Stasi S1, Chalimourdas A1, Diochnou A1, Polikreti V1, Papathanasiou G1
1Laboratory of Neuromuscular and Cardiovascular Study of Motion, Physiotherapy Department, University of West Attica, Athens, Greece
Background: The modified Harris Hip Score (mHHS) is the patient-reported modification of the Harris Hip Score, which has been widely used in hip arthroscopy surgery. Given that the mHHS was not initially developed for the evaluation of patients with hip chronic diseases and/or after major hip surgeries, there is lack of information regarding its measurement properties.
Purpose: The present observational study aimed to explore the reliability and validity properties of the Greek version of the modified Harris Hip Score (mHHS-Gr) in patients with hip osteoarthritis.
Methods: The study's sample consisted of 90 patients (males and females), aged > 55 years old, with hip osteoarthritis. An extensive reliability study was carried out to explore mHHS-Gr questionnaire's internal consistency, test-retest reliability between the mHHS-Gr outcomes of day-1 and day-8 [intra-class correlation coefficients with 95 % confidence intervals (ICC 95%CI) & paired samples t-test], and the convergent validity of the questionnaire (item-total correlation). The construct validity of the mHHS-Gr was testing against the Greek version of the Lower Extremity Functional Scale (LEFS-Greek), the Likert 3.1 Greek for Greece translation of the Western Ontario and McMaster Osteoarthritis Index (WOMAC® - Gr), the Face Pain Scale - Revised (FPS-R)], and against both physical performance measures [Timed Up and Go (TUG) test, and 9-stairs- ascend/descend test].
Results:
Reliability Properties: The internal consistency of mHHS-Gr was moderate (Cronbach's a=0.614, p 0.001). Test-retest reliability was excellent [ICC (95%CI):0.881(0.824-0.920)]. Additionally, paired samples t-test showed no significant difference between means of mHHS-Gr total score between day-1 and day-8 (52.140 vs 50.747, p=0.092) indicated that the Greek version of mHHS-Gr was remarkably consistent between the two measurements. Finally, the item-total correlation indicated low to high convergent validity (0.421 - 0.845).
Validity Properties: The mHHS-Gr correlated strong with both LEFS-Greek and WOMAC-Gr [Pearson's r = 0.801 & Pearson's r = -0,783, respectively (p 0.001)], while the correlation between mHHS-Gr and FPS-R was moderate (Spearman's ρ = -0.645, p 0.001). Likewise, the correlations of mHHS-Gr with TUG and with 9-stairs-ascend/descend tests were moderate [(Spearman's ρ= -0.547 & Spearman's ρ= -0.575, respectively (p 0.001)].
Conclusion(s): The mHHS-Gr showed significant moderate to excellent reliability and significant moderate to strong validity properties. Overall, it can be suggested that mHHS-Gr could be a reliable and valid tool for assessing patients with hip osteoarthritis.
Implications: The present study suggests that mHHS-Gr is a valid and reliable assessment tool that could be used in the clinical practice for the assessment of patients with hip osteoarthritis. A broader awareness of these findings in the Greek setting would facilitate objective comparisons between studies of different national origin and would contribute to the validity of future meta-analyses.
Keywords: modified Harris Hip Score, validity, reliability
Funding acknowledgements: This work was unfunded.
Purpose: The present observational study aimed to explore the reliability and validity properties of the Greek version of the modified Harris Hip Score (mHHS-Gr) in patients with hip osteoarthritis.
Methods: The study's sample consisted of 90 patients (males and females), aged > 55 years old, with hip osteoarthritis. An extensive reliability study was carried out to explore mHHS-Gr questionnaire's internal consistency, test-retest reliability between the mHHS-Gr outcomes of day-1 and day-8 [intra-class correlation coefficients with 95 % confidence intervals (ICC 95%CI) & paired samples t-test], and the convergent validity of the questionnaire (item-total correlation). The construct validity of the mHHS-Gr was testing against the Greek version of the Lower Extremity Functional Scale (LEFS-Greek), the Likert 3.1 Greek for Greece translation of the Western Ontario and McMaster Osteoarthritis Index (WOMAC® - Gr), the Face Pain Scale - Revised (FPS-R)], and against both physical performance measures [Timed Up and Go (TUG) test, and 9-stairs- ascend/descend test].
Results:
Reliability Properties: The internal consistency of mHHS-Gr was moderate (Cronbach's a=0.614, p 0.001). Test-retest reliability was excellent [ICC (95%CI):0.881(0.824-0.920)]. Additionally, paired samples t-test showed no significant difference between means of mHHS-Gr total score between day-1 and day-8 (52.140 vs 50.747, p=0.092) indicated that the Greek version of mHHS-Gr was remarkably consistent between the two measurements. Finally, the item-total correlation indicated low to high convergent validity (0.421 - 0.845).
Validity Properties: The mHHS-Gr correlated strong with both LEFS-Greek and WOMAC-Gr [Pearson's r = 0.801 & Pearson's r = -0,783, respectively (p 0.001)], while the correlation between mHHS-Gr and FPS-R was moderate (Spearman's ρ = -0.645, p 0.001). Likewise, the correlations of mHHS-Gr with TUG and with 9-stairs-ascend/descend tests were moderate [(Spearman's ρ= -0.547 & Spearman's ρ= -0.575, respectively (p 0.001)].
Conclusion(s): The mHHS-Gr showed significant moderate to excellent reliability and significant moderate to strong validity properties. Overall, it can be suggested that mHHS-Gr could be a reliable and valid tool for assessing patients with hip osteoarthritis.
Implications: The present study suggests that mHHS-Gr is a valid and reliable assessment tool that could be used in the clinical practice for the assessment of patients with hip osteoarthritis. A broader awareness of these findings in the Greek setting would facilitate objective comparisons between studies of different national origin and would contribute to the validity of future meta-analyses.
Keywords: modified Harris Hip Score, validity, reliability
Funding acknowledgements: This work was unfunded.
Topic: Musculoskeletal: lower limb
Ethics approval required: Yes
Institution: University of West Attica (former Technological Educational Institution of Athens)
Ethics committee: Research Committee of the University of West Attica
Ethics number: 4625 / 28-11-16
All authors, affiliations and abstracts have been published as submitted.
