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Hip Outcome Score

Hip Disability and Osteoarthritis Outcome Score

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Purpose

The HOOS is a self-report questionnaire designed to further develop the WOMAC. It is used for people with hip disability, with or without hip osteoarthritis (OA). Dimensions have been added to the WOMAC to create the HOOS, as was done with the KOOS.

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Instrument Details

Acronym HOOS

Area of Assessment

Activities of Daily Living
Functional Mobility
Life Participation
Pain
Quality of Life
Seating

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil

Cost

Free

Diagnosis/Conditions

  • Arthritis + Joint Conditions
  • Pain Management
  • Sports Medicine

Key Descriptions

  • The HOOS is a 40-item self-report questionnaire with 5 subsets.
  • The five subscales include:
    1) 10 items on pain
    2) 5 items for symptoms (3 symptoms items, 2 stiffness items)
    3) 17 items for ADLs
    4) 4 items for sports and recreations
    5) 4 items for hip related quality of life.
  • Scoring: Each question contains five answer choices ranging from never (score of 0) to extreme (score of 4). A normalized score is calculated for each subscale with 0 indicating extreme symptoms and 100 representing no symptoms.

Number of Items

40

Equipment Required

  • Copy of outcome measure (paper format)
  • Pencil

Time to Administer

10-15 minutes

Required Training

No Training

Age Ranges

Adolescent

13 - 17

years

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Initially reviewed by Anne McGinty, SPT Hilary Frimenko, SPT Jackson Rollins, SPT Jason Hube, SPT Jennifer Arms, SPT Lisa Cole, SPT Melani Graves, SPT Meredith Ramsey, SPT Olivia Hebert, SPT and Ryan McCarty, SPT in 7/2014.

Body Part

Lower Extremity

ICF Domain

Body Structure
Body Function
Activity
Participation
Environment

Measurement Domain

Activities of Daily Living
Motor
Sensory

Considerations

Individuals should be cognitively intact; must meet specifically established hip criteria (Klassbo, 2003).

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Joint Pain and Fractures

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Standard Error of Measurement (SEM)

Hip Disability With or Without Hip OA (Full Scale):

  • 3.7 – 6.94 (Nilsdotter, 2011)

Minimal Detectable Change (MDC)

Hip Disability with or without Hip OA:

  • 95% = 10.3-19.2 (Nilsdotter, 2011)

Test/Retest Reliability

Hip Disability With or Without Hip OA: 

  • Excellent ICC = 0.75 – 0.97 (Nilsdotter, 2011) 

Internal Consistency

Hip Disability With or Without Hip OA: 

  • 0.82 – 0.98, excellent (Nilsdotter, 2011) 

Floor/Ceiling Effects

Hip Disability with or without Hip OA:

  • Floor effects are more common on the Sports/Rec subscale where worst possible scores have been reported to range from 4.1 – 17.8% in subjects eligible for THR (Nilsdotter, 2011), adequate 

 

Osteoarthritis

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Minimal Detectable Change (MDC)

Clinically Diagnosed Primary Hip OA

  • Total= ±1.96 (Ornetti, 2009) 
    • Pain= 15.1 
    • Symptoms= 10.5 
    • ADLs= 9.6 
    • Sports/rec= 15.5 
    • QOL= 16.2 

Test/Retest Reliability

Clinically Diagnosed Primary Hip OA: 

  • Pain= 0.89, excellent 
  • Symptoms= 0.86, excellent 
  • ADL= 0.89, excellent 
  • Sports/Rec= 0.91, excellent 
  • QOL= 0.78, excellent (Klassbo, 2003) 
  • Excellent ICC= 0.83 – 0.89 (Ornetti, 2009) 

 

Internal Consistency

Clinically Diagnosed Primary Hip OA:

  • Pain = 0.93, excellent 
  • Symptoms = 0.82, excellent 
  • ADLs = 0.96, excellent 
  • Sport/Rec = 0.88, excellent 
  • QOL = 0.77, adequate (Klassbo, 2003) 
  • Total= 0.82 – 0.94, excellent (Ornetti, 2009) 

 

Construct Validity

Primary Hip OA HOOS compared to Lequesne Index:

  • Pain= 0.67, excellent convergent 
  • Symptoms= 0.49, adequate convergent 
  • ADLs= 0.71, excellent convergent 
  • Sports/Rec= 0.58, adequate convergent 
  • QOL= 0.55, adequate convergent (Ornetti, 2009)

