      • Talar Tilt
      • Tarsal Tunnel Syndrome Test
      • Test for Interdigital Neuroma
      • Windlass Test