Validity and responsiveness of the Oxford hip score in a prospective study with Japanese total hip arthroplasty patients

doi:10.1007/s00776-008-1292-9

Journal of Orthopaedic Science

Volume 14, Issue 1, January 2009, Pages 35-39

https://doi.org/10.1007/s00776-008-1292-9 Get rights and content

Abstract

Background.

With the increasing need for disease-specific health outcome measurements, the Oxford hip score was developed to measure health-related quality of life of total hip arthroplasty (THA) patients in the United Kingdom. The Oxford hip score comprises 12 items pertaining to pain and physical function, which are increasingly used to measure health outcomes of patients who have undergone THA. The purpose of this study was to establish the validity and responsiveness of the Oxford hip score in a prospective study of Japanese patients.

Methods.

The study was conducted at two hospitals. The eligibility criterion for the study was consenting adult patients who underwent primary unilateral THA between April 2005 and October 2007. Three scales were self-administered at the preoperative stage and 6 months after THA. These scales were the Oxford hip score, the Short Form-36 (SF-36) version 2, and three activities requiring deep flexion of the hip (i.e., clipping one’s toenails; use of a Japanese squat toilet; “seiza” — sitting on one’s legs on the floor, a common posture while eating in Japan.

Results.

A total of 224 consenting adult patients were recruited. Among them, 125 (61.9%) participated in pre- and postoperative surveys. Altogether, 108 (22 men, 86 women; mean age, 58.4 ± 12.5 years) of the 125 patients answered all the items. A significant improvement in the mean scores was observed in all scales. Correlation coefficients between the Oxford hip score and the SF-36 version 2 (physical functioning, role physical, bodily pain) ranged from 0.60 to 0.76 preoperatively and postoperatively. Effect size was 1.7 for pain and 1.3 for physical function. The effect size for seiza was small (0.3).

Conclusions.

This study demonstrated the validity and responsiveness of the Oxford hip score in a prospective study. However, it does not measure activities requiring deep flexion of the hip joint, and the use of additional items is suggested.

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Cited by (59)

