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髋关节疼痛和髋关节骨性关节炎实践指南

已有 2310 次阅读 2017-6-21 08:06 |个人分类:临床指南和病例解析|系统分类:观点评述| style, 髋关节, color, 骨性关节炎

髋关节疼痛和髋关节骨性关节炎实践指南

髋关节疼痛和髋关节骨性关节炎实践指南

DIAGNOSIS/CLASSIFICATION
2017 Recommendation
Clinicians should use the following criteria to classify adults over the age of 50 years into the International Statistical Classification of Diseases and Related Health Problems (ICD) category of coxarthrosis and the associated International Classification of Functioning, Disability and Health (ICF) impairment-based category of hip pain (b28016 Pain in joints) and mobility deficits (b7100 Mobility of a single joint): moderate anterior or lateral hip pain during weightbearing activities, morning stiffness less than 1 hour in duration after wakening, hip internal rotation range of motion less than 24° or internal rotation and hip flexion 15° less than the nonpainful side, and/or increased hip pain associated with passive hip internal rotation.

DIFFERENTIAL DIAGNOSIS
2017 Recommendation
Clinicians should revise the diagnosis and change their plan of care, or refer the patient to the appropriate clinician, when the patient’s history, reported activity limitations, or impairments of body function and structure are not consistent with those presented in the diagnosis/classification section of this guideline, or when the patient’s symptoms are not diminishing with interventions aimed at normalization of the patient’s impairments of body function.

EXAMINATION – OUTCOME MEASURES: ACTIVITY LIMITATION/SELF-REPORT MEASURES
2017 Recommendation
Clinicians should use validated outcome measures that include domains of hip pain, body function impairment, activity limitation, and participation restriction to assess outcomes of treatment of hip osteoarthritis.
Measures to assess hip pain may include the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale, Brief Pain Inventory (BPI), pressure pain threshold (PPT), and pain visual analog scale (VAS).
Activity limitation and participation restriction outcome measures may include the WOMAC physical function subscale, the Hip disabi ity and Osteoarthritis Outcome Score (HOOS), Lower Extremity Functional Scale (LEFS), and Harris Hip Score (HHS).

EXAMINATION – ACTIVITY LIMITATION/PHYSICAL
PERFORMANCE MEASURES
2017 Recommendation
To assess activity limitation, participation restrictions, and changes in the patient’s level of function over the episode of care, clinicians should utilize reliable and valid physical performance measures, such as the 6-minute walk test, 30-second chair stand,stair measure, timed up-and-go test, self-paced walk, timed singleleg stance, 4-square step test, and step test.
Clinicians should measure balance performance and activities that predict the risk of falls in adults with hip osteoarthritis,especially those with decreased physical function or a high risk of falls because of past history. Recommended balance tests for patients with osteoarthritis include the Berg Balance Scale, 4-square step test, and timed single-leg stance test.
Clinicians should use published recommendations from the Academy of Geriatric Physical Therapy of the American Physical Therapy Association6 to guide fall risk management in patients with hip osteoarthritis to assess and manage fall risk.

EXAMINATION – PHYSICAL IMPAIRMENT MEASURES
2017 Recommendation
When examining a patient with hip pain/hip osteoarthritis over an episode of care, clinicians should document the flexion, abduction, and external rotation (FABER or Patrick’s) test and passive hip range of motion and hip muscle strength, including internal rotation,external rotation, flexion, extension, abduction, and adduction.

INTERVENTIONS – PATIENT EDUCATION
2017 Recommendation
Clinicians should provide patient education combined with exercise and/or manual therapy. Education should include teaching activity modification, exercise, supporting weight reduction when overweight, and methods of unloading the arthritic joints.

INTERVENTIONS – FUNCTIONAL, GAIT, AND BALANCE TRAINING
2017 Recommendation
Clinicians should provide impairment-based functional, gait, and balance training, including the proper use of assistive devices (canes, crutches, walkers), to patients with hip osteoarthritis and activity limitations, balance impairment, and/or gait limitations when associated problems are observed and documented during the history or physical assessment of the patient.
Clinicians should individualize prescription of therapeutic activities based on the patient’s values, daily life participation, and functional activity needs.

INTERVENTIONS – MANUAL THERAPY
2017 Recommendation
Clinicians should use manual therapy for patients with mild to moderate hip osteoarthritis and impairment of joint mobility,flexibility, and/or pain. Manual therapy may include thrust, nonthrust,and soft tissue mobilization. Doses and duration may range from 1 to 3 times per week over 6 to 12 weeks in patients with mild to moderate hip osteoarthritis. As hip motion improves, clinicians should add exercises including stretching and strengthening to augment and sustain gains in the patient’s range of motion, flexibility, and strength.

INTERVENTIONS – FLEXIBILITY, STRENGTHENING, AND ENDURANCE EXERCISES
2017 Recommendation
Clinicians should use individualized flexibility, strengthening, and endurance exercises to address impairments in hip range of motion, specific muscle weaknesses, and limited high (hip) muscle flexibility. For group-based exercise programs, effort should be made to tailor exercises to address patients’ most relevant physical impairments. Dosage and duration of treatment for effect should range from 1 to 5 times per week over 6 to 12 weeks in patients with mild to moderate hip osteoarthritis.

INTERVENTIONS – MODALITIES
2017 Recommendation
Clinicians may use ultrasound (1 MHz; 1 W/cm2 for 5 minutes each to the anterior, lateral, and posterior hip for a total of 10 treatments over a 2-week period) in addition to exercise and hot packs in the short-term management of pain and activity limitation in individuals with hip osteoarthritis.

INTERVENTIONS – BRACING
2017 Recommendation
Clinicians should not use bracing as a first line of treatment. A brace may be used after exercise or manual therapies are unsuccessful in improving participation in activities that require turning/pivoting for patients with mild to moderate hip osteoarthritis, especially in those with bilateral hip osteoarthritis.

INTERVENTIONS – WEIGHT LOSS
2017 Recommendation
In addition to providing exercise intervention, clinicians should collaborate with physicians, nutritionists, or dietitians to support weight reduction in individuals with hip osteoarthritis who are overweight or obese.
*These recommendations and clinical practice guidelines are based on the scientific literature published prior to April 2016. Please refer to our previously published guidelines on “Hip Pain and Mobility Deficits – Hip Osteoarthritis” for literature reviewed prior to 2009.