The HOOS is a questionnaire for evaluating symptoms and limitations in patients with hip pain. The questionnaire consists of 40 items divided into five domains: symptoms (5 items), pain (10 items), ADL (17 items), sports/leisure (4 items) and quality of life (4 items). Scoring is done using a 5-point Likert scale, with a higher score reflecting fewer symptoms.
Validity and Reliability
The HOOS is valid for individuals with various stages of hip OA and in a sample of people at a mean of 3 years following hip arthroscopy (de Groot et al. 2007, Martin 2007).
The absence of floor and ceiling effects indicates strong construct validity (de Groot et al. 2007). The Graded Chronic Pain Scale showed strong construct validity with the Brazilian Portuguese version (Machado et al. 2019). It also has a strong correlation with the Oxford Hip Score (Putman et al. 2021).
The HOOS-PS, however, was also shown to have variable content validity, poor construct validity, and ambiguous responsiveness, according to Braaksma et al. (2020).
The internal consistency and reliability of the Dutch translation are good (de Groot et al. 2007). Through test-retest reliability, the Brazilian Portuguese version likewise demonstrated good internal consistency (Machado et al. 2019). The Hip Disability and Osteoarthritis Outcome Score – Physical Function Shortform (HOOS-PS) in a modified version was evaluated by Braaksma et al. (2020) in their meta-analysis which reports moderate evidence for adequate reliability and internal consistency. The functional state and performance reported by patients themselves is the sole basis for the HOOS score. It is advised to utilize the HOOS score as a tool to complete further information and evaluation because this may be a disadvantage compared to instruments that incorporate an objective physical examination.
Scoring and Interpretation
The outcome score consists of the total of the 5 subscales (1; Symptoms/stiffness, 2; Pain, 3; Functioning in ADL, 4; Activities and 5; Quality of life.)
Pain (P) contains 10 items with a total score of 40 points.Symptoms (S) contains 5 items with a total score of 20 points.Activities contains 17 items with a total score of 68 points.Functioning in ADL and Quality of Life both contain 4 items with a total score of 16 points each.
To interpret the score, convert the outcome score to a worst-best scale from 0 to 100, where 100 indicates no symptoms and 0 indicates extreme symptoms.
To calculate the total HOOS score, the subscales should be summed, using the following formula:
HOOS Questionnaire Online Calculator
de Groot IB, Reijman M, Terwee CB, Bierma-Zeinstra SM, Favejee M, Roos EM, Verhaar JA. Validation of the Dutch version of the Hip disability and Osteoarthritis Outcome Score. Osteoarthritis Cartilage. 2007 Jan;15(1):104-9
Machado, R. K., Casagrande, A. A., Pereira, G. R., Vissoci, J. R. N., Pietrobon, R., & Ferreira, A. P. B. (2019). Hip Disability and Osteoarthritis Outcome Score (HOOS): A Cross-Cultural Validation of the Brazilian Portuguese Version Study. Revista brasileira de ortopedia, 54(3), 282–287.
Braaksma, C., Wolterbeek, N., Veen, M. R., Prinsen, C. A. C., & Ostelo, R. W. J. G. (2020). Systematic review and meta-analysis of measurement properties of the Hip disability and Osteoarthritis Outcome Score – Physical Function Shortform (HOOS-PS) and the Knee Injury and Osteoarthritis Outcome Score – Physical Function Shortform (KOOS-PS). Osteoarthritis and cartilage, 28(12), 1525–1538.
Martin, R. L., & Philippon, M. J. (2007). Evidence of validity for the hip outcome score in hip arthroscopy. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association, 23(8), 822–826.
Putman, S., Preda, C., Girard, J., Duhamel, A., & Migaud, H. (2021). Mapping and Crosswalk of the Oxford Hip Score and Different Versions of the Hip Disability and Osteoarthritis Outcome Score. Clinical orthopaedics and related research, 479(7), 1534–1544.
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