Informed Decisions and Patient Outcomes: An Interdisciplinary Approach to Chronic Hip Pain

Ohio State University, Columbus OH

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Abstract

PROJECT SUMMARY Persons with non-arthritic hip disease (NAHD) go through frustrating encounters with the health care system, often seeing more than 3 providers before receiving a diagnosis. These patients experience pain, weakness, and disability which limits their participation in activities of daily living. While surgical treatment for these patients is common after failed conservative treatment, a systematic review and meta-analysis demonstrated that only 25% of patients achieve an optimal state of health on average 2.5 years after hip arthroscopy. These sub- optimal outcomes may be attributed to the lack of evidence supporting 1) identification of appropriate surgical versus non-surgical candidates and 2) effectiveness of non-operative intervention. A majority of these patients present with abnormal movement patterns before and after surgery during functional tasks such as walking, stair climbing, and squatting. These patients may benefit from specific posture and movement training (PMT), which has recently demonstrated positive effects on movement and patient-reported outcomes from preliminary results of a randomized controlled trial. An interdisciplinary evaluation, including assessment of posture and movement, may be the critical mechanism by which patients can make informed decisions about their treatment options. In my process of becoming an independent clinician-scientist, the long term goal of my training project is to optimize interdisciplinary care between physical therapists and physicians to improve patient outcomes after treatment for NAHD. Interdisciplinary collaboration between these practitioners provides the opportunity to review the patient?s history, impairments, and their treatment recommendations. Applying this interdisciplinary evaluation will allow identification of any effect on treatment decisions for persons with NAHD (Aim 1). Furthermore, the literature lacks information detailing the effect short-term PMT has on both the biomechanics of movement and patient-reported outcomes in this population (Aim 2) and how changes from PMT can influence treatment decisions (Aim 3). Through these aims, we will test the overarching hypothesis that interdisciplinary evaluation and subsequent treatment of patients with NAHD will improve patient-reported outcomes and satisfaction through a more informed, comprehensive decision-making process. If the results of this project support our hypothesis, this model interdisciplinary evaluation has the potential to impact clinical decision- making process for a variety of orthopaedic conditions.