Here we are, on the final paper from my 12 Top Hip Papers series of miniblogs from 2023 series. I hope you enjoyed catching up on the 12 top hip papers that have contributed this year to our understanding of hip conditions and/or the assessment or management of hip pain or injury. If you haven't already, you can pick up the ebook for the 12 top hip papers of 2022 series. Keep an eye out in January for the ebook from the 2023 series.
Our last paper is one that looked at the effects of hip pain diagnostic labels and their explanations on beliefs about hip pain and how to manage it. I hope you enjoy this last edition.
For your convenience, we have also developed this content into a FREE 31-page full colour ebook!
Packed full of 12 Top Hip Papers - peer reviewed scientific papers from 2023, that have contributed to our understanding of hip conditions and/or the assessment or management of hip pain or injury.
12 of 12 Top Hip Papers of 2023 : Effects of hip pain diagnostic labels and their explanations on beliefs about hip pain and how to manage it1
There has been much discussion about the potential harmful effects of some of the language and explanations that health professionals use for musculoskeletal conditions, but we still have limited information that guides us around 'best language' and 'best explanations' for hip pain.
- To compare the effects of diagnostic labels and their explanations on people’s beliefs about managing hip pain.
What was done:
- A 3-arm, parallel group,
superiority randomised clinical trial
- Participants were randomised to receive a diagnostic label and explanation of
- (1) hip osteoarthritis,
- (2) persistent hip pain, or
- (3) hip degeneration.
- Participants who were aged ≥45 years, with and without hip pain, were delivered all information and responses collected during a single online session, through the Qualtrics platform.
- They were asked to consider a hypothetical scenario where they were provided their assigned diagnosis and its explanation in an initial medical consultation.
- Based on the information provided, beliefs on the following were collected:
- exercise would damage the hip,
- surgery is necessary at some stage,
- other treatments, and
- care providers.
- Participants who were allocated to hip osteoarthritis and persistent hip pain believed exercise was less damaging for their condition, compared to those diagnosed with hip degeneration.
- Participants who were allocated to persistent hip pain believed surgery was less necessary that those receiving a diagnosis of hip osteoarthritis.
- Participants allocated to hip osteoarthritis and persistent hip pain were less concerned about their hip and believed exercise and care from an exercise and sports physician, rheumatologist, or physiotherapist would be more helpful, and care from an orthopaedic surgeon less helpful.
- Participants diagnosed with hip osteoarthritis and hip degeneration may be more satisfied with the label and explanation provided, compared to those who received a diagnosis and explanation of persistent hip pain.
- People who received a diagnosis and explanation of hip degeneration or hip osteoarthritis were more likely to express that the diagnosis made them feel old, concerned and worried, but less often felt frustrated, annoyed or uninformed compared to those who received a diagnosis of persistent hip pain.
The main takeaways from this paper are:
i) A diagnosis of hip degeneration may be unhelpful, generating relatively high levels of concern and fear of exercise as potentially damaging.
ii) A diagnosis of persistant hip pain may also be unhelpful, due to the frustration caused by a lack of structural explanation for ongoing pain.
iii) Of the 3 provided, hip osteoarthritis may be the most helpful diagnosis, providing more clarity for the patient while still resulting in a favourable view of active rehabilitation.
There seems to have been a trend towards very generic diagnostic terms and explanations in musculoskeletal medicine. Diagnoses such as 'persistant hip pain' or 'hip related pain' may be less worrisome for the patient, but often leave the patient uninformed and frustrated.
While in medicine, we are embracing the biopsychosocial approach and acknowledging the multifaceted nature of pain, patients are often seeking a structural diagnosis. While this might not be possible for all situations, if there is a structural explanation, discussing this with the patient within a positive framework, with the focus on what can be done, is often empowering for the patient.
The fact that the study was a simulation, rather than an exploration of beliefs in people with hip joint related pain may be considered a limitation. However, the authors were trying to elicit a response from people who might be receiving the diagnosis and explanation for the first time, which would not be possible for those who are already aware of their condition.
While we still have a way to go in elucidating 'best language' and 'best explanations' of hip pain, this study is a useful addition to the evidence base, and a stimulus for further research. Thanks to the authors for their work in this important field.
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Thank you to all the authors of the papers featured in this year's 12 Top Hip Papers of 2023! Your contributions are essential to the ongoing challenge for researchers and clinicians to better understand, assess and manage hip pain, and optimise outcomes for those suffering with such conditions.
I hope readers enjoyed the key learnings and infographics from these papers. Thanks once again for joining me, and don't forget to keep an eye out for the ebook in January.
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- Haber T, Hall M, Dobson F, Lawford BJ, McManus F, Lamb KE, Hinman RS. Effects of Hip Pain Diagnostic Labels and Their Explanations on Beliefs About Hip Pain and How to Manage It: An Online Randomized Controlled Trial. J Orthop Sports Phys Ther. 2023 Nov;53(11):673-684. doi: 10.2519/jospt.2023.11984. PMID: 37795555.