1 of 12 Top Hip Papers of 2024 | Core Outcome Set for Gluteal Tendinopathy
Welcome to my 12 Top Hip Papers series of miniblogs from 2024, starting with this paper that started the important process of develoing a Core Outcome Set for Gluteal Tendinopathy.1
Some of you might have joined me for my 12 Top Hip Papers of 2023 series last year - 12 papers from 2023 papers that contributed strongly to our understanding of hip conditions and/or the assessment or management of hip pain or injury. If you haven't already downloaded your free ebook of 12 top hip papers from 2023, you can do it by clicking HERE.
This year, I'll be focusing on helpful hip papers published in 2024. I am aiming to provide an overview of how the research has moved the hip space forward this year. I have prepared infographics and key learnings for each paper from 2024. Quick, but info-packed reads for this busy time of year.
SPECIAL HOLIDAY OFFER!
$100 OFF
your Hip Academy joining fee
Offer Only Available During the 12 Hip Days of Christmas (13th-24th December). Do not miss this exclusive offer!
Now only AUD $345 (usually $445) to join to receive immediate access to over $4,500 worth of content!!
(AUD$345 equates to approximately 181 GBP and 230 USD)
USE COUPON CODE: xmas24hip
Let's kick off day one then, with this paper that asked the experts and consulted the evidence around which outcome measures might be suitable for a Core Outcome Set for Gluteal Tendinopathy.
1 of 12 Top Hip Papers of 2024 :The development of a core outcome set for gluteal tendinopathy
Background:
-
A Core Outcome Set is a minimal set of outcome measures to be used consistently in research, for better synthesis and translation of evidence.
-
Currently, studies of patients with gluteal tendinopathy or greater trochanteric pain syndrome (GTPS) use a wide range of varied outcome measures, many of these being hip osteoarthritis measures that are not ideal for measuring outcomes of patients with gluteal tendinopathy. This makes it difficult to interpret outcomes, and compare outcomes across studies in systematic reviews.
-
A standardised group of measures, covering the different health-related domains for tendinopathy is necessary.
Study Aim:
The aim of this project was to develop a Core Outcome Set for Gluteal Tendinopathy (COS-GT) to optimise pooling of data in evidence synthesis and to ensure patients with GT are being evaluated with the most
meaningful measures.
What was done:
- The study involved a scoping review of outcome measures used in GT or GTPS, a systematic review and meta-analysis of available clinimetric properties of the different measures, a Delphi study of experts (2 surveys and a live online meeting) and a Patient Focus Group. Only measures that mapped to the ICON core health-related domains for tendinopathy2 were considered.
This paper was a culmination of many years of work by our research group. This is a brief overview of the steps involved.
Scoping review of the literature and mapping of outcomes to domains
- 64 unique outcome measurements were identified.
- 57 outcome measures were mapped to the ICON core domains.2
Survey 1 of Expert Health Professionals
- Health professionals (n=34 experts) were asked to vote on the truth and feasibility of the outcome measures identified in the scoping review.
- They voted in 5 Outcome Measures, 6 Outcome Measures were excluded, with the remaining undecided.
Systematic Review and Meta-analysis of Clinimetrics of Outcome Measures for GT/GTPS
- This meta-analysis (published as a separate paper) found only 2 measures had undergone clinimetric testing, with neither achieving a pass for a COS within the COSMIN guidelines i.e., NO MEASURES WERE ADEQUATE FOR A COS.3
Survey 2 of Expert Health Professionals
- Health professionals (n=33 experts) considered which measures may then be recommended in the interim.
- 8 Outcome Measures reached consensus for recommendation, with 2 others close to consensus.
Patient Focus Group
- 7 Outcome Measures were considered useful by a patient group with GT (n=7), and valuable insight into their experience was provided.
Final Consensus Meeting of Expert Health Professionals
- Health professionals (n= 18 who could attend a live meeting) discussed Survey 2 results and the patient input.
- Recommendations and research priorities were developed.
Key Findings:
No outcome measures are currently adequate for inclusion in a COS-GT.
These are the recommended interim measures for each domain.
Clinical Implications:
In clinical practice, time is short and the clinician is unlikely to be able to collect measureable data in each of these core health-related domains. Choose what is most relevant to the individual and use the best measures currently available.
Measuring Pain
Pain is usually a primary concern for those with GT/GTPS, so measuring it and how it responds to treatment is important. Patients often find it difficult to put a number on their pain, which is why our patient focus group were not in agreeance with measuring pain intensity.
