The American Journal of Sports Medicine http://ajs.sagepub.com/

The Patient Acceptable Symptomatic State for the Modified Harris Hip Score and Hip Outcome Score Among Patients Undergoing Surgical Treatment for Femoroacetabular Impingement Jaskarndip Chahal, Geoffrey S. Van Thiel, Richard C. Mather III, Simon Lee, Sang Hoon Song, Aileen M. Davis, Michael Salata and Shane J. Nho Am J Sports Med 2015 43: 1844 originally published online June 15, 2015 DOI: 10.1177/0363546515587739 The online version of this article can be found at: http://ajs.sagepub.com/content/43/8/1844

Published by: http://www.sagepublications.com

On behalf of: American Orthopaedic Society for Sports Medicine

Additional services and information for The American Journal of Sports Medicine can be found at: Email Alerts: http://ajs.sagepub.com/cgi/alerts Subscriptions: http://ajs.sagepub.com/subscriptions Reprints: http://www.sagepub.com/journalsReprints.nav Permissions: http://www.sagepub.com/journalsPermissions.nav

>> Version of Record - Jul 31, 2015 OnlineFirst Version of Record - Jun 15, 2015 What is This?

Downloaded from ajs.sagepub.com at EMORY UNIV on August 7, 2015

The Patient Acceptable Symptomatic State for the Modified Harris Hip Score and Hip Outcome Score Among Patients Undergoing Surgical Treatment for Femoroacetabular Impingement Jaskarndip Chahal,*y MD, MSc, FRCSC, Geoffrey S. Van Thiel,z MD, MBA, Richard C. Mather III,§|| MD, MPH, Simon Lee,z BSc, Sang Hoon Song,z BS, Aileen M. Davis,{# PhD, Michael Salata,** MD, and Shane J. Nho,z MD, MS Investigation performed at Rush University Medical Center, Chicago, Illinois, USA Background: There is minimal information available on the threshold at which patients consider themselves to be well for patientreported outcome measures used in patients treated with hip arthroscopy for femoroacetabular impingement (FAI). Purpose: To determine the patient acceptable symptomatic state (PASS) for the modified Harris Hip Score (mHHS) and the Hip Outcome Score (HOS) in patients with FAI treated with arthroscopic hip surgery. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: A consecutive series of patients at a single institution with FAI who were treated with arthroscopic labral surgery, acetabular rim trimming, and femoral osteochondroplasty were eligible. The mHHS (score range, 0-100) and the HOS (score range, 0100) were administered at baseline and at 12 months postoperatively. An external anchor question at 1 year postoperatively was utilized to determine PASS values: ‘‘Taking into account all the activities you have during your daily life, your level of pain, and also your functional impairment, do you consider that your current state is satisfactory?’’ Results: There were 130 patients (mean 6 SD age, 35.6 6 11.7 years), and 42.3% were male. Based on a receiver operator curve analysis, the PASS values—at which patients considered their status to be satisfactory—at 1 year after surgery were 74 (mHHS), 87 (HOS–activities of daily living subscale), and 75 (HOS–sports subscale). The PASS threshold was not affected by baseline scores across different instruments. However, patients with higher baseline scores were more likely to achieve the PASS (odds ratios: 3.36 [mHHS], 3.83 [HOS–activities of daily living], 3.38 [HOS-sports]). Age and sex were not significantly related to the odds of achieving the PASS for the mHHS or the HOS. Conclusion: This is the first study to determine the PASS for 2 commonly used hip joint patient-reported outcome measures in patients undergoing surgery for FAI. The study findings can allow researchers to determine if interventions related to FAI are meaningful to patients at the individual level across various domains and will also be useful for responder analyses in future randomized trials related to hip arthroscopy and the treatment of FAI. Keywords: femoroacetabular impingement; hip arthroscopy; patient-reported outcome measure; patient acceptable symptomatic state

