Hip Flexion Range of Motion and Physical Function

in Hip Osteoarthritis : Mediating Effects of Hip

Extensor Strength and Pain
Yong Hao Pua, Tim V. Wrigley, Sallie M. Cowan, and Kim L. Bennell
It is Structured to Meet the Task of Critics Journal Musculosceletal System

BY :
DADANG PUTRAWANSYAH

(105070200131003)

ANGGRAENI CITRA SETYANINGTYAS

(105070200131007)

TIARA GITA PUTRI

(105070204131002)

K3LN NURSING DEPARTMENT

MEDICAL FACULTY
BRAWIJAYA UNIVERSITY
MALANG
2011

Hip Flexion Range of Motion and Physical Function in Hip

Osteoarthritis: Mediating Effects of Hip Extensor Strength and
Pain
Yong Hao Pua, Tim V. Wrigley, Sallie M. Cowan, and Kim L. Bennell

1. IDENTIFY THE TOPIC

Hip flexion range of motion (ROM), hip extensor strength (torque
production), and hip pain are important correlates of physical function in
individuals with hip osteoarthritis (OA) to examine whether pain and hip
extensor strength mediate the hip flexion/physical. However, the
relationships among these variables remain unclear.
2. MOTIVE / BACKGROUND OF THE PROBLEM
Osteoarthritis is a disease of degeneration of the cartilage and is a
form of arthritis is most commonly found and often lead to disability
(disability). Age is directly related to the joint degeeneratif process, given
the ability of cartilage to withstand mikrofraktur artikuler with low payload
repeatedly experiencing a decline. Osteoarthritis often begins in the third
decade of age and peaked dianatara fifth and sixth decades.
Osteoarthritis affects approximately 27 million people in the United
States. An estimated 80% of the population older than 65 years have
radiographic evidence as osteoarthritis, although only 60% that cause
symptoms.
Problem of osteoarthritis in Indonesia appear larger than the
western countries in view of the high prevalence of osteoarthritis in
Malang. The incidence of osteoarthritis reach 360-380 of 100,000
inhabitants, and an estimated 1 to 2 million elderly people suffering from
disability due to osteoarthritis. In Indonesia there are two communitybased study conducted in 1992 in Bandungan (Darmawan J) and 1994 in
Malang (Kalim H). Osteoarthritis in Malang found about 10% (urban
areas), and 13.5% in rural areas. However, community surveys in
Bandungan for rural areas was much lower at around 5.4%.
From the data of the Ministry of Health, there is a significant
increase of the number of outpatients for diseases of the musculoskeletal
system and connective tissue from 2007 to 2008. In 2007, patients

amounted to 500 640 people or 1.79% of the total number of outpatients,

whereas in 2008 amounted to 175,132 people or 2.98%.
Moreover, all but a few intervention and case studies in individuals
with hip OA have documented concomitant improvement in hip flexion
ROM, pain reduction, and phys-ical function. Collectively, these findings
underscore the importance of understanding how hip flexion ROM exerts
its influence on physical function.
To our knowledge, no empirical studies have explored the
mechanistic pathways that may exist between hip flexion ROM and
physical function. Previous studies have tended to analyze the impairment
measures of hip flexion ROM, hip extensor strength, and pain as
independent correlates of physical function. However, it is biologically
plausible that these impairment measures are interrelated, and that the
influence of pain and hip extensor strength may be the potential
mechanisms by which hip flexion ROM influences physical function.
3. PURPOSE OF WRITING
The purpose of this study was to examine whether hip extensor
strength in OA patients and hip pain mediate the association between hip
flexion ROM and physical function.
4. METHODS
This study forms part of a series of experiments to investigate the
correlates of physical function in persons with hip OA. The study sample
comprised 100 consecutive community-dwelling adults who fulfilled the
eligibility criteria. All volunteers lived in Victoria, Australia and responded
to advertisements in newspapers and local magazines. Participants were
recruited if they had hip or groin pain on most days of the past 1 month,
and had radiographic hip OA as confirmed by a radiologist. Specifically,
radiographic disease severity was assessed using the Kellgren/Lawrence
scale, in which higher grades indicate greater severity. In this study, only
those participants with a Kellgren/Lawrence score 2 were considered to
have hip OA. The exclusion criteria included significant back or other joint
pain; secondary hip OA due to trauma, inflammatory, or metabolic
rheumatic diseases; lower extremity joint replacement; inability to
understand English; or the presence of neurologic, cardiac, or other
medical conditions that would compromise physical function.