An important thing with measuring pain, is trying to anchor it to something that the patient can relate to - ask them to reflect on a set timeframe (e.g., over the last week) or anchor it to a painful and meaningful task for the patient (e.g. walking up a flight of stairs).
Pain constancy over the last week (where 0% is no pain and 100% is constant pain) is also a useful concept that may improve even while pain intensity remains stable.
Overall Rating of Condition
Another quick and easy thing to measure outcomes of treatment is a Global Rating Of Change (GROC) score. A 7-point GROC was recommended and patients in our patient focus group liked this score as well.
The patient is asked something like: 'With respect to your hip condition, how would you describe yourself now compared to when you first began treatment?' There are a range of options either side of 'No Change'. If the patient is better, they rate how much better - slightly, moderately, or much better. If the patient is worse, they rate how much worse - slightly, moderately, or much worse.
Physical Measures
The only physical measure that was considered was an abductor strength test, measured with a dynamometer to improve objectivity and reliability. This is usually performed in supine with belt fixation.
The clinician can also physically test painful functional tasks like standing on one leg or stepping up a step, and ask the patient to rate the level of pain they experience on the test - this is considered a 'Pain on Loading' test and is commonly used to measure progress in other lower limb tendinopathies.
Other Measures
Depending on the health domains that are most impacted for the individual patient, you may also consider tracking changes in Psychological Factors, Quality of Life and Disability. There wasn't great agreement between professionals and patients regarding the currently available measures in those last 2 domains.
Further work needs to be done with patient input to develop measures in these domains that people with GT/GTPS consider will better reflect and measure change in their experience.
NEXT STEPS
Our research group is continuing this journey of partnering with ppeople with lived experience of this condition, to improve the way we measure outcomes in those with gluteal tendinopathy.
Like to learn more about managing gluteal tendinopathy?
In this course, you can find detailed information on pathoaetiology, assessment and management of lateral hip pain associated with gluteal tendinopathy (greater trochanteric pain syndrome, trochanteric 'bursitis'), and many other conditions. To learn more, take the online course, or join me in a workshop.
This online course is included in Hip Academy and Hip Academy members receive discounts for online workshops.
I hope you enjoyed the infographic and key learnings from Day 1 of my 12 Top Hip Papers of 2024. There are 11 more papers in this series, so keep an eye out for day 2 below, to see what other top papers and infographics I have prepared for you!
Paper 2 comes out tomorrow!
Have you heard about Hip Academy?
Enjoy the benefits of a world class educational Hip Program, specifically designed by Dr Alison Grimaldi to help improve your knowledge surrounding the Hip and Pelvis, and become an expert in your field.
With all Hip Courses included, enjoy all the extra inclusions, including; access to the entire eBook series, growing video library, expanding PDF resource centre, regular member meetings, forums + lots more!
Reference
- Fearon AM, Grimaldi A, Mellor R, Nasser AM, Fitzpatrick J, Ladurner A; COS-GT consensus group; Vicenzino B. ICON 2020-International Scientific Tendinopathy Symposium Consensus: the development of a core outcome set for gluteal tendinopathy. Br J Sports Med. 2024 Jan 12:bjsports-2023-107150. doi: 10.1136/bjsports-2023-107150. Epub ahead of print. PMID: 38216320.
- Vicenzino B, de Vos RJ, Alfredson H, Bahr R, Cook JL, Coombes BK, Fu SN, Gravare Silbernagel K, Grimaldi A, Lewis JS, Maffulli N, Magnusson SP, Malliaras P, Mc Auliffe S, Oei EHG, Purdam C, Rees JD, Rio EK, Scott A, Speed C, Akker-Scheek IVD, Weir A, Wolf JM, Zwerver J. ICON 2019-International Scientific Tendinopathy Symposium Consensus: There are nine core health-related domains for tendinopathy (CORE DOMAINS): Delphi study of healthcare professionals and patients. Br J Sports Med. 2020 Apr;54(8):444-451. doi: 10.1136/bjsports-2019-100894. Epub 2019 Nov 4. PMID: 31685525.
- Nasser AM, Fearon AM, Grimaldi A, Vicenzino B, Mellor R, Spencer T, Semciw AI. Outcome measures in the management of gluteal tendinopathy: a systematic review of their measurement properties. Br J Sports Med. 2022 Aug;56(15):877-887. doi: 10.1136/bjsports-2021-104548. Epub 2022 Apr 8. PMID: 35396205.
Want to catch up on the 12 Top Hip Papers from 2021, 2022, and 2023?
Click below to find out more!
Sign up to my mailing list for updates and my MONTHLY HIP FACT FILES - with clinically relevant facts, stats, and featured papers.