Popularized by Ganz et al,6 the concept of femoroacetabular impingement (FAI) represents a clinical syndrome involving abnormalities in the structure and anatomy of the hip joint.2 With regard to pathoanatomy, it is caused by the abnormal contact between the femoral head-neck junction and the acetabular rim, either because of a femoral-sided cam lesion or in association with a pincer

that in turn is related to local or global acetabular overcoverage.2,4 Rather than being completely distinct entities, the majority of patients have mixed cam and pincer pathology.1,7 The downstream sequelae of such pathomechanical changes might predispose the development of osteoarthritis secondary to chondrolabral degeneration and injury.1,2,4,7 In parallel with the increased recognition of FAI as a pertinent clinical entity, the advent of improved surgical techniques and instrumentation has led to the increasing popularity of hip arthroscopy as a treatment modality for symptomatic FAI.19 There is increasing evidence, albeit mostly in the form of small case series, that hip

The American Journal of Sports Medicine, Vol. 43, No. 8 DOI: 10.1177/0363546515587739 Ó 2015 The Author(s)

1844 Downloaded from ajs.sagepub.com at EMORY UNIV on August 7, 2015

Vol. 43, No. 8, 2015

PASS in Patients Treated With Surgery for FAI 1845

arthroscopy for FAI results in good short- to intermediateterm outcomes with regard to symptom resolution, functional improvement, and return to sport.2,15 The latter outcome parameters can be captured in the form of patientreported outcome measures (PROMs) that have been shown to be reliable, valid, and responsive. However, compared with the other subspecialties in orthopaedic sports medicine, there remains limited psychometric data for PROMs utilized to evaluate outcome in people treated for symptomatic FAI.2 The most commonly used questionnaires in the FAI literature at the present time include the modified Harris Hip Score (mHHS) and the Hip Outcome Score (HOS).19 While the former has been shown to demonstrate good construct validity, the HOS has been shown to have high internal consistency, reliability, and responsiveness.19 With respect to PROMs in orthopaedic sports medicine, the interpretation of the results of these studies can be problematic because of an inability to adequately determine the clinical relevance of changes in outcome scores.17 Statistical significance does not necessarily imply clinically important change.17 Traditionally, the concept of what constitutes a clinically relevant change at the individual patient level has been considered in the context of the minimal clinically important difference (MCID) or minimally important difference.12 This term was defined by Jaeschke et al10 as ‘‘the smallest difference which patients perceived as beneficial and which would mandate, in the absence of troublesome side effects and excessive cost, a change in the patient’s management.’’ Simply put, in this context, the MCID is defined as the smallest change in a measurement that signifies an important improvement or worsening in a symptom.18 However, Tubach et al21 stated that ‘‘for the patient, it is important to be better (ie, exceed the MCID), but it is even more important to assess the chance of being good or to achieve an acceptable symptom state.’’ The latter refers to another measure of clinical improvement at the individual level—specifically, the patient acceptable symptomatic state (PASS).13 The PASS defines a level of symptoms that discriminates between feeling well and unwell.13 Unlike the MCID, the PASS is an absolute value, not a change.20 The MCID deals with the concept of improvement or ‘‘feeling better,’’ while the PASS deals with the concept of well-being or ‘‘feeling good.’’ Compared with MCID, the PASS has the advantage: because it represents a threshold beyond which patients report feeling well for a given score on PROM, it represents a tangible and clinically relevant treatment target and can provide critical information to researchers for the design

PASS Score = 75 Above 75, paents are considered to be “Feeling Good” MCID eg, if the MCID is 10, a change score of at least 10 (postoperave minus preoperave score) needs to occur for a paent to achieve MCID or “Feel Beer” Example: If the MCID=10 and PASS=75 Paents can achieve one of the following 3 states:

MCID only (Box 1) • Change score >10, final score 10, final score >75

PASS only (Box 3) • Change score 75

Box 3: Change score 8

100

0 Paent-Reported Outcome Score (0-100)

75

Figure 1. A visual illustration of the minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS). and analyses of randomized controlled trials.18,20 At the individual level, both the PASS and the MCID can be used to express results in clinical trials as the proportion of patients who consider themselves to be better or well in the various treatment arms.20 Figure 1 illustrates the concepts of MCID and PASS. To date, the PASS has not been determined for PROMs commonly used in patients surgically treated for FAI in the hip. The objective of the present study was to determine the PASS for the mHHS and Hip Outcome Scale in patients with a diagnosis of FAI who were treated with arthroscopic hip surgery.