Study procedure. The participants attended a test session at our

facility following informed consent. Prior to the physical performance
assessment, the participants height, waist circumference, and body mass
were obtained. Each participant also completed a set of questionnaires
pertaining to, among other things, living arrangements (alone or with
others), comorbidities, physical activity, pain level, and physical function.
Specifically, we obtained information about comorbidities using a checklist
of 6 common conditions: hypertension, diabetes mellitus, coronary vessel
disease, ulcer or stomach disease, pulmonary disease, and cancer (prior).
Physical activity was measured using the Physical Activity Scale
for the Elderly (PASE).
Pain and physical function were measured using the Short Form
36 (SF-36) general health survey, Short Form 36 is a generic
questionnaire designed to measure health-related quality of life in general
and specific populations.
The SF-36 Health Survey includes one multi-item scale measuring each
of the following eight health concepts:
a.
b.
c.
d.
e.

physical functioning
role limitations because of physical health problems;
bodily pain;
social functioning;
general mental health (psychological distress and psychological well-

being);
f. role limitations because of emotional problems;
g. vitality (energy/fatigue); and
h. general health perceptions.
The SF-36 comprises 36 items related to 8 subscales of health; we
used the bodily pain and physical function subscales. Each subscale
ranges from 0 100, with higher scores representing better health states.
In this study, used the Australian SF-36 version 2 which directs
participants to consider the previous 4 weeks for the bodily pain subscale;
however, items in the physical function subscale indicate the present time.
Physical performance was assessed by the gait speed, step test,
and stair climb test.
Hip extensor strength test was quantified by a modification of the
supine hip extensors test.
Perry, et.al., 1999 in The Supine Hip Extensor Manual Muscle Test: A
Reliability and Validity Study.

Hip flexion ROM was measured using a Dualer digital inclinometer

(JTech, American Fork, UT).

The inclinometer was attached to a long (55 cm) flat metal strip that was
aligned directly over the femoral landmarks.
5. RESULT OF THE RESEARCH FROM JOURNAL

Among the participants, there was a 1,9 9,5 fold difference between
minimum and maximum values of gait speed, step test repetitions,
stair climb time, and SF-36 physical function scores. One participant
was unable to perform the stair climb test, and this participant was
excluded from the analyses involving the stair climb variable.

Correlation coefficients of the physical function measures with the

independent variable and the mediators were in the expected direction,

0.17 0.35, and statistically significant with the exception of gait speed,
which correlated weakly with hip flexion ROM and SF-36 bodily pain.

the mediator models explained a statistically significant amount of

variance in physical function, ranging from 27% for gait speed to
50% for stair climb time. Consistent with the partial correlation
analyses, hip flexion ROM was significantly associated with
physical function (total effect, path c), with the exception of hip
flexion ROM, which only marginally improved the model of gait

speed test.
hip flexion ROM was associated with hip extensor strength and
SF-36 bodily pain. With regard to the effects of the mediators on
physical function, hip extensor strength covaried with all measures
of physical function with the exception of stair climb time; SF-36
bodily pain covaried with SF-36 physical function and stair climb

time.
the putative mediators explained between 40% and 88% of the
total hip flexion effects on physical function. Because controlling
for

the mediators and

covariates resulted in

attenuated,

nonsignificant effects of hip flexion on all measures of physical

function.

The specific indirect effects through SF-36 bodily pain were

statistically significant for models of SF-36 physical function and
stair climb time.

6. SUGGESTION TO JOURNAL
a. Excess Of Journal
- This research can increase the movement of hip flexion ROM,
-

decrease the pain, and physical function with OA patients.

This research show how important to understand effect and the

influence in physical function with hip flexion ROM.

This research show the intervention to improve hip ROM, it may
have potention to decrease pain and blind of muscle in physical
function.

b. Lack Of Journal
- not explained about what kind of pain that are assessed using the
-

SF 36.
not explained when the sampling time, whether as severe pain or

when pain is getting better.

no data from the measurement results using the inclinometer.
Only used the bodily pain and physical function subscales from SF
36.

7. APPLICATION OF THE RESEARCH IN HEALTH CARE SETTING IN

INDONESIA
if the criteria of volunteer and equipment in Indonesia same with Australia
may be this research :
- Can be apply in a patient with OA in a hip and for health medics to
-

give holistic n better care.

Can be useful as a research with more samples to give more proof

in a medical department.
The quessioner methode of SF 36 can be applied in Indonesia
because its easy and simple to understand.