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Diagnostic accuracy of patient history in the diagnosis of hip-related pain: a systematic review

Wright AA, Ness BM, Donaldson M

Archives of Physical Medicine and Rehabilitation 2021 Dec;102(12):2454-2463

systematic review

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 to 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 to 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.

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