Introduction
Hip osteoarthritis and joint replacement profoundly affect patients’ mobility and quality of life, necessitating precise and reliable assessment tools. Consequently, the Hip Disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS-JR) stands out as a vital instrument for researchers and clinicians. Developed by Stephen Lyman, Patricia D. Franklin, and colleagues in 2015, this concise 6-item questionnaire evaluates hip function, pain, and daily activities in patients undergoing total hip arthroplasty. Moreover, it has over 550 citations on Google Scholar, making it indispensable in orthopedic research and clinical practice.
Therefore, this article explores the HOOS-JR’s structure, applications, and clinical value, empowering professionals to enhance patient outcomes.
Key Features of the Hip Disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS-JR)
Purpose and Use
The HOOS-JR is specifically designed to assess patients’ perceptions of their hip-related issues, focusing on symptoms and functional limitations associated with hip osteoarthritis and joint replacement. Primarily, it is used in clinical and research settings, it