M. Abady Avman1, P. Osmotherly1, D. Rivett1, S. Snodgrass1
1University of Newcastle, Faculty of Health and Medicine, School of Health Sciences, Newcastle, Australia
Background: Chronic Nonspecific low back pain (CNSLBP) is a common musculoskeletal problem affecting approximately 80% of the population during their lifetime.
Evidence supporting the association between hip joint movement impairment and CNSLBP is inconsistent. However, a recent survey of American physiotherapists reported clinicians often examine the hip joint in patients with low back pain. Clinical guidelines recommend hip joint assessment in individuals with CNSLBP, however, specific recommendations are lacking. Therefore, there is a need to gather expert opinion to inform the relevance and type of hip joint assessment that may be most useful for patients with CNSLBP. Evidence from experts may provide recommendations to inform a more structured and concise assessment of the hip joint in the management of CNSLBP patients.
Evidence supporting the association between hip joint movement impairment and CNSLBP is inconsistent. However, a recent survey of American physiotherapists reported clinicians often examine the hip joint in patients with low back pain. Clinical guidelines recommend hip joint assessment in individuals with CNSLBP, however, specific recommendations are lacking. Therefore, there is a need to gather expert opinion to inform the relevance and type of hip joint assessment that may be most useful for patients with CNSLBP. Evidence from experts may provide recommendations to inform a more structured and concise assessment of the hip joint in the management of CNSLBP patients.
Purpose: Establish consensus as to the relevance and importance of hip joint movement assessment, movement types and directions (active, passive, passive accessory) in individuals with CNSLBP using the Delphi method approach.
Methods: Through a three-round (online) survey process, experts in the field rated levels of agreement (5-point Likert scale) and importance (4-point Likert) of assessing proposed hip joint movement impairments. Experts were defined as first or last authors of peer-reviewed publications relating to the relationship between hip range of motion (ROM) and CNSLBP and expert musculoskeletal clinicians who were Fellows of the Australian College of Physiotherapists.
Consensus was defined a priori as ≥75% agreement. Data analysis at the end of round III formed, by consensus, a list and rationale of hip joint movements that are recommended to be assessed in individuals with CNSLBP.
Consensus was defined a priori as ≥75% agreement. Data analysis at the end of round III formed, by consensus, a list and rationale of hip joint movements that are recommended to be assessed in individuals with CNSLBP.
Results: The expert panel (n=27) included a mix of international clinicians and researchers with the majority of the sample (n= 26, 96%) being involved in research.
All participants (100%) agreed that limited hip movement can be associated with CNSLBP and should be assessed, and that this provides information regarding compensatory movement of the lumbar spine. Experts reached consensus that the following types of hip movements should be assessed, and were important to assess: active hip movement (92% agreed should be assessed; 92% agreed were important), passive hip movement (100%; 100%); active movements recommended for assessment were hip flexion (96%; 92%), extension (92%; 92%) and abduction (85%; 85%); passive hip movements were flexion (96%; 100%), extension (100%; 96%), abduction (85%; 96%) and internal and external rotation (92%; 92%). Experts did not agree on whetherpassive accessory movement should be assessed.
All participants (100%) agreed that limited hip movement can be associated with CNSLBP and should be assessed, and that this provides information regarding compensatory movement of the lumbar spine. Experts reached consensus that the following types of hip movements should be assessed, and were important to assess: active hip movement (92% agreed should be assessed; 92% agreed were important), passive hip movement (100%; 100%); active movements recommended for assessment were hip flexion (96%; 92%), extension (92%; 92%) and abduction (85%; 85%); passive hip movements were flexion (96%; 100%), extension (100%; 96%), abduction (85%; 96%) and internal and external rotation (92%; 92%). Experts did not agree on whetherpassive accessory movement should be assessed.
Conclusions: The expert panel agreed that the assessment of active and passive hip joint movement impairment is relevant and important, and may be informative to clinicians in their management of individuals with CNSLBP. Most commonly reported as essential to assess were active ROM of flexion, extension, and abduction, and passive ROM of flexion, extension, internal/external rotation and abduction.
Implications: Hip joint ROM assessment (active and passive) is relevant and informative and experts recommend it should be part of standard physical examination in patients presenting with CNSLBP. This study did not examine the relevance of, and types of interventions recommended for hip joint movement impairments in CNSLBP patients, hence clinical implications for management are limited.
Funding acknowledgements: There was no funding for this study
Keywords:
Low back pain
Hip joint range of movement
Hip joint assessment
Low back pain
Hip joint range of movement
Hip joint assessment
Topics:
Musculoskeletal
Musculoskeletal: spine
Musculoskeletal: spine
Musculoskeletal
Musculoskeletal: spine
Musculoskeletal: spine
Did this work require ethics approval? Yes
Institution: University of Newcastle, Australia
Committee: Human Research Ethics Committee
Ethics number: H-2021-0203
All authors, affiliations and abstracts have been published as submitted.
