To develop and validate a sports activity scale for patients with a diagnosis of femoroacetabular impingement (FAI).
Methods
A nine level Hip Sports Activity Scale (HSAS) was constructed both in German and English languages. Fifty-nine consecutive patients undergoing surgical treatment for FAI at two centers in Switzerland and in the US completed a questionnaire set consisting of the HSAS, the University of California at Los Angeles (UCLA) activity scale and different hip joint-specific and generic outcome tools. For reliability assessment, the HSAS was completed twice about nine days apart. Evidence of reliability, validity and responsiveness was investigated by classical psychometric analyses.
Results
Reliability was excellent for both the German and the English versions with intraclass correlation coefficients of 0.94 and 0.96, respectively. Evidence of convergent validity was supported by moderate to high correlations with the UCLA activity scale and with the joint-specific measures used. Evidence of divergent validity was supported by low correlations with the SF-12 Mental Component Scale and the WOMAC stiffness subscale. The standardised response mean was 0.69.
Conclusions
The HSAS is a reliable and valid tool to determine sports levels in patients suffering from FAI. Its use in future studies investigating outcomes in young patients with hip disease can be recommended.
Level of Evidence
Level III, Diagnostic Studies – An independent, masked comparison with an appropriate population of patients, but reference standard not applied to all study patients.
ClohisyJ.C., BeauléP.E., O'MalleyA., SafranM.R., SchoeneckerP.AOA symposium. Hip disease in the young adult: current concepts of etiology and surgical treatment.J Bone Joint Surg Am.2008; 90(10): 2267–81.
2.
GanzR., ParviziJ., BeckM., LeunigM., NotzliH., SiebenrockK.A.Femoroacetabular impingement: a cause for osteoarthritis of the hip.Clin Orthop Relat Res.2003; 417(417): 112–20.
3.
LeunigM., BeauléP.E., GanzR.The concept of femoroacetabular impingement: current status and future perspectives.Clin Orthop Relat Res.2009; 467(3): 616–22.
4.
PhilipponM.J., SchenkerM.L.Arthroscopy for the treatment of femoroacetabular impingement in the athlete.Clin Sports Med.2006; 25(2): 299–308.
5.
WeirA., de VosR.J., MoenM., HölmichP., TolJ.L.Prevalence of radiological signs of femoroacetabular impingement in patients presenting with long standing adductor related groin pain.Br J Sports Med.2011; 45(1): 6–9.
6.
BeauléP.E., DoreyF.J., HokeR., LeduffM., AmstutzH.C.The value of patient activity level in the outcome of total hip arthroplasty.J Arthroplasty.2006; 21(4): 547–52.
7.
BizziniM., NotzliH.P., MaffiulettiN.A.Femoroacetabular impingement in professional ice hockey players: a case series of 5 athletes after open surgical decompression of the hip.Am J Sports Med.2007; 35(11): 1955–9.
8.
BrunnerA., HorisbergerM., HerzogR.F.Sports and recreation activity of patients with femoroacetabular impingement before and after arthroscopic osteoplasty.Am J Sports Med.2009; 37(5): 917–22.
9.
IlizaliturriV.M.Jr., Orozco-RodriguezL., Acosta-RodríguezE., Camacho-GalindoJ.Arthroscopic treatment of cam-type femoroacetabular impingement: preliminary report at 2 years minimum follow-up.J Arthroplasty.2008; 23(2): 226–34.
10.
LarsonC.M., GiveansM.R.Arthroscopic management of femoroacetabular impingement: early outcomes measures.Arthroscopy.2008; 24(5): 540–6.
11.
LarsonC.M., GiveansM.R.Arthroscopic debridement versus refixation of the acetabular labrum associated with femoroacetabular impingement.Arthroscopy.2009; 25(4): 369–76.
12.
NaalF.D., MiozzariH.H., SchaerM., HesperT., NötzliH.P.Midterm results of surgical hip dislocation for the treatment of femoroacetabular impingement.Am J Sports Med.2012; 40(7): 1501–10.
13.
NaalF.D., MiozzariH.H., WyssT.F., NötzliH.P.Surgical hip dislocation for the treatment of femoroacetabular impingement in high-level athletes.Am J Sports Med.2011; 39(3): 544–50.
14.
PhilipponM.J., BriggsK.K., YenY.M., KuppersmithD.A.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.
15.
PhilipponM., SchenkerM., BriggsK., KuppersmithD.Femoroacetabular impingement in 45 professional athletes: associated pathologies and return to sport following arthroscopic decompression.Knee Surg Sports Traumatol Arthrosc.2007; 15(7): 908–14.