Face Validity

Measured level of importance of each item to the patient, ranked unimportant, important, and very important (Klassbo, 2003)

Floor/Ceiling Effects

Clinically Diagnosed Primary Hip OA: 

  • 38% of items with a floor effect; poor (Klassbo, 2003) 
  • 17.8% ceiling effect in Sports/Rec for the surgery group; adequate; this disappeared after THR (Ornetti, 2009) 

 

 

 

Responsiveness

Clinically Diagnosed Primary Hip OA:

  • Medical group SRM = 0.51 to 1.04, Effect size 0.73 – 1.86, moderate to large effect 
  • Surgery group SRM = 1.97 to 3.24, Effect size 1.47 – 2.08, large effect (Ornetti, 2009) 

Orthopedic Surgery

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Standard Error of Measurement (SEM)

Primary Hip OA Assigned to Hip Replacement Surgery (Full Scale):

  • 4.78 – 10.07 (Nilsdotter, 2003) 

 

Hip Arthroscopic Surgery for Intra-Articular Hip Lesions (Subscales):

  • Pain- 3; Symptoms- 5; ADL- 3; Sports/Rec- 6; QOL- 5 (Kemp, 2013)

Minimal Detectable Change (MDC)

Primary Hip OA Assigned to Hip Replacement Surgery: 

  • 95% = 13.2 – 27.9 (Nilsdotter, 2003) 

 

Hip Arthroscopy 

  • Total= ± 3 (Martin, 2008) 

 

Hip Arthroscopic Surgery for Hip Intra-Articular Hip Lesions

  • Pain= 10 
  • Symptoms= 14 
  • ADLs= 9 
  • Sports/Rec= 17 
  • QOL= 15 (Kemp, 2013)

Minimally Clinically Important Difference (MCID)

Hip Arthroscopy:

  • ADL= 9 
  • Sports/Rec= 6 (Martin, 2008)

Test/Retest Reliability

Hip Arthroplasty with Mild to Moderate and Severe Hip OA:

  • Excellent ICC = 0.78 – 0.91 (de Groot, 2007) 

 

Hip Arthroscopy for Intra-Articular Hip Lesions: 

  • Pain = 0.96, excellent 
  • Symptoms = 0.93, excellent 
  • ADLs = 0.96, excellent 
  • Sports/Rec = 0.93, excellent 
  • QOL = 0.95, excellent (Kemp, 2013)

Internal Consistency

Pre and Post Total Hip Replacement:

  • 0.79, adequate (Davis, 2009) 

 

Hip Arthroplasty with Mild to Moderate and Severe Hip OA: 

  • 0.75 -0.97, adequate to excellent (de Groot, 2007) 

 

Hip Arthroscopic for Hip Intra-Articular Lesions: 

  • Pain = 0.93, excellent 
  • Symptoms = 0.91, excellent 
  • ADL = 0.96, excellent 
  • Sports/Rec = 0.96, excellent 
  • QOL = 0.95, excellent (Kemp, 2013)

Construct Validity

Pre and Post Total Hip Replacement:

  • HOOS-PS (short form) compared to: 
    • Physical function = 0.90, excellent convergent 
    • Physical function exclusion = 0.86, excellent convergent 
    • WOMAC pain = 0.70, excellent convergent 
    • Chronic pain grade = 0.56, adequate convergent 
    • POMS fatigue = 0.38, adequate convergent 
    • HADS anxiety = 0.19, poor 
    • HADS depression = 0.36, adequate convergent (Davis, 2009) 

 

Primary Hip OA Assigned to Total Hip Replacement: 

  • SF-36 subscales compared to HOOS subscales: 
    • Physical function vs ADL = 0.66, excellent convergent 
    • Physical function vs Sports/Rec = 0.49, adequate convergent 
    • Bodily pain vs Pain = 0.61, excellent convergent (Nilsdotter, 2003) 

 

Content Validity

Primary Hip OA Assigned to Total Hip Replacement:

  • Asked patients to rank relevance of questions to their condition on a scale of 0 – 3. 0 indicated no relevance, 3 was very relevant. Required a mean relevance score of 2.

