Predicting patient-reported outcomes in patients with pre-arthritic hip disorders

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PROJECT SUMMARY / ABSTRACT Dr. Abby L Cheng, MD, is a sports medicine physiatrist with a background in biomedical engineering whose research goal is to develop and implement a comprehensive, evidence-based management algorithm for patients with pre-arthritic hip disorders (PAHD). Her educational, clinical, and research experiences uniquely prepare her to pursue this work, and this career development award will facilitate the complementary epidemiological training she requires, with an emphasis on risk prediction modeling, bioinformatics, clinical trials, and dissemination and implementation research. All research and training activities will occur at the Washington University School of Medicine, an institution with a strong health services research program and a multidisciplinary hip research group. PAHD are bony and soft tissue hip morphologies that predispose adolescents and young adults to developing hip pain, chronic impairment, and early osteoarthritis (OA). Proper management may prevent these sequelae, but current evidence, especially regarding non-operative treatment options, is limited. To address this need, the purpose of this project is to identify predictors of response to non- operative PAHD treatment options and to synthesize these predictors into a clinical prediction tool that informs non-operative one-year outcomes using data available during patients’ initial evaluation. Aim 1 is a retrospective analysis that will quantify associations between PAHD patients’ one-year clinical outcomes and their baseline clinical characteristics, Patient-Reported Outcomes Measurement Information System (PROMIS) scores, and hip-specific “legacy” patient-reported outcome measure (PROM) scores. The analysis will also determine a minimum combination of PROMIS and legacy PROM measures that reduces survey burden while maintaining similar predictive utility when compared to administration of all currently collected legacy and PROMIS measures. Aim 2 will be a prospective study to identify predictors of PAHD patient adherence and symptom response to eight weeks of therapeutic activity modification. Activity modification is a conservative treatment that addresses how patients perform routine and strenuous activities in order to reduce hip pain. It has proven to be efficacious in a randomized trial setting, but it is not yet widely discussed by physicians in the clinic setting. Finally, Aim 3 will be a prospective study to develop a clinical prediction tool that determines PAHD patients’ risk of chronic impairment or progression to surgery at one year follow-up and identifies potentially modifiable predictors. Patients’ demographics, biopsychosocial profile, movement and activity patterns, and anatomy will be considered as predictors. Completing the aims and mentored training outlined in this career development award will prepare Dr. Cheng to create, validate, and implement patient-centered, evidence based treatment models which yield quicker pain relief, improved restoration of function, and reduced long-term societal healthcare resources for patients with PAHD and other musculoskeletal conditions.