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RehabMeasures Instrument

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A 12-item subjective questionnaire to measure the outcome of total hip replacement.

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Instrument Details

Acronym OHS

Area of Assessment

Activities of Daily Living
Functional Mobility
Negative Affect
Occupational Performance

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil




  • Arthritis + Joint Conditions
  • Pain Management


Key Descriptions

  • There are 12 items in the instrument.
  • Each of the items has 5 categories of response.
  • Each item is scored 1 to 5 (from least to most difficult) and the items are added together.
  • The minimum score is a 12 indicating least difficulty.
  • The maximum score is a 60 indicating most difficulty.
  • Questionnaire issued to patients (couldn’t find any administration instructions).
  • The outcome developed is a questionnaire that is to be completed by the patient, relative, friend, or researcher. The questionnaire is available to be completed by mail, as well.

Number of Items


Equipment Required

  • Oxford Hip Score and a writing utensil

Time to Administer

5 minutes

5 minutes or less

Required Training

No Training

Age Ranges


18 - 64


Elderly Adult

65 +


Instrument Reviewers

Initially reviewed by Adrienne Barr, SPT, Neal Darmody, SPT, Brent Denisar, SPT, Katie Kinsinger, SPT, Zainab Kothari, SPT, Lauren Ott, SPT, Anthony Phan, SPT, Bryan Pyrc, SPT, Lauren Ryan, SPT, Charliann Scott, SPT, and Rebecca Schuck, SPT. 8/10/13

Body Part

Lower Extremity

ICF Domain

Body Structure
Body Function

Measurement Domain

Activities of Daily Living
General Health

Professional Association Recommendation

(Pynsant et al, 2005)

  • Recommend alternative scoring method to account for missing data and to make scoring less confusing and more readily interpretable 
    • Always score both limbs to cover the scope of the joint issues 
    • Completely healthy joints scored at 0% and completely unhealthy joints scored at 100%, as opposed to 12 points and 60 points respectively 


(Murray et al, 2007) 

  • Some question wording can be changed or clarified in order to make sure that the patient understands what the question is asking 
  • The OHS should be scored on a scale of 0 to 48 with 0 being the worst result and 48 being the best result; specifically, the questions should be scored on a scale of 0 to 4 
  • The OHS is the best and most reliable assessment of hip replacement 
    • It can be used in conjunction with other general health outcome measures in order to get a better picture of overall health improvement after a hip replacement
  • When used during cohort studies, the OHS should be assessed pre-operatively and post-operatively in order to evaluate the change in score and the final outcome score 
    • The post-operative score could be assessed one year post-op because most functional improvements occur within the first year 
  • If there are bilateral hip problems, it is recommended to administer two separate questionnaires, rather than modify one to include both extremities
  • Categorization should be avoided, as evidence based cut points are still being developed and current cut points may only be approximate 
    • If cut points must be used, its recommended that they are the following (based on the 0 to 48 scale, 48 being the best result):
      • Excellent: > 41
      • Good: 34 - 41
      • Fair: 27 - 33
      • Poor: < 27 
  • The OHS can be used for other hip impairments, though it has not been validated for any use other than hip replacements 
  • If a patient leaves two or more questions unanswered the questionnaire should not be scored 
  • If a patient chooses more than one answer for a question, the worst response should be adopted


(Martinelli et al, 2011)

  • OHS is the only validated outcome measure in an Italian version, thus can be used as a comparison of outcome in groups of Italian patients 

(Paulsen et al, 2012)

  • Since the patients are all post-operative, it was expected the OHS to be highly skewed, and it could therefore be argued that referring to ceiling effects could be misleading

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Standard Error of Measurement (SEM)

Hip Osteoarthritis:

(Martinelli et al, 2011; = 96; mean age = 62.7 (5.8) years; mean OA duration = 2.5 (1.4) years; Italian speaking sample) 

  • SEM = 1.92; calculated from 5.81 x (square root (1-.89))

Minimal Detectable Change (MDC)

Hip Osteoarthritis:

(Martinelli et al, 2011)

  • Smallest Detectable Difference = 6.11 points

Normative Data

Total Hip Replacement: 

(Fitzpatrick et al, 2000; n = 7151; mean age = 67.8; patients evaluated preoperatively initially and 3 months post-op total hip replacement) 

  • Weak association between ASA and OHS outcomes 
    • 3 month follow up: OHS difference -1.5 for fit and healthy on ASA versus minor or severe medical problems on ASA 
    • 12 month follow up: OHS difference -2.3 for fit and healthy on ASA versus minor or severe medical problems on ASA

Test/Retest Reliability

Hip Osteoarthritis:

(Martinelli et al, 2011) 

  • Excellent test retest reliability (ICC = 0.89) 


Total Hip Replacement:

(Paulsen et al, 2012; n = 2278; ages 30 - 80 years; the patients had received a primary THR either one to tow, five to six, or ten to eleven years before dispatch of the PROMs) 

  • Adequate test retest reliability (ICC > 0.70)

Interrater/Intrarater Reliability

Total Hip Replacement:

(Kalairajah et al, 2005; n = 196; mean age = 68.4 years; 5 years post-op total hip arthroplasty) 

  • Adequate interrater agreement (Weighted kappa = 0.679)

Internal Consistency

Total Hip Replacement: 

(Fitzpatrick et al, 2000) 

  • Excellent internal consistency at baseline, 3 months post-op, and 12 months post-op (Cronbach’s alpha = 0.86, 0.90, 0.92 respectively) 


Hip Osteoarthritis:

