The PCR Hip study:
Osteoarthritis of the Hip in Primary Care: A prospective Community-Based Study of Hip Pain Osteoarthritis is a major public health problem in Britain and It is the principal cause of disability in the older population; Osteoarthritis of the hip is its most disabling manifestation. It is estimated that 5 per cent of adults over 65 years have symptomatic osteoarthritis of the hip (Willock: 1979) and this condition is responsible for most of the 39,000 hip replacements performed each year in this country (Frankels: 1990).
The principal aims of our study were to:
- To determine the clinical and radiological outcome in patients newly presenting with hip osteoarthritis in primary care.
- To determine the influence of baseline demographic, clinical and radiographic status on subsequent outcome in these patients.
Methods
General practitioners were recruited via the Primary Care Rheumatology Society. All participants were asked to enrol consecutive new attenders aged 40 years or older presenting with musculoskeletal pain in the hip area. Factors of interest include hip pain symptoms, activities, impact on health status (SF-36) standardised examination of the hip movement, AP pelvis radiographic scored for minimal joint space and modified Kellegren & Lawrence grades and referral for total hip replacement. A total of 195 subjects were recruited on to the study. A total of 135 subjects have been successfully followed up to year five of the study. The data returns are very good. We have achieved excellent response rates in year five with 93% of clinical history data, 88% of WOMAC and pain questionnaires, 75% of examination data and 63% of x-ray data has been returned to date; data collection is still underway. All patients are now in their fifth and final year of the study.
Study team
There have been a number of changes to the study team. Dr Fraser Birrell has returned to Rheumatology, having successfully completed his PHD. Ms Jean Martin has moved into a teaching position at a further Education College, and Dr Elizabeth Nahit is the National project manager of study looking at smoking prevalence in young people. Cara Afzal has taken over the task of co-ordinating the project and will see the study through to the end of data collection.
Publications
Predicting radiographic hip osteoarthristis from range of movement Birrell F, Silman A, Croft P,Cooper C, Hosie G, Macfarlane G, on behalf of the PCR Hip study groups Rheumatology (2001; 40:506-512). Radiographic change is common in new presenters in primary care with hip pain Birrell F, Silman A, Croft P,Cooper C, Hosie G, Macfarlane G, Rheumatology (2000; 39:772-775)Health impact of pain in the hip region with and without radiographic evidence of osteoarthritis a study of new attenders to primary care Birrell F, Silman A, Croft P,Cooper C, Hosie G, Macfarlane G Ann Rheum dis (2000; 59) We are continuing to analyse the data in relation to radiographic change as a predictor of disability and long-term pain a manuscript on this work is in preparation.
Presentation of results
We have found that there is a substantial impact from hip pain, even at first presentation to primary care with this problem. New hip pain attenders with radiographic OA had restricted movement at the hip compared with those without radiographic change. Restriction in internal rotation was most predictive and flexion least predictive of radiographic OA. (F. Birrell: 2001).
Final note
The success of this study has largely been due to the invaluable support we have received from the recruiting GP's from the Primary Care Rheumatology Society. Together we will be able to improve the power of the study.We would like to take this opportunity to thank all the GP's your valuable contribution is much appreciated.
Poster Presentations
The Musculoskeletal Survey we have undertaken has been presented at the following venues:
- ISOPOR International Symposium in Washington
- OARSI International Symposium in Barcelona
The interest generated has resulted in modifications to the Survey. You may have noticed that we included questions from the MRC Health Services Research Collaboration Bristol Unit. At the European Health Economics Symposium in Rotterdam, we had a poster presentation based around our NICE submission on Cox II's.