Oxford Hip Scores, Floor-Sitting Score Trajectories, and Postoperative Satisfaction Rates at 10 Years After Primary Total Hip Arthroplasty
2023, Journal of Arthroplasty
Available evidence on outcomes at 5 years and beyond for total hip arthroplasty (THA) is mainly limited to patient-reported outcome measures (PROMs). This study documented the trajectory of functional measurement using the Oxford hip score (OHS) and floor-sitting posture in Japan for up to 10 years post-THA and investigated predictors of dissatisfaction at 10 years with THA.
Patients scheduled for primary THA at a university hospital in Japan between 2003 and 2006 were enrolled in this prospective study. Overall, 826 preoperative participants were eligible for follow-up, with response rates ranging from 93.6% to 69.4% at each postoperative survey point. The OHS and floor-sitting scores were calculated using a self-administered questionnaire 6 times up to 10 years postoperatively. Patient satisfaction, including general surgery, walking ability, and activities of daily living (ADL), was assessed in the 10-year survey.
The linear mixed-effects model demonstrated a postoperative improvement, peaking at 7 years for OHS and 5 years earlier for the floor-sitting score. The postoperative overall surgical dissatisfaction at 10 years with THA was very low (3.2%). No predictors of surgical dissatisfaction were identified in the logistic regression analyses. Predictors of walking ability dissatisfaction were older age, men, and worse OHS at 1 year postoperatively. Predictors of ADL dissatisfaction were poorer preoperative and 1-year postoperative floor-sitting scores and 1-year postoperative OHS.
The floor-sitting score is a simple PROM suitable for the Japanese population; other populations would require a scale suitable for their lifestyles.
Propensity score-matched comparison of physical activity and quality of life between revision total hip arthroplasty and primary total hip arthroplasty
2023, Journal of Orthopaedics
Studies on physical activity (PA) after revision total hip arthroplasty (THA) are limited. It is important to assess PA levels as well as improvements in physical function and pain after revision THA. The purpose of the study was to compare accelerometer-measured PA and health-related quality of life (HR-QoL) in patients 1–3 years after revision or primary THA. We also clarified the relationship between measured PA and HR-QoL.
This cross-sectional study included 64 patients who underwent revision THA and 188 who underwent primary THA 1–3 years earlier. Outcome measures were accelerometer-measured light PA, moderate-to-vigorous intensity PA, number of steps, questionnaire-based Oxford hip score, SF-8 physical and mental component scores. We conducted propensity-score matching for age, sex, comorbidities, body mass index, and postoperative follow-up duration and compared PA levels and HR-QoL scores between patients after revision THA and primary THA of each 50 patients.
Based on propensity scores in the revision THA (68.3 years) and primary THA (67.8 years) groups, light PA, number of steps, and HR-QoL scores 1–3 years after revision THA were significantly lower than those after primary THA (P < 0.05). Moderate-to-vigorous intensity PA did not different between groups (P = 0.204). Measured light PA, moderate-to-vigorous intensity PA, and number of steps after re-THA were moderately correlated with HR-QoL scores.
Increasing the time and frequency spent on light PA to the levels after primary THA may lead to an increase in overall PA levels after revision THA. A detailed understanding of PA, including light PA, in daily life and an approach that promotes activity levels are necessary.
Cross-cultural adaptation, reliability and validity of the Japanese version of the Hospital for Special Surgery Hip Replacement Expectations Survey
2020, Journal of Orthopaedic Science
The Hospital for Special Surgery Hip Replacement Expectations Survey (HSS-THRES) is used in many countries to determine patient expectations before surgery. This study aimed to assess the reliability and validity of the Japanese version of HSS-THRES.
A total of 134 patients scheduled for total hip arthroplasty (THA) underwent a self-administered preoperative survey questionnaire. Patient's expectation and quality of life (QOL) were measured using the Japanese version of HSS-THRES, overall expectations for THA, Oxford hip score (OHS), and EuroQol-5D (EQ-5D). Some patients completed the Japanese version of HSS-THRES and the overall expectations for THA after a ten-day interval. Cross-cultural adaptation was validated by an expert committee comprising health professionals, a methodologist, language experts, and orthopedic specialists. The internal consistency was evaluated by the Cronbach α coefficient. The test-retest reliability was examined using the intraclass coefficient correlation (ICC) and the Bland and Altman analysis. To test the construct validity, nine priori hypotheses were tested by correlation analysis between the Japanese version of HSS-THRES and two QOL scales, and by examining the association with demographic variables.
A total of 116 patients completed four scales. Patients were predominantly female (75.9%), with an average age of 62.2 ± 11.7. In the cross-cultural adaptation, all patients responded to the questionnaire without problems. The Japanese version of HSS-THRES showed good internal consistency (Cronbach α: 0.9). ICC was 0.94 and Bland–Altman analysis indicated no bias. The correlation between Japanese HSS-THRES and overall expectations for THA was high (r = 0.67). Similarly, the correlation with the OHS was higher than that with EQ-5D. A total of 77.8% of the hypotheses were confirmed.
The Japanese version of HSS-THRES showed good cultural acceptability, high reliability, and validity to evaluate preoperative expectations for THA patients.
Three-Year Follow-Up Study of Physical Activity, Physical Function, and Health-Related Quality of Life After Total Hip Arthroplasty
2020, Journal of Arthroplasty
Little is known about the long-term changes in physical activity (PA) after total hip arthroplasty (THA). The purpose of this study is to describe the changes in the number of steps and intensity of PA as measured by accelerometers, patient-reported physical function, and health-related quality of life of THA patient preoperatively and at 1 and 3 years after THA.