Floor/Ceiling Effects

Hip Arthroplasty with Mild to Moderate and Severe Hip OA: 

  • 5.1% floor effects in Sports/Rec; adequate (de Groot, 2007) 

 

Primary Hip OA Assigned to Total Hip Replacement: 

  • Pre-operatively; adequate floor effects 
    • Sports/Rec function = 12 patients out of 90
    • QOL = 4 patients
    • Symptoms = 2 patients 
  • Pre-operatively; adequate ceiling effect 
    • Symptoms; 1 patient 
  • Post-operatively; no floor effects, excellent 
  • Post-operatively; adequate ceiling effects 
    • Pain scale = 19% 
    • Symptoms scale = 10% 
    • ADLs = 5% 
    • Sports/Rec = 9% 
    • Hip related QOL = 9% (Nilsdotter, 2003) 

 

Hip Arthroscopic Surgery for hip intra-articular lesions:

  • Poor ceiling effects 
    • ADL = 28% 
    • Sports/Rec 16% (Kemp, 2013)

Responsiveness

Pre and Post Total Hip Replacement:

  • HOOS-PS: SRM= 1.5, large effect size (Davis, 2009) 

 

Primary Hip OA Assigned to Total Hip Replacement:

  • HOOS (greater responsiveness when compared to the WOMAC) 
    • pain SRM= 2.11, large effect size 
    • symptoms SRM= 1.83, large effect size -
    • Sports/Rec SRM= 1.29, large effect size -
    • QOL= 1.64, large effect size 
  • WOMAC: 
    • Pain SRM= 1.83, large effect size 
    • Stiffness= 1.28, large effect size 
  • All 5 subscales’ SRM is higher for individuals less than 66 years old compared to individuals older than 66 years old 
    • Pain = 2.60 vs 1.97, large effects 
    • Symptoms = 3.0 vs 1.6, large effects 
    • ADL = 2.51 vs 1.52, large effects 
    • Sports/Rec = 1.53 vs 1.21, large effects 
    • Hip-related QOL = 1.95 vs 1.57, large effects (Nilsdotter, 2003) 

 

Hip Arthroscopy: 

  • SRM for ADLs= 1.2, large effect 
  • SRM for Sports/Rec= 1.5, large effect (Martin, 20

Bibliography

Davis, A. M., A. V. Perruccio, et al. (2009). "Comparative, validity and responsiveness of the HOOS-PS and KOOS-PS to the WOMAC physical function subscale in total joint replacement for osteoarthritis." Osteoarthritis Cartilage 17(7): 843-847.

Davis, A. M., A. V. Perruccio, et al. (2008). "The development of a short measure of physical function for hip OA HOOS-Physical Function Shortform (HOOS-PS): an OARSI/OMERACT initiative." Osteoarthritis Cartilage 16 (5): 551-559.

De Groot, I., M. Reijman, et al. (2007). "Validation of the Dutch version of the Hip disability and Osteoarthritis Outcome Score." Osteoarthritis and cartilage 15(1): 104-109.

Kemp, J. L., N. J. Collins, et al. (2013). "Psychometric properties of patient-reported outcome measures for hip arthroscopic surgery." Am J Sports Med 41(9): 2065-2073.

Klassbo, M., E. Larsson, et al. (2003). "Hip disability and osteoarthritis outcome score. An extension of the Western Ontario and McMaster Universities Osteoarthritis Index." Scand J Rheumatol 32(1): 46-51.

Martin, R. L. and M. J. Philippon (2008). "Evidence of reliability and responsiveness for the hip outcome score." Arthroscopy: The Journal of Arthroscopic & Related Surgery 24(6): 676-682.

Nilsdotter, A. and A. Bremander (2011). "Measures of hip function and symptoms: Harris Hip Score (HHS), Hip Disability and Osteoarthritis Outcome Score (HOOS), Oxford Hip Score (OHS), Lequesne Index of Severity for Osteoarthritis of the Hip (LISOH), and American Academy of Orthopedic Surgeons (AAOS) Hip and Knee Questionnaire." Arthritis Care Res (Hoboken) 63 Suppl 11: S200-207.

Nilsdotter, A. K., L. S. Lohmander, et al. (2003). "Hip disability and osteoarthritis outcome score (HOOS)--validity and responsiveness in total hip replacement." BMC Musculoskelet Disord 4: 10.

Ornetti, P., S. Parratte, et al. (2010). "Cross-cultural adaptation and validation of the French version of the Hip disability and Osteoarthritis Outcome Score (HOOS) in hip osteoarthritis patients." Osteoarthritis and cartilage 18(4): 522-529.

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