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Diagnostic Accuracy of Patient History in the Diagnosis of Hip-Related Pain: A Systematic Review

Published:April 27, 2021DOI:https://doi.org/10.1016/j.apmr.2021.03.029

      Abstract

      Objective

      To investigate the diagnostic accuracy of patient history associated with hip pain.

      Data Sources

      A systematic, computerized search of electronic databases (PubMed, MEDLINE, Cumulative Index of Nursing and Allied Health Literature, and Web of Science), a search of the gray literature, and review of the primary author's personal library was performed. Hip-specific search terms were combined with diagnostic accuracy and subjective or self-report history-based search terms using the Boolean operator “AND.”

      Study Selection

      This systematic review was conducted and reported according to the protocol outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The inclusion criteria were: (1) patients with hip pain; (2) the statistical association of at least 1 patient history item was reported; (3) study designs appropriate for diagnostic accuracy; (4) adults aged ≥18 years; (5) written in English; and (6) used an acceptable reference standard for diagnosed hip pathology. Titles and abstracts of all database-captured citations were independently screened by at least 2 reviewers.

      Data Extraction

      Two reviewers independently extracted information and data regarding author, year, study population, study design, criterion standard, and strength of association statistics associated with the subjective findings.

      Data Synthesis

      For hip osteoarthritis (OA), a family history of OA (positive likelihood ratio [+LR], 2.13), history of knee OA (+LR, 2.06), report of groin or anterior thigh pain (+LR, 2.51-3.86), self-reported limitation in range of motion of 1 or both hips (+LR, 2.87), constant low back pain or buttock pain (+LR, 6.50), groin pain on the same side (+LR, 3.63), and a screening questionnaire (+LR, 3.87-13.29) were the most significant findings. For intra-articular hip pathology, crepitus (+LR, 3.56) was the most significant finding.

      Conclusions

      Patient history plays a key role in differential diagnosis of hip pain and in some cases can be superior to objective tests and measures.

      Keywords

      List of abbreviations:

      FAI (femoroacetabular impingement), LR (likelihood ratio), OA (osteoarthritis), OR (odds ratio), QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies), SP (specificity)
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