- Open Access
- Open Peer Review
Responsiveness differences in outcome instruments after revision hip arthroplasty: What are the implications?
© Singh; licensee BioMed Central Ltd. 2011
- Received: 6 May 2011
- Accepted: 23 May 2011
- Published: 23 May 2011
Responsiveness to change is an important psychometric property of an outcome instrument. Assessment of health-related quality of life (HRQoL) is critical to outcome assessment after total joint replacement, a surgery aimed at improving pain, function and HRQoL of the patients undergoing these procedures. In a recent study, Shi et al. examined the responsiveness to change of various subscales of two instruments, physician-administered Harris Hip Score and patient self-administered Short Form-36 (SF-36), 6 months after revision total hip arthroplasty. The responsiveness statistics for both scales were reasonable, higher for Harris Hip Score than SF-36. This is the first study to examine responsiveness of these instruments in revision THA patients in a systematic fashion.
- hip arthroplasty
- harris hip score
- short-form 36
This study provides evidence that both HHS and SF-36 are responsive to change in patients undergoing revision THA and can be used in HRQoL assessment for longitudinal studies in patients with revision THA. This study also provides estimates of MID, which can be used to power future studies comparing different surgical approaches or implant types in patients undergoing revision THA, using either of these two measures as primary or secondary outcome measures. The finding that the disease-specific HHS was more sensitive to change than generic SF-36 is not surprising and should not be interpreted as a rationale to not include SF-36 in the assessment of patients with revision THA. In fact, a generic instrument such as SF-36 captures HRQoL domains differently than the disease-specific HHS, and can compliment the information obtained by the use of HHS. In addition, availability of population norms for SF-36 and availability of scores for other health conditions and chronic diseases allows comparisons of HRQoL gains across disease conditions, which plays an important role in health care policy. In conclusion, this study advances our knowledge in HRQoL assessment in patients with hip arthroplasty, and provides clinicians with tools for assessment of outcomes in clinical practice and researchers and trialists with additional data to design more robust studies in the future.
This material is the result of work supported by the resources and the use of facilities at the Birmingham VA Medical Center, Alabama, USA. No specific grant was obtained to support this work.
"The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government."
- Gershon RC, Rothrock N, Hanrahan R, Bass M, Cella D: The use of PROMIS and assessment center to deliver patient-reported outcome measures in clinical research. J Appl Meas. 2010, 11 (3): 304-14.PubMedPubMed CentralGoogle Scholar
- Riddle DL, Stratford PW, Bowman DH: Findings of extensive variation in the types of outcome measures used in hip and knee replacement clinical trials: a systematic review. Arthritis Rheum. 2008, 59 (6): 876-83. 10.1002/art.23706.View ArticlePubMedGoogle Scholar
- Shi HY, Chang JK, Wong CY, Wang JW, Tu YK, Chiu HC: Responsiveness and minimal important differences after revision total hip arthroplasty. BMC Musculoskelet Disord. 2010, 11: 261-10.1186/1471-2474-11-261.View ArticlePubMedPubMed CentralGoogle Scholar
- Blanchard C, Feeny D, Mahon JL, Bourne R, Rorabeck C, Stitt L: Is the Health Utilities Index responsive in total hip arthroplasty patients?. Journal of Clinical Epidemiology. 2003, 56 (11): 1046-54. 10.1016/S0895-4356(03)00203-8. [Comparative Study Research Support, Non-U.S. Gov't]View ArticlePubMedGoogle Scholar
- Hoeksma HL, Van den Ende CHM, Ronday HK, Heering A, Breedveld FC, Dekker J: Comparison of the responsiveness of the Harris Hip Score with generic measures for hip function in osteoarthritis of the hip. Annals of the Rheumatic Diseases. 2003, 62 (10): 935-8. 10.1136/ard.62.10.935.View ArticlePubMedPubMed CentralGoogle Scholar
- Angst F, Aeschlimann A, Steiner W, Stucki G: Responsiveness of the WOMAC osteoarthritis index as compared with the SF-36 in patients with osteoarthritis of the legs undergoing a comprehensive rehabilitation intervention. Ann Rheum Dis. 2001, 60 (9): 834-40.PubMedPubMed CentralGoogle Scholar
- Soohoo NF, Vyas RM, Samimi DB, Molina R, Lieberman JR: Comparison of the responsiveness of the SF-36 and WOMAC in patients undergoing total hip arthroplasty. J Arthroplasty. 2007, 22 (8): 1168-73. 10.1016/j.arth.2006.10.006.View ArticlePubMedGoogle Scholar
- Cohen J: A power primer. Psychol Bull. 1992, 112 (155-9):Google Scholar
- Kane RL, Saleh KJ, Wilt TJ, Bershadsky B: The functional outcomes of total knee arthroplasty. J Bone Joint Surg Am. 2005, 87 (8): 1719-24. 10.2106/JBJS.D.02714.View ArticlePubMedGoogle Scholar
- Gioe TJ, Pomeroy D, Suthers K, Singh JA: Can patients help with long-term total knee arthroplasty surveillance?. Comparison of the American Knee Society Score self-report and surgeon assessment. Rheumatology (Oxford). 2009, 48 (2): 160-4.Google Scholar
- Quintana JM, Escobar A, Bilbao A, Arostegui I, Lafuente I, Vidaurreta I: Responsiveness and clinically important differences for the WOMAC and SF-36 after hip joint replacement. Osteoarthritis Cartilage. 2005, 13 (12): 1076-83. 10.1016/j.joca.2005.06.012.View ArticlePubMedGoogle Scholar
- Escobar A, Quintana JM, Bilbao A, Arostegui I, Lafuente I, Vidaurreta I: Responsiveness and clinically important differences for the WOMAC and SF-36 after total knee replacement. Osteoarthritis Cartilage. 2007, 15 (3): 273-80. 10.1016/j.joca.2006.09.001.View ArticlePubMedGoogle Scholar
- Singh J, Sloan JA, Johanson NA: Challenges with health-related quality of life assessment in arthroplasty patients: problems and solutions. J Am Acad Orthop Surg. 2010, 18 (2): 72-82.View ArticlePubMedPubMed CentralGoogle Scholar
- Riddle DL, Stratford PW, Singh JA, Strand CV: Variation in outcome measures in hip and knee arthroplasty clinical trials: a proposed approach to achieving consensus. J Rheumatol. 2009, 36 (9): 2050-6. 10.3899/jrheum090356.View ArticlePubMedGoogle Scholar
- The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2474/12/107/prepub
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.