Reliability of the Doha Agreement Classification of Groin Pain
Condition: Groin Injury; Hip Pain Chronic; Adductor Tendinitis; Inguinal Hernia; Iliopsoas Syndrome
MeSH terms: Tendinopathy; Hernia, Inguinal
Study type: Observational

Summary: 
      This study will investigate the reproducibility of a clinical diagnostic classification
      system for groin pain between two different examiners.
    

Detailed description: 
      Groin pain is prevalent in field and court sport athletes. It is particularly prevalent in
      soccer, Gaelic football and rugby union. The wide variety of possible injuries in numerous
      anatomical structures and high prevalence of "abnormal imaging findings" in asymptomatic
      athletes contribute to the complexity. Heterogeneous taxonomy of groin injuries in athletes
      adds further to the confusion. Clinical practice is challenging with clinicians using
      differing groin pain terminology, where even the same term can have multiple interpretations.
      A recent systematic review on the treatment of groin pain in athletes included 72 studies, in
      which 33 different diagnostic terms were used. The "Doha agreement meeting on terminology and
      definitions in groin pain in athletes" was convened to attempt to resolve this problem. The
      Doha agreement meeting on terminology and definitions in groin pain in athletes reached a
      consensus on a clinically based taxonomy using three major categories. These definitions and
      terminology are based on history and physical examination to categorize athletes, making it
      simple and suitable for both clinical practice and research.

      The purpose of this study is therefore to investigate the inter-examiner reliability of the
      "Doha agreement meeting on terminology and definitions in groin pain in athletes." The study
      will be performed at a Sports Medicine Hospital in Qatar.

      Prior to the clinical examination participants will be requested to complete the Copenhagen
      Hip and Groin Outcome Score (HAGOS). This is a patient-reported outcome measure, which
      quantifies a patient's current subjective perception of their hip and groin pain within the
      last week on six subscales, each with a score between 0 and 100. Additionally, participants
      will be requested to complete the Oslo Sports Trauma Research Center (OSTRC) overuse injury
      questionnaire with a focus on groin problems within the last week.

      A standardized clinical examination will be performed. Palpation, resistance testing and
      stretching of affected muscle groups are used to categorize athletes into defined clinical
      entities. The pain reported by the athlete during the tests should also be felt in the
      affected structure. For example, in adductor-related groin pain, the pain on resisted
      adduction testing should reproduce the athlete's recognizable pain in the adductors. Pain
      felt in a different location-for example, the inguinal region on resisted adduction
      testing-would not signify adductor-related groin pain.

      Statistical analyses Cohen's Kappa statistic (κ) is used to signify agreement between
      clinicians. Agreement was considered almost perfect if κ=0.81-1.00, moderate κ=0.41-0.60,
      substantial κ=0.61-0.80, fair κ=0.21-0.40, slight κ=0-0.20, and poor if κ<0. In addition,
      absolute agreement, prevalence, and bias index will be calculated. Statistical analyses will
      be performed using SPSS software.

      Sample size With two examiners at each site, an expected Kappa of at least 0.8 with a lower
      limit of a 95% confidence interval of 0.4, and an expected prevalence between 0.3-0.7 for the
      three expected main defined clinical entities (adductor-related, inguinal-related, and
      iliopsoas-related groin pain), assuming no bias between examiners, the required sample size
      is determined to be 48 using a 2-tailed test. As pubic-related and hip-related groin pain is
      expected to be less frequent, a lower limit confidence interval of 0 for these entities is
      accepted, which in a 1-tailed test, maintaining an expected kappa of 0.8, requires a sample
      of only 10 participants. Thus 48 participants will be included.
    

Intervention name(s): Clinical examination
Intervention type(s): Diagnostic Test
Intervention description(s): Standardized clinical examination consisting of pain provocation test, including palpation, muscle resistance and stretch test.
Observational model: Case-Only
Time perspective: Cross-Sectional
Sampling method: Probability Sample
Study population: 
        Adult male individuals regularly participating in recreational or elite sports activity
        (≥once/week) with a current primary complaint of hip and/or groin pain of a non-acute onset
        that worsens on exercise, or of acute onset, which has not recovered and become
        longstanding (˃6w).
      
Keywords: Groin pain; Adductor-related; Inguinal-related; Pubic-related; Iliopsoas-related; Hip-related