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Return to Sport after Hip Arthroscopy. Perspectives on a journey with many destinations.

Wörner, Tobias LU (2021) In Lund University, Faculty of Medicine Doctoral Dissertation Series
Abstract
Femoroacetabular impingement (FAI) syndrome is often treated with hip arthroscopy (HA) with the goal of enabling return to sport. While the number of HAs has been rising, little is known about the rehabilitation process or about outcomes related to return to sport (RTS) following the procedure. The overarching aim of this thesis was
to describe the rehabilitation process following HA in Scandinavia and to investigate RTS and factors potentially associated with it.

We described current rehabilitation strategies following HA in Scandinavia by surveying specialized clinicians (62 physiotherapists and 28 surgeons) in Denmark, Norway, and Sweden. We then cross-sectionally described RTS rates in 127 patients 3–39 months following HA... (More)
Femoroacetabular impingement (FAI) syndrome is often treated with hip arthroscopy (HA) with the goal of enabling return to sport. While the number of HAs has been rising, little is known about the rehabilitation process or about outcomes related to return to sport (RTS) following the procedure. The overarching aim of this thesis was
to describe the rehabilitation process following HA in Scandinavia and to investigate RTS and factors potentially associated with it.

We described current rehabilitation strategies following HA in Scandinavia by surveying specialized clinicians (62 physiotherapists and 28 surgeons) in Denmark, Norway, and Sweden. We then cross-sectionally described RTS rates in 127 patients 3–39 months following HA for FAI syndrome, defining RTS on a continuum according to consensus terminology. Subsequently, we measured patient-reported and clinically measured hip function in 33 patients 6–10 months following HA, comparing these patients with a healthy control group in a cross-sectional study. Finally, we modified and validated a patient-reported outcome measure, i.e., Hip—Return to Sport after Injury (Hip-RSI) scale, to assess psychological readiness to RTS in HA patients.

Clinicians rated structured rehabilitation as very important and reported similar expectations regarding the rehabilitation timeline during the first three months following HA for FAI syndrome. Approaching RTS, clinicians’ expectations increasingly varied, with surgeons being more optimistic than physiotherapists. Nine out of ten patients returned to some sort of sport or physical activity, while half returned to their previous sport and only one out of five returned to their previous performance level. During the time when patients could be expected to RTS, they displayed impairments in self-reported hip function and in measures related to hip mobility. The Hip-RSI
displayed adequate psychometric properties to be recommended as a valid tool in the assessment of psychological readiness in HA patients.

In the absence of evidence-based rehabilitation protocols following HA, a description of current clinical practice may serve as a first step toward establishing clinical consensus, also highlighting areas for future research. Our description of RTS rates may be used to create realistic patient expectations regarding RTS. Impairments in hip
mobility and mobility-related performance may influence but cannot fully explain observed RTS rates and impairments in self-reported function. Psychological readiness to RTS may play an important role in the RTS process following HA and can now be assessed and investigated further with the help of the Hip-RSI. (Less)
Please use this url to cite or link to this publication:
author
supervisor
opponent
  • professor Karlsson, Jón, Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
organization
publishing date
type
Thesis
publication status
published
subject
keywords
Femoroacetabular impingement, Rehabilitation, Physiotherapy, Performance, Muscle strength, Range of motion, Psychological readiness
in
Lund University, Faculty of Medicine Doctoral Dissertation Series
issue
2021:88
pages
65 pages
publisher
Lund University, Faculty of Medicine
defense location
H02-salen, Health Science Centre, Baravägen 3 i Lund. Join by Zoom: https://lu-se.zoom.us/j/63531368942
defense date
2021-09-23 13:00:00
ISSN
1652-8220
ISBN
978-91-8021-095-9
language
English
LU publication?
yes
id
02f17ee4-314d-4631-a616-341e60e9ae1e
date added to LUP
2021-08-31 14:58:43
date last changed
2021-08-31 17:43:55
@phdthesis{02f17ee4-314d-4631-a616-341e60e9ae1e,
  abstract     = {{Femoroacetabular impingement (FAI) syndrome is often treated with hip arthroscopy (HA) with the goal of enabling return to sport. While the number of HAs has been rising, little is known about the rehabilitation process or about outcomes related to return to sport (RTS) following the procedure. The overarching aim of this thesis was<br/>to describe the rehabilitation process following HA in Scandinavia and to investigate RTS and factors potentially associated with it.<br/><br/>We described current rehabilitation strategies following HA in Scandinavia by surveying specialized clinicians (62 physiotherapists and 28 surgeons) in Denmark, Norway, and Sweden. We then cross-sectionally described RTS rates in 127 patients 3–39 months following HA for FAI syndrome, defining RTS on a continuum according to consensus terminology. Subsequently, we measured patient-reported and clinically measured hip function in 33 patients 6–10 months following HA, comparing these patients with a healthy control group in a cross-sectional study. Finally, we modified and validated a patient-reported outcome measure, i.e., Hip—Return to Sport after Injury (Hip-RSI) scale, to assess psychological readiness to RTS in HA patients.<br/><br/>Clinicians rated structured rehabilitation as very important and reported similar expectations regarding the rehabilitation timeline during the first three months following HA for FAI syndrome. Approaching RTS, clinicians’ expectations increasingly varied, with surgeons being more optimistic than physiotherapists. Nine out of ten patients returned to some sort of sport or physical activity, while half returned to their previous sport and only one out of five returned to their previous performance level. During the time when patients could be expected to RTS, they displayed impairments in self-reported hip function and in measures related to hip mobility. The Hip-RSI<br/>displayed adequate psychometric properties to be recommended as a valid tool in the assessment of psychological readiness in HA patients.<br/><br/>In the absence of evidence-based rehabilitation protocols following HA, a description of current clinical practice may serve as a first step toward establishing clinical consensus, also highlighting areas for future research. Our description of RTS rates may be used to create realistic patient expectations regarding RTS. Impairments in hip<br/>mobility and mobility-related performance may influence but cannot fully explain observed RTS rates and impairments in self-reported function. Psychological readiness to RTS may play an important role in the RTS process following HA and can now be assessed and investigated further with the help of the Hip-RSI.}},
  author       = {{Wörner, Tobias}},
  isbn         = {{978-91-8021-095-9}},
  issn         = {{1652-8220}},
  keywords     = {{Femoroacetabular impingement; Rehabilitation; Physiotherapy; Performance; Muscle strength; Range of motion; Psychological readiness}},
  language     = {{eng}},
  number       = {{2021:88}},
  publisher    = {{Lund University, Faculty of Medicine}},
  school       = {{Lund University}},
  series       = {{Lund University, Faculty of Medicine Doctoral Dissertation Series}},
  title        = {{Return to Sport after Hip Arthroscopy. Perspectives on a journey with many destinations.}},
  url          = {{https://lup.lub.lu.se/search/files/101836986/Avhandling_Tobias_W_rner.pdf}},
  year         = {{2021}},
}