This study included 153 patients (mean age, 61.4 years; 86.3% women) who wore an accelerometer for 10 consecutive days and completed the Oxford Hip Score (OHS) and the Short Form 8 at the 5-year follow-up after THA. PA was evaluated based on the mean steps per day and the time spent performing moderate-to-vigorous PA (MVPA) per week.
All 5 indicators had significantly increased at 1 year after THA, although only MVPA and OHS had further increased significantly at the 3-year follow-up. The predictor of improvement in the number of steps from baseline to 1 year post-THA was younger age, while those of improvement in MVPA from baseline to 3-year post-THA were younger age, higher OHS, and better Short Form 8 mental component scores using mixed-model analysis. Participation in the PA measurements was high (69.9%) at the 3-year follow-up. No significant changes were observed for these outcomes in the remaining cohort beyond 3 years after THA.
In post-THA patients, MVPA continued to increase for 3 years postoperatively. Therefore, PA must be measured over the medium term to long term following THA.
Expectations and depression in patients who have undergone total hip arthroplasty in Japan: A prospective cohort study
2019, International Journal of Orthopaedic and Trauma Nursing
Patients with hip osteoarthritis may be severely depressed preoperatively due to pain and limited daily-living activities. Hence, evaluating their expectations preoperatively might underestimate their true hopes regarding the upcoming total hip arthroplasty (THA).
We aimed to assess changes in patients’ level of depression, understand their expectations and fulfillment, and identify factors affecting fulfillment.
We performed a longitudinal study of 366 Japanese patients who had undergone THA during 2005–2006. Those with THA of the contralateral hip were excluded. Patients’ expectations, fulfillment, depression, and physical function were assessed perperative and at 6 weeks and one year postoperatively using our own questionnaire, the Arthritis Impact Measurement Scale 2, and by the Oxford Hip Score . Logistic regression analysis was applied to identify independent predictors of expectation fulfillment.
At 6 weeks, 78.1% expressed expectation fulfillment and drastic alleviation of depression. Preoperative depression and fulfillment of patient expectations at 6 weeks were significant predictors of expectation fulfillment at 1 year (95% confidence intervals: 1.01–2.48 and 2.30–9.92, respectively.
It is worthwhile for health providers to investigate patients’ expectations early in the postoperative period by considering their preoperative depression to confirm fulfillment of expectations.
Exploring the validation of a Japanese version of the International Hip Outcome Tool 12: Reliability, validity, and responsiveness
2019, Journal of Orthopaedic Science
Citation Excerpt :
Furthermore, the direct application of PROMs in the English language might not be optimal for patients who do not speak English as their first language due to the potential misunderstanding and lack of comprehension regarding the content of the inquiries. Currently, only two internationally-validated arthroscopic hip surgery PROMs are available in Japanese; the Japanese version of the Oxford Hip Score (OHS) [8,9] and the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ) [10]. As a matter of fact, the OHS was developed to evaluate artificial hip joint replacement in recipients [8,9].
The International Hip Outcome Tool 12 (iHOT12) was authorized by the Multicenter Arthroscopy of the Hip Outcomes Research Network (MAHORN). iHOT12 is increasingly being adopted in orthopedic studies to report patient outcomes. This study aimed to develop a Japanese version of the International Hip Outcome Tools “iHOT12J”, and to establish its reliability, validity, and responsiveness.
To assess test-retest reliability, an identical set of patients reported outcome measures with five qualitative scoring measures including iHOT12; these were filled out by each patient twice. Reliability was explored using Cronbachss alpha and intraclass correlation coefficient. The Bland–Altman plot was used to explore the absolute agreement. To evaluate validity, we examined the relationships between SF36 and iHOT12. Responsiveness was assessed by comparing the smallest detectable change to the minimal important change by applying an anchor-based approach.
Fifty patients (51 joints) were analyzed from March 2016 to October 2017 in Japanese four facility. The Cronbach α coefficient was 0.90 and the average value of intraclass coefficient (ICC) was 0.89. Bland–Altman plot analysis showed a solid agreement. Regarding the validity, the Spearman rank correlation coefficients were strong with PF (r = 0.69, p < 0.01), BP (r = 0.71, p < 0.01) and PCS (r = 0.69, p < 0.01). The smallest detectable change (3.19) was smaller than the minimum important change (12.40).
We developed iHOT12J, which seems to show sufficient reliability, validity, and responsiveness. We believe that this patient reported outcome measure is beneficial in studying Japanese patients with femoroacetabular impingement.

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Original articleValidity and responsiveness of the Oxford hip score in a prospective study with Japanese total hip arthroplasty patients

Abstract

Background.

Methods.

Results.

Conclusions.

Lancet

Semin Arthritis Rheum

J Arthroplasty

J Arthroplasty

Osteoarthritis Cartilage

Osteoarthritis Cartilage

J Arthroplasty

The short form-36 is preferable to the SIP as a generic health status measure in patients undergoing elective total hip arthroplasty

Arthritis Care Res

The effect of elective total hip replacement on health-related quality of life

J Bone Joint Surg Am

Questionnaire on the perceptions of patients about total hip replacement

J Bone Joint Surg Br

Comparison of measures to assess outcomes in total hip replacement surgery

Qual Health Care

The MOS 36-item short-form health survey (SF-36). 1. Conceptual framework and item selection

Med Care

Health-related quality of life and appropriateness or knee or hip joint replacement

Arch Intern Med

Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee

J Rheumatol

Original article
Validity and responsiveness of the Oxford hip score in a prospective study with Japanese total hip arthroplasty patients