Association between physical measures of spinopelvic alignment and physical functioning with patient reported outcome measures (PROMs) after total hip arthroplasty: Protocol for systematic review and meta-analysis

PLOS ONE STUDY PROTOCOL Association between physical measures of spinopelvic alignment and physical functioning with patient reported outcome measures (PROMs) after total hip arthroplasty: Protocol for systematic review and meta-analysis a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 Sima Vatandoost ID1*, Katie Kowalski ID1, Brent Lanting2, K. C. Geoffrey Ng3, Saghar Soltanabadi ID1, Alison Rushton ID1 1 School of Physical Therapy, Western University, London, Ontario, Canada, 2 Department of Surgery, Division of Orthopaedic Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada, 3 Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada * OPEN ACCESS Citation: Vatandoost S, Kowalski K, Lanting B, Ng KCG, Soltanabadi S, Rushton A (2024) Association between physical measures of spinopelvic alignment and physical functioning with patient reported outcome measures (PROMs) after total hip arthroplasty: Protocol for systematic review and meta-analysis. PLoS ONE 19(5): e0304382. https://doi.org/10.1371/journal.pone.0304382 Editor: Hugh Cowley, Public Library of Science, UNITED KINGDOM Received: July 29, 2023 Accepted: May 10, 2024 Published: May 24, 2024 Copyright: © 2024 Vatandoost et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: No datasets were generated or analysed during the current study. All relevant data from this study will be made available upon study completion. Funding: The author(s) received no specific funding for this work. Competing interests: The authors have declared that no competing interests exist. Abstract Introduction Prevalence of total hip arthroplasty (THA) has trended upwards over past decades and is projected to increase further. Optimizing outcomes after surgery is essential to avoid surgical revision and maximize outcomes. Low back pain is reported as a problem post THA. Patient-reported outcome measures (PROMs) are commonly used to evaluate THA outcomes but have limitations (e.g., ceiling effects). It is therefore important to assess a comprehensive range of outcomes. Physical outcome measures of spinopelvic alignment and physical functioning demonstrate potential value, but no evidence synthesis has investigated their association with PROMs. The objectives of this systematic review are to evaluate the association between spinopelvic alignment and physical outcome measures of physical functioning with PROMs and characteristics of low back pain after THA. Methods and analysis This protocol is aligned with the Preferred Reporting Items for Systematic Review and MetaAnalysis Protocols. Cross-sectional and longitudinal cohort studies evaluating the association between the physical outcome measures and PROMs (any outcome measures reported) following THA by any approach/implant will be included except surface replacement and revision THA. Studies investigating THA for developmental pathology and inflammatory conditions will be excluded. A systematic search in MEDLINE (Ovid), Embase (Ovid), Scopus, Web of Science, CINAHL, and the grey literature will be carried out from inception to July 31, 2023. Two independent reviewers will evaluate eligibility of retrieved PLOS ONE | https://doi.org/10.1371/journal.pone.0304382 May 24, 2024 1 / 11 PLOS ONE Physical measures of spinopelvic alignment, physical functioning and PROMs in total hip arthroplasty articles, extract data and assess risk of bias (NIH quality assessment tool) of included studies. A third reviewer will mediate disagreements. Random-effects meta-analyses will be conducted if studies are sufficiently homogeneous in design, population, physical measures and PROMs; reporting odds ratios and 95% confidence intervals. Where meta-analyses are not possible, a narrative synthesis will be conducted. Confidence in cumulative evidence will be assessed using a modified GRADE (Grading of Recommendations Assessment, Development, and Evaluation). PROSPERO registration number PROSPERO Registration number CRD42023412744. Introduction Osteoarthritis (OA) is a leading cause of disability among older adults [1], with the hip joint commonly affected by this degenerative disease [2]. One of the most common and effective surgeries to alleviate pain and improve function in hip OA is total hip arthroplasty (THA) [3, 4]. Utilization of THA has followed an upward trend in the past two decades and is projected to continue to increase due to multiple factors including an aging population and increased life expectancy [5–7]. Optimizing outcomes after surgery can avoid surgical revision and poor clinical outcomes. Patient-reported outcome measures (PROMs) are commonly used to evaluate outcomes following THA [8]. However, use of PROMs can be problematic owing to observed ceiling effects limiting their ability to evaluate higher levels of functional improvement [9, 10], and PROMs might not be correlated with physical outcome measures [11]. For example, although perceived physical functioning measured by PROMs was significantly improved four years following THA, Vissers et al found that other aspects of physical functioning like walking speed did not follow the same pattern [12]. Thus, physical outcome measures and PROMs may evaluate different constructs, making it essential to have a comprehensive assessment of multiple outcomes post THA. For THA, physical outcome measures of spinopelvic alignment and physical functioning are important to patient outcomes [13–15]. Spinopelvic alignment is defined as the interactions between the spine and pelvic regions, recognizing that a change in one region may lead to a reciprocal change in the other [16, 17]. In severe hip OA, patients can experience flexion contracture of the hip, and their spine is forwardly inclined with a higher risk of imbalanced alignment [18]. After THA surgery, radiographic parameters of spinopelvic alignment such as pelvic tilt and sacral slope may change, but the magnitude of these changes was not consistent amongst studies [19]. In addition, imbalanced spinopelvic alignment can be associated with poor clinical outcomes including function and quality of life. Spinopelvic alignment may also be associated with the presence of low back pain (LBP) after THA [13, 20, 21]. It has been observed that lumbar scoliosis and consequently LBP improved for patients who underwent unilateral THA [17]. However, it has also been observed by Eyvazov et al that LBP improvement was not associated with changes in spinopelvic alignment [22]. The evidence is therefore conflicting. Physical functioning has been defined as the ability to do the physical activities of daily living [23], and as advised by OARSI, can be assessed using PROMs s (...truncated)