16.
PhilipponM.J., YenY.M., BriggsK.K., KuppersmithD.A., MaxwellR.B.Early outcomes after hip arthroscopy for femoroacetabular impingement in the athletic adolescent patient: a preliminary report.J Pediatr Orthop.2008; 28(7): 705–10.
17.
TegnerY., LysholmJ.Rating systems in the evaluation of knee ligament injuries.Clin Orthop Relat Res.1985; 198(198): 43–9.
18.
MarxR.G., StumpT.J., JonesE.C., WickiewiczT.L., WarrenR.F.Development and evaluation of an activity rating scale for disorders of the knee.Am J Sports Med.2001; 29(2): 213–8.
19.
NaalF.D., ImpellizzeriF.M., LeunigM.Which is the best activity rating scale for patients undergoing total joint arthroplasty?Clin Orthop Relat Res.2009; 467(4): 958–65.
20.
BeauléP.E., Le DuffM.J., ZaragozaE.Quality of life following femoral head-neck osteochondroplasty for femoroacetabular impingement.J Bone Joint Surg Am.2007; 89(4): 773–9.
21.
LingardE.A., SledgeC.B., LearmonthI.D.Kinemax Outcomes Group. Patient expectations regarding total knee arthroplasty: differences among the United States, United kingdom, and Australia.J Bone Joint Surg Am.2006; 88(6): 1201–7.
22.
MancusoC.A., SalvatiE.A., JohansonN.A., PetersonM.G., CharlsonM.E.Patients’ expectations and satisfaction with total hip arthroplasty.J Arthroplasty.1997; 12(4): 387–96.
23.
BeatonD.E., BombardierC., GuilleminF., FerrazM.B.Guidelines for the process of cross-cultural adaptation of self-report measures.Spine.2000; 25(24): 3186–91.
MartinR.L., KellyB.T., PhilipponM.J.Evidence of validity for the hip outcome score.Arthroscopy.2006; 22(12): 1304–11.
26.
NaalF.D., ImpellizzeriF.M., MiozzariH.H., MannionA.F., LeunigM.The German Hip Outcome Score: validation in patients undergoing surgical treatment for femoroacetabular impingement.Arthroscopy.2011; 27(3): 339–45.
27.
BellamyN., BuchananW.W., GoldsmithC.H., CampbellJ., StittL.W.Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee.J Rheumatol.1988; 15(12): 1833–40.
28.
StuckiG., MeierD., StuckiS.. Evaluation of a German version of WOMAC (Western Ontario and McMaster Universities) Arthrosis Index.Z Rheumatol.1996; 55(1): 40–9.
29.
DawsonJ., FitzpatrickR., CarrA., MurrayD.Questionnaire on the perceptions of patients about total hip replacement.J Bone Joint Surg Br.1996; 78(2): 185–90.
30.
NaalF.D., SieverdingM., ImpellizzeriF.M., von KnochF., MannionA.F., LeunigM.Reliability and validity of the cross-culturally adapted German Oxford hip score.Clin Orthop Relat Res.2009; 467(4): 952–7.
31.
NilsdotterA.K., LohmanderL.S., KlässboM., RoosE.M.Hip disability and osteoarthritis outcome score (HOOS) – validity and responsiveness in total hip replacement.BMC Musculoskeletal Disord.2003; 4(1): 10.
32.
GandekB., WareJ.E., AaronsonN.K., ApoloneG., BjornerJ.B., BrazierJ.E., BullingerM., KaasaS., LeplegeA., PrietoL., SullivanM.Cross-Validation of Item Selection and Scoring for the SF-12 Health Survey in Nine Countries: results from the IQOLA Project.J Clin Epidemiol.1998; 51(11): 1171–8.
33.
WareJ.Jr., KosinskiM., KellerS.D.A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity.Med Care.1996; 34(3): 220–33.
34.
McGrawK.O., WongS.P.Forming inferences about some intraclass correlation coefficients.Psychol Methods.1996; 1(1): 30–46.
35.
HustedJ.A., CookR.J., FarewellV.T., GladmanD.D.Methods for assessing responsiveness: a critical review and recommendations.J Clin Epidemiol.2000; 53(5): 459–68.
36.
TerweeC.B., DekkerF.W., WiersingaW.M., PrummelM.F., BossuytP.M.On assessing responsiveness of health-related quality of life instruments: guidelines for instrument evaluation.Qual Life Res.2003; 12(4): 349–62.
