Hip Disability and Osteoarthritis Outcome Score

Original Editor - Sanne Delporte

Top Contributors - Sanne Delporte, Evan Thomas, Scott Buxton and Bridgit A Finley

Objective

The hip disability and osteoarthritis outcome score (HOOS) is a questionnaire intended to be used to assess the patient’s opinion about their hip and associated problems and to evaluate symptoms and functional limitations related to the hip during a therapeutic process [1][2]. Other questionnaires that can be presented are the Western Ontario and McMaster Universities osteoarthritis index (WOMAC), the algofunctional index (AFI) and the intermittent and constant osteoarthritis pain index (ICOAP) [3].

Intended Population

This measuring instrument, judging functions and anatomical qualities combined with activities and participation, is recommended when there is talk of hip disability with or without osteoarthritis (OA).
Hip osteoarthritis is a common and chronic musculoskeletal condition and a cause of pain, functional disability and reduced quality of life [4].
The HOOS is meant to be used over short and long-term intervals to assess changes induced by treatment (medication, physical therapy, operation) or over years due to the primary injury or post-traumatic osteoarthritis [2].

Method of Use

The HOOS questionnaire is self-explanatory, user-friendly, patient-administered and takes 7 to 10 minutes to complete.
The outcome score consists of 40 items assessing 5 subscales. The 5 separate patient-relevant dimensions are Pain (P), Symptoms (S), Activity limitations daily living (ADL), Function in sport and recreation (SP) and hip related quality of life (QOL).
Pain (P) includes 10 items with a total score of 40 points, Symptoms (S) includes 5 items with a total score of 20, Activity limitations daily living (ADL) includes 17 items with a total score of 68 and finally Function in sport and recreation (SP) and hip related quality of life both include 4 items with a total score of 16 each.

To answer the questions, standardized answer options are given in 5 Likert-boxes with scores from 0 to 4 (no, mild, moderate, severe and extreme).

To interpret the score, the outcome measure is transformed in a worst to best scale from 0 to 100, with 100 indicating no symptoms and 0 indicating extreme symptoms.

To calculate the total HOOS score the subscales need to be summed up, using following formula for all dimension.

100 – [(patient's score of the subscale x 100)/(total score of the subscale)]

The subscales can be plotted as a HOOS profile, by connecting the mean scores for all 5 dimensions with a line[1][2].

Evidence

Reliability

The Dutch hip disability and osteoarthritis outcome score questionnaire has a good internal consistency and reliability [5].
The HOOS score is entirely based on self-report of functional status and performance. This may be a disadvantage in comparison to instruments that include objective physical examination findings or an assessment of symptoms.
It is recommended to use the HOOS score as a tool to complete additional information [6].

Validity

The construct validity is good with absence of floor and ceiling effects [5].
The hip osteoarthritis outcome score is valid in a sample of subject at a mean of 3 years after hip arthroscopy and for patients with different stadia of hip OA [5][6].

Responsiveness

Thanks to the addition of two subscales, sport and recreation function (SP) and hip related quality of life (QOL), the HOOC shows a higher sensitivity and responsiveness, compared to the Western Ontario and McMaster Universities osteoarthritis index (WOMAC).
Patients younger than 66 years report higher responsiveness in all five subscales than patients older than 66 years [1].

Miscellaneous

The hip disability and osteoarthritis outcome score (HOOS) is an extension of the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) and knee injury and osteoarthritis outcome score (KOOS) [1].

The HOOS questionnaire is also useful compared with the Nonarthritic hip score and the modified Harris hip score (MHHS) [6].

Links

References

  1. 1.0 1.1 1.2 1.3 NILSDOTTER A.K., LOHMANDER L.S., KLÄSSBO M., ROOS E.M., Hip disability and osteoarthritis outcome score (HOOS) – validity and responsiveness in total hip replacement, BMC Musculoskeletal Disord., May 2003, level of quality C
  2. 2.0 2.1 2.2 Pain symptoms ADL, Hip disability and osteoarthritis outcome score (HOOS). www.koos.nu (accessed 23 October)
  3. KNGF-guidline, osteoarthritis of the hip and knee. https://www.kngfrichtlijnen.nl/downloads/Osteoarthritis_of_the_hip_and_knee_V06-2010_PRL_ENG.pdf (accessed 23 October)
  4. POULSEN E., Conservative treatment of hip osteoarthritis: effect of manual therapy and hip school on pain, function and quality of life – a single-blind randomized controlled trial (abstract), December 2009
  5. 5.0 5.1 5.2 DE GROOT I.B., REIJMAN M., TERWEE C.B., BEIRMA-ZEINSTRA S.M.A., FAVEJEE M., ROOS E.M., VERHAAR J., Validation of the Dutch version of the hip disability and osteoarthritis outcome score, Osteoarthritis and cartilage, vol. 15 nr. 1, 2007, page. 104-109, level of quality C
  6. 6.0 6.1 6.2 MARTIN R.L., PHILIPPON M.J., Evidence of validity for the hip outcome score in hip arthroscopy, The journal of arthroscopic and related surgery, vol. 23 nr. 8, August 2007, page. 822-826, level of quality B