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PHYS THER
Vol. 87, No. 10, October 2007, p. 1407
DOI: 10.2522/ptj.2007.87.10.1407.1
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Letters and Responses

On "Development of a clinical prediction rule..." Currier et al. Phys Ther. 2007;87:1106–1119.


We read with interest the paper by Currier et al.1 Although we do not dispute the authors’ conclusion that their clinical prediction rule (CPR) can help identify candidates for hip mobilization in the population with knee pain, our alternative interpretation of their findings is that the CPR has helped to identify a subgroup of subjects with symptomatic hip osteoarthritis (OA) in their study cohort. Specifically, in the study by Currier and colleagues, all subjects except one had radiographic evidence or magnetic resonance imaging findings of hip OA. Given that the 2 CPR predictors of (1) hip or groin pain and (2) limited hip medial rotation are closely related to the clinical diagnosis of hip OA,2 we think it is reasonable to conclude that most of the responders to hip mobilization were likely to have satisfied both the radiographic and clinical criteria of hip OA.

Identifying patients with symptomatic hip OA poses a diagnostic challenge. Khan et al3 examined the pain location in the lower limb of 120 patients awaiting total hip arthroplasty or spinal decompression, and anterior thigh pain was found to be present in 70% of the patients with symptomatic hip OA. Furthermore, the researchers found that groin pain (positive likelihood ratio [PLR]=2.8) was the only region that distinguished symptomatic hip OA from a lumbosacral condition.

In 97 patients with lower-extremity pain, Brown and colleagues4 reported that groin pain and limited medial rotation of the hip were more closely associated with the presence of symptomatic hip OA than with the presence of spinal conditions. In a multicenter study of 195 patients with hip and groin pain, Birrell and colleagues5 found that limited hip medial rotation (<23°) alone was most predictive of mild to moderate radiographic hip OA (PLR=2.5). In the study by Currier and colleagues,1 among the CPR predictors, pain or paresthesia in the ipsilateral hip or groin had the highest PLR (8.10) in the bivariate analyses, whereas limited hip medial rotation (<17°) had the second highest PLR (6.02). Interestingly, when the standard error of measurement (6°) is considered in the interpretation of the latter predictor, the resultant cutoff value (upper bound) of hip medial rotation is remarkably similar to that found by Birrell and colleagues.5

In summary, we believe an equally tenable interpretation of the study by Currier et al is that subjects with radiographic and specific clinical symptoms of hip OA, as defined by the CPR, tended to respond favorably to hip mobilization.

Yong-Hao Pua and Boon Whatt Lim

YH Pua is doctoral candidate, Centre for Health, Exercise, and Sports Medicine, The University of Melbourne, Victoria, Australia

Address all correspondence to Yong-Hao Pua at: y.pua{at}pgrad.unimelb.edu.au


  Footnotes
 
This letter was posted as a Rapid Response on July 11, 2007, at www.ptjournal.org.

References

  1. Currier LL, Froehlich PJ, Carow SD, McAndrew RK. Development of a clinical prediction rule to identify patients with knee pain and clinical evidence of knee osteoarthritis who demonstrate a favorable short-term response to hip mobilization. Phys Ther. 2007;87:1106–1119.[Abstract/Free Full Text]
  2. Altman R, Alarcon G, Appelrouth D, et al. The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hip. Arthritis Rheum. 1991;34:505–514.[Web of Science][Medline]
  3. Khan AM, McLoughlin E, Giannakas K, et al. Hip osteoarthritis: where is the pain? Ann R Coll Surg Engl. 2004;86:119–121.[CrossRef][Web of Science][Medline]
  4. Brown MD, Gomez-Marin O, Brookfield KF, Li PS. Differential diagnosis of hip disease versus spine disease. Clin Orthop Relat Res. 2004;419:280–284.[CrossRef][Medline]
  5. Birrell F, Croft P, Cooper C, et al. Predicting radiographic hip osteoarthritis from range of movement. Rheumatology (Oxford). 2001;40:506–512.[CrossRef][Medline]

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This Article
Right arrow Extract Freely available
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Rapid Responses are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Pua, Y.-H.
Right arrow Articles by Lim, B. W.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Pua, Y.-H.
Right arrow Articles by Lim, B. W.
Related Collections
Right arrow Injuries and Conditions: Knee
Right arrow Osteoarthritis
Right arrow Clinical Prediction Rules
Right arrow Osteoarthritis
Social Bookmarking
Add to CiteULike   Add to Complore   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Reddit   Add to Technorati  
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