(Martinelli et al, 2011) 

  • Excellent internal consistency (Cronbach’s alphas = 0.85 to 0.89) at baseline and after treatment 


Total Hip Replacement:

(Paulsen et al, 2012) 

  • Excellent internal consistency (Cronbach’s alpha = 0.99)

Construct Validity

Total Hip Replacement:

(Baumen et al, 2007; n = 170; mean age = 66.4 years; post-op 1 year total hip arthroplasty) 

  • Poor correlation with UCLA (r = -0.2) 


Total Hip Replacement:

(Garbuz et al, 2006; n = 402; mean age = 61 years; patients evaluated preoperatively initially and 12 months post-op total hip replacement) 

  • Excellent correlation with WOMAC global, pain, and functional subscales (Spearman’s p = 0.82, 0.81, 0.87) 


Total Hip Replacement:

(Kalairajah et al, 2005) 

  • Excellent negative correlation between Harris Hip Score and Oxford Hip score (Spearman’s p = -0.712) 


Hip Osteoarthritis:

(Martinelli et al, 2011) 

  • Excellent correlation with SF-36 subscales physical functioning, bodily pain, and social functioning mean change pre and post treatment (Spearman’s p = 0.58, 0.63, 0.50 respectively) 
  • Excellent correlation with VAS mean change pre and post treatment (Spearman’s p = -0.60) 


Total Hip Replacement:

(Paulsen et al, 2012) 

  • Adequate to excellent correlation with HOOS Pain, HOOS PS and HOOS QoL; the pain/discomfort domain, mobility, current state of health and the usual activities domain from the EQ - 5D; and the body pain domain from the SF-12 (Spearman’s p = 0.50 - 0.80) 
  • Poor correlation with the anxiety/depression and self-care domains of the EQ - 5D, and the mental component score, vitality and social functioning domains from the SF - 12 (Spearman’s p < 0.50)

Floor/Ceiling Effects

Total Hip Replacement:

(Garbuz et al, 2006) 

  • Poor ceiling effects: 25.4% in pain subscale, 22.6% in function subscale, 13.4% in global subscale (postoperation); 0.5% in function subscale (preoperation) 
  • Adequate floor effects: 1.5% in pain subscale, 0.3% in function subscale (preoperation); 0.3% in pain subscale, 0.3% in function subscale (postoperation) 


Hip Osteoarthritis:

(Martinelli et al, 2011) 

  • Excellent ceiling effects: No ceiling effects 
  • Excellent floor effects: No floor effects 


Total Hip Replacement:

(Paulsen et al, 2012) 

  • Adequate ceiling effects: 19.9% in post- operative patients 
  • Excellent floor effects: No floor effects


Total Hip Replacement:

(Baumen et al, 2007) 

  • Large responsiveness (Effect size = 3.96) 


Total Hip Replacement:

(Fitzpatrick et al, 2000) 

  • 3 months: Large responsiveness (Effect size = 2.5) 
  • 12 months: Large responsiveness (Effect size = 3.1) 


Total Hip Replacement:

(Garbuz et al, 2006) 

  • Moderate responsiveness for Global and pain (Effect size = 0.4, 0.66 respectively) 
  • Small responsiveness for pain (Effect size = - 0.23)


Hip Osteoarthritis:

(Martinelli et al, 2011) 

  • Large responsiveness (Effect Size = 1.98) and (Standardized Response Mean = 1.12) after treatment with hyaluronic acid injections 


Total Hip Replacement:

(Paulsen et al, 2012) 

  • Large responsiveness: 87.4%


Bauman, S., Williams, D., et al. (2007). "Physical activity after total joint replacement: a cross-sectional survey." Clin J Sport Med 17(2): 104-108. Find it on PubMed  

Dawson, J., Jameson-Shortall, E., et al. (2000). "Issues relating to long-term follow-up in hip arthroplasty surgery." The Journal of Arthroplasty 15(6): 710-717. 

Fitzpatrick, R., Morris, R., et al. (2000). "The value of short and simple measures to assess outcomes for patients of total hip replacement surgery." Quality in Health Care 9(3): 146-150. 

Garbuz, D. S., Xu, M., et al. (2006). "Patients' outcome after total hip arthroplasty: a comparison between the Western Ontario and McMaster Universities index and the Oxford 12-item hip score." The Journal of arthroplasty 21(7): 998-1004. 

Kalairajah, Y., Azurza, K., et al. (2005). "Health outcome measures in the evaluation of total hip arthroplasties--a comparison between the Harris hip score and the Oxford hip score." The Journal of arthroplasty 20(8): 1037. 

Martinelli, N., Longo, U. G., et al. (2011). "Cross-cultural adaptation and validation with reliability, validity, and responsiveness of the Italian version of the Oxford Hip Score in patients with hip osteoarthritis." Qual Life Res 20(6): 923-929. Find it on PubMed

Murray, D., Fitzpatrick, R., et al. (2007). "The use of the Oxford hip and knee scores." Journal of Bone & Joint Surgery, British Volume 89(8): 1010-1014.

Paulsen, A., Odgaard, A., et al. (2012). "Translation, cross-cultural adaptation and validation of the Danish version of the Oxford hip score: Assessed against generic and disease-specific questionnaires." Bone Joint Res 1(9): 225-233. Find it on PubMed

Pynsent, P., Adams, D., et al. (2005). "The Oxford hip and knee outcome questionnaires for arthroplasty OUTCOMES AND STANDARDS FOR SURGICAL AUDIT." Journal of Bone & Joint Surgery, British Volume 87(2): 241-248.