METHODS Design Prospective longitudinal cohort study.

Participants Between 2012 and 2014, we included patients (1) who were older than 16 years with a diagnosis of FAI, (2) who had failure of nonoperative treatment for a minimum of 3 months, and (3) who underwent definitive treatment with hip arthroscopy, labral surgery, as well as acetabular rim trimming and/or femoral osteochondroplasty. Diagnosis of FAI was based on a physical examination consistent

*Address correspondence to Jaskarndip Chahal, MD, MSc, FRCSC, Toronto Western Hospital, 399 Bathurst Street–1 East 447, Toronto, ON, M5T 2S8, Canada (email: [email protected]). y University of Toronto Orthopaedic Sports Medicine Program at Women’s College Hospital, Toronto, Canada. z Hip Preservation Center, Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, USA. § Division of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA. || Duke University Medical Center, Durham, North Carolina, USA. { Toronto Western Research Institute, University Health Network, Toronto, Canada. # Institute of Health Policy, Management, and Evaluation and Department of Physical Therapy, University of Toronto, Toronto, Canada. **Division of Orthopaedic Surgery, Case Western Reserve University, Cleveland, Ohio, USA. The authors declared that they have no conflicts of interest in the authorship and publication of this contribution.

Downloaded from ajs.sagepub.com at EMORY UNIV on August 7, 2015

1846 Chahal et al

The American Journal of Sports Medicine

with impingement (positive FADIR test [flexion, adduction, internal rotation]), radiographs (To¨nnis grade 1, center-edge angle .20°, and alpha angle .50°), and magnetic resonance imaging consistent with labral injury. We excluded patients with radiographic arthritis of the hip or patients who did not provide informed consent. All participants were enrolled from a single institution, and all surgeries were performed by the senior investigator in this article (S.J.N.).

Procedures Research ethics board approval was obtained at Rush University Medical Center. Individuals who consented to participate were asked to complete baseline questionnaires, including a demographic form, the mHHS, and the HOS. At time of surgery, all arthroscopic findings were documented, including the status of the articular cartilage, the condition of the labrum, as well as the size, location, and extent of the associated pincer/cam lesion. If the above eligibility criteria were met, the patients continued in the study and completed the aforementioned outcome measures at 12 months postoperatively as well as the anchor questions described below. The anchor question, designed by Tubach et al,20 was utilized to determine the PASS for HOS subscales and the mHHS. Patients were asked the following binomial (yes/no) question: ‘‘Taking into account all the activities you have during your daily life, your level of pain, and also your functional impairment, do you consider that your current state is satisfactory?’’ Standardized Measures. The mHHS3,16 is a surgeonderived outcome measure and contains 8 items representing different aspects of pain and function. Arbitrary weights have been assigned to each item, and a total score from 0 to 100 (worst to best) is calculated.8 Although patients representative of those with FAI were not involved in the development of this score, it remains the most widely used PROM in hip arthroscopy to date.2,8 With regard to psychometric properties, the mHHS has been shown to have high construct validity because it correlates well with the bodily pain and physical function subscales of the Short Form–36.19 The test-retest reliability of the mHHS in a population with FAI was reported to be good, with an intraclass correlation coefficient (ICC) value of 0.76.9 In a heterogeneous population of patients undergoing hip arthroscopy for FAI, labral pathologic changes, or chondropathy, the mHHS demonstrated excellent testretest reliability (ICC, 0.91), construct validity, the presence of ceiling effects, and MCID of 8 points.11 The HOS3 contains 2 domains—activities of daily living (ADL) and sports—based on 26 items scored on a 5-point Likert scale.8 The subscale scores are summed and transformed to a scale of 0 to 100 (worst to best). The target population is patients undergoing hip arthroscopy. However, patients were not involved in questionnaire development, as is also the case for the mHHS.8 With regard to measurement properties, the HOS has demonstrated internal consistency, construct validity, test-retest reliability, and responsiveness.19 In a cohort of patients with FAI, the

reported test-retest reliability for the sports and ADL subscales was 0.90 and 0.73, respectively.9 In a heterogeneous population of patients undergoing arthroscopic hip procedures for chondral lesions, FAI, labral lesions, and capsular laxity, Martin and Philippon14 reported an ICC of 0.98 and 0.92 for the ADL and sports subscales, respectively. In this latter study, MCID values of 9 and 6 points for the ADL and sports subscales, respectively, were obtained at 7 months postoperatively.14 Similarly, Kemp et al11 reported MCID values of 5 and 6 for the HOS ADL and sport subscales, respectively, as well as ICC values of 0.95 and 0.96. At the present time, the HOS is the second most commonly used instrument in the FAI-specific literature.2 Analysis. A receiver operator curve was constructed and used to determine the cutoff point that optimally defined the PASS based on sensitivity and specificity values.12 PASS values were calculated at 1 year after surgery, as most surgeons consider that recovery from FAI surgery should plateau by this point in time. Logistic regression was performed to determine if age and sex had an effect on PASS estimates. We also stratified the analysis on baseline scores (above and below 50th percentile) to determine if baseline scores across the subscales or the overall mHHS score had an effect on PASS threshold value. P values \.05 were considered as statistically significant. All statistical analyses were performed on SAS v 9.2 (SAS Institute).

RESULTS There were 130 patients, with a mean 6 SD age of 35.6 6 11.7 years, and 55 (42.3%) were male. The average preoperative alpha angle was 60.8° 6 9.5° and the center-edge angle was 34.4° 6 6.0°. There were 23 patients with predominantly an isolated cam lesion (17.7%), 3 with an isolated pincer (2.3%), and 103 with combined cam and pincer deformities (81.5%). With respect to surgical procedures, 126 patients underwent a femoral osteochondroplasty (96.9%), 107 had acetabular rim trimming (82.3%), 114 had a labral repair (87.7), and 11 had labral debridement (8.5%). Among patients who had a labral repair, the mean number of anchors used was 2.5 6 1.1. Concomitant procedures included synovectomy (n = 80, 61.5%), psoas release (n = 17, 13.1%), trochanteric bursectomy (n = 2, 1.5%), and iliotibial band lengthening (n = 1, 0.8%). With respect to cartilage lesions, all lesions were focal and on the acetabular side. Eleven patients had International Cartilage Research Society grade IV lesions (8.5%), and 1 patient in this subgroup was treated with a concomitant microfracture. Overall and stratified baseline and 12-month scores for the mHHS and the HOS are reported in Table 1. The PASS values for the outcome measures in this study are reported in Table 2. The observed PASS values at 1 year after surgery were as follows: mHHS, 74 (sensitivity, 89.7%; specificity, 87.5%); HOS-ADL, 87 (sensitivity, 82.7%; specificity, 84.4%); HOS-sport, 75 (sensitivity, 79.6%; specificity, 96.9%). Table 3 presents PASS values for our selected instruments based on upper and lower 50th-percentile baseline

Downloaded from ajs.sagepub.com at EMORY UNIV on August 7, 2015

Vol. 43, No. 8, 2015

PASS in Patients Treated With Surgery for FAI 1847

TABLE 1 Mean Scores at Baseline and 12 Months: Overall and Stratified by Low vs High Baseline Scoresa Score

HOS-ADL HOS-sports mHHS

Low Baseline Score

High Baseline Score

Patients by Baseline Score, n (%)

Baseline

12 mo

Baseline

12 mo

Baseline

12 mo

Below Median

Median or Above

67.5 6 17.7 (20.0-98.5) 43.2 6 26.2 (0-100.0) 58.4 6 13.1 (24.0-85.0)

88.0 6 11.1 (29.4-100.0) 75.4 6 19.7 (0-100.0) 76.1 6 11.1 (42.0-91.0)

49.4 6 10.4 (20-65) 19.4 6 11.2 (0-36.0) 46.9 6 9.5 (24.0-57.0)

83.6 6 11.1 (54.0-100.0) 68.8 6 21.2 (0.0-100.0) 72.7 6 11.0 (47.0-91.0)

79.5 6 9.3 (66.0-98.5) 63.1 6 16.8 (38.0-100.0) 67.3 6 7.3 (58.0-85.0)

90.9 6 10.2 (29.4-100.0) 80.9 6 16.6 (0.0-100.0) 78.8 6 10.5 (42.0-91.0)

50 (40.0)

75 (60.0)

57 (45.6)

68 (54.4)

54 (43.9)

69 (56.1)

a Values are expressed as mean 6 SD (range) unless otherwise indicated. Low baseline score: lower 50th percentile; high baseline score: upper 50th percentile. ADL, activities of daily living; HOS, Hip Outcome Score; mHHS, modified Harris Hip Score.

TABLE 2 Optimal Scores Based on PASSa PASS Grouping, Mean 6 SD

HOS-ADL HOS-sports mHHS

Receiver Operator Curve Analysis

No

Yes

Optimal Final Score Cutoff

Sensitivity

Specificity

76.81 6 12.95 54.24 6 17.49 63.47 6 10.65

92.09 6 7.15 83.26 6 14.66 80.73 6 7.04

87.00 75.00 74.00

82.7 79.6 89.7

84.4 96.9 87.5

a

ADL, activities of daily living; HOS, Hip Outcome Score; mHHS, modified Harris Hip Score; PASS, patient acceptable symptomatic state.

TABLE 4 Patients Achieving PASS Stratified by Level of Baseline Scorea

TABLE 3 PASS After Stratification Based on Baseline Scoresa Baseline Scores Lower 50th percentile HOS-ADL HOS-sports mHHS Upper 50th percentile HOS-ADL HOS-sports mHHS

Optimal Final Score

Sensitivity

Specificity

84.00 73.00 73.00

82.4 72.2 80.6

90.0 95.2 88.9

87.00 72.22 76.00

83.1 89.7 96.4

85.7 90.0 64.3

HOS-ADL HOS-sports mHHS

Low Baseline Score

High Baseline Score

24 (48.0) 24 (42.1) 30 (55.6)

57 (76.0) 51 (75.0) 55 (79.7)

a

Values are expressed as n (%). Low baseline score: lower 50th percentile; high baseline score: upper 50th percentile. ADL, activities of daily living; HOS, Hip Outcome Score; mHHS, modified Harris Hip Score; PASS, patient acceptable symptomatic state.

a

ADL, activities of daily living; HOS, Hip Outcome Score; mHHS, modified Harris Hip Score; PASS, patient acceptable symptomatic state.

score values. The PASS was not affected by baseline scores for either the mHHS or the HOS. Patients with baseline scores in the upper 50th percentile, however, were more likely to achieve the PASS (mHHS: odds ratio, 3.36 [95% CI, 1.79-6.31]; HOS-ADL: odds ratio, 3.83 [95% CI, 2.097.04]; HOS-sports: odds ratio, 3.38 [1.83-6.25]). Table 4 reports the proportion of patients in this sample who were able to achieve the PASS, stratified by high versus low baseline scores. Age and sex were not significantly related to the odds of achieving the PASS for the mHHS or the HOS. A post hoc analysis demonstrated that for the mHHS, HOS-ADL, and HOS-sports, 69% (n = 85), 65% (n = 81),

and 60% (n = 75) of patients, respectively, were able to achieve the PASS. We also noted that 15% (n = 19), 16% (n = 20), and 11% (n = 14) of patients had a score above the PASS at baseline for the HOS-ADL, HOS-sport, and mHHS, respectively.

DISCUSSION This is the first study in the literature to determine the PASS for the mHHS and the HOS among patients specifically diagnosed with FAI and treated with arthroscopic hip surgery. The findings of this study are informative because they will allow investigators to determine the clinical threshold for improvement in pertinent PROMs and they will aid investigators in responder analyses for clinical trials. One of the limitations of PROMs is that outcome scores

Downloaded from ajs.sagepub.com at EMORY UNIV on August 7, 2015

1848 Chahal et al

The American Journal of Sports Medicine

have traditionally been expressed as continuous data at the group level (ie, mean and standard deviation), which can be difficult to interpret and challenging to translate to the responses of individual patients.18 This study provides investigators with the ability to address such a limitation. In the current study, baseline scores (stratified according to upper or lower 50th percentile) did not have an effect on PASS estimates (Figure 1). This intuitively makes sense since the PASS is an absolute threshold, above which patients are considered to be feeling good (ie, in a healthy or satisfactory state). However, baseline scores did have an effect on whether one was more or less likely to achieve the PASS (Figure 1 and Table 3). For both the HOS and the mHHS, patients who had higher baseline scores (ie, upper 50th percentile) were more likely to have attained postoperative scores above the PASS threshold. This can be explained by the fact that since patients are starting with a higher score, there is less movement in PROM scores required before the PASS threshold is crossed. Another explanation is that there was a proportion of patients (11%-16%) who had a baseline score above the initial pass threshold. With regard to the latter point, patients who have baseline HOS and mHHS scores above our PASS estimates should be strongly considered for nonoperative management. It is important to interpret this statement with caution, as the PASS values presented here are estimates with an intrinsic amount of measurement error. Hence, if patients fail to progress with nonoperative care, then consideration for surgery would not be unreasonable. Finally, Kemp et al11 demonstrated significant ceiling effects for the mHHS in a mixed cohort of patients treated with hip arthroscopy, which implies that this questionnaire may lack the ability to differentiate among patients who are scoring on the higher end of the score range. The presence of ceiling effects may result in an overestimation of patients who achieve the PASS estimates for the included outcome measures in this study. The strengths of this study include its prospective enrollment of patients with a single diagnosis who underwent similar treatment, as well as its use of an established methodology related to determining PASS values. Furthermore, an anchor-based approach was utilized that is endorsed by the Food and Drug Administration.5 Finally, similar estimates of PASS were obtained using both the receiver operator curve and 75th-percentile analytic methods. Limitations include using a smaller sample size, which permitted examination of baseline scores based only on upper and lower 50th percentiles (as opposed to tertiles, for example) and the heterogeneous patient sample. The latter could not be avoided given the mixed nature of cam, pincer, chondral, and labral pathologic changes in the FAI population. Another limitation is that mHHS and HOS are not patient-derived scores but are nevertheless commonly used in hip arthroscopy outcomes research. Future directions include defining the MCID for the outcome studies used in this study, as well as determining the MCID and PASS for the International Hip Outcome Tool, which is a novel hip joint–specific instrument for young patients with hip disorders.

CONCLUSION This is the first study to determine the PASS for 2 commonly used hip joint PROMs in patients undergoing surgery for FAI. Our findings will allow researchers to determine if interventions related to FAI are meaningful to patients at the individual level across various domains and will also be useful for responder analyses in future randomized trials related to hip arthroscopy and the treatment of FAI.

REFERENCES 1. Anderson CN, Riley GM, Gold GE, Safran MR. Hip-femoral acetabular impingement. Clin Sports Med. 2013;32(3):409-425. 2. Ayeni OR, Adamich J, Farrokhyar F, et al. Surgical management of labral tears during femoroacetabular impingement surgery: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2014;22(4):756762. 3. Byrd JW, Jones KS. Prospective analysis of hip arthroscopy with 2year follow-up. Arthroscopy. 2000;16(6):578-587. 4. Chaudhry H, Ayeni OR. The etiology of femoroacetabular impingement: what we know and what we don’t. Sports Health. 2014;6(2): 157-161. 5. Food and Drug Administration. Guidance for industry patientreported outcome measures: use in medical product development to support labeling claims. http://www.fda.gov/downloads/Drugs/ Guidances/UCM193282.pdf. Accessed January 1, 2013. 6. Ganz R, Parvizi J, Beck M, Leunig M, No¨tzli H, Siebenrock KA. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res. 2003;417:112-120. 7. Gupta AK, Abrams GD, Nho SJ. What’s new in femoroacetabular impingement surgery: will we be better in 2023? Sports Health. 2014;6(2):162-170. 8. Harris-Hayes M, McDonough CM, Leunig M, Lee CB, Callaghan JJ, Roos EM. Clinical outcomes assessment in clinical trials to assess treatment of femoroacetabular impingement: use of patient-reported outcome measures. J Am Acad Orthop Surg. 2013;21(suppl 1):S39S46. 9. Hinman RS, Dobson F, Takla A, O’Donnell J, Bennell KL. Which is the most useful patient-reported outcome in femoroacetabular impingement? Test-retest reliability of six questionnaires. Br J Sports Med. 2014;48(6):458-463. 10. Jaeschke R, Singer J, Guyatt GH. Measurement of health status: ascertaining the minimal clinically important difference. Control Clin Trials. 1989;10(4):407-415. 11. Kemp JL, Collins NJ, Roos EM, Crossley KM. Psychometric properties of patient-reported outcome measures for hip arthroscopic surgery. Am J Sports Med. 2013;41(9):2065-2073. 12. King MT. A point of minimal important difference (MID): a critique of terminology and methods. Expert Rev Pharmacoecon Outcomes Res. 2011;11(2):171-184. 13. Kvien TK, Heiberg T, Hagen KB. Minimal clinically important improvement/difference (MCII/MCID) and patient acceptable symptom state (PASS): what do these concepts mean? Ann Rheum Dis. 2007;66(suppl 3):iii40-iii41. 14. Martin RL, Philippon MJ. Evidence of reliability and responsiveness for the Hip Outcome Score. Arthroscopy. 2008;24(6):676-682. 15. Philippon MJ, Briggs KK, Yen YM, Kuppersmith DA. Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction: minimum two-year follow-up. J Bone Joint Surg Br. 2009;91(1):16-23. 16. Potter BK, Freedman BA, Andersen RC, Bojescul JA, Kuklo TR, Murphy KP. Correlation of Short Form-36 and disability status with outcomes of arthroscopic acetabular labral debridement. Am J Sports Med. 2005;33(6):864-870.

Downloaded from ajs.sagepub.com at EMORY UNIV on August 7, 2015

Vol. 43, No. 8, 2015

PASS in Patients Treated With Surgery for FAI 1849

17. Tashjian RZ, Deloach J, Green A, Porucznik CA, Powell AP. Minimal clinically important differences in ASES and simple shoulder test scores after nonoperative treatment of rotator cuff disease. J Bone Joint Surg Am. 2010;92(2):296-303. 18. Tashjian RZ, Deloach J, Porucznik CA, Powell AP. Minimal clinically important differences (MCID) and patient acceptable symptomatic state (PASS) for visual analog scales (VAS) measuring pain in patients treated for rotator cuff disease. J Shoulder Elbow Surg. 2009;18(6):927-932. 19. Tijssen M, van Cingel R, van Melick N, de Visser E. Patient-reported outcome questionnaires for hip arthroscopy: a systematic review of

the psychometric evidence. BMC Musculoskelet Disord. 2011; 12:117. 20. Tubach F, Ravaud P, Baron G, et al. Evaluation of clinically relevant states in patient reported outcomes in knee and hip osteoarthritis: the patient acceptable symptom state. Ann Rheum Dis. 2005;64(1): 34-37. 21. Tubach F, Ravaud P, Beaton D, et al. Minimal clinically important improvement and patient acceptable symptom state for subjective outcome measures in rheumatic disorders. J Rheumatol. 2007; 34(5):1188-1193.

For reprints and permission queries, please visit SAGE’s Web site at http://www.sagepub.com/journalsPermissions.nav

Downloaded from ajs.sagepub.com at EMORY UNIV on August 7, 2015

The Patient Acceptable Symptomatic State for the Modified Harris Hip Score and Hip Outcome Score Among Patients Undergoing Surgical Treatment for Femoroacetabular Impingement.

There is minimal information available on the threshold at which patients consider themselves to be well for patient-reported outcome measures used in...
219KB Sizes 3 Downloads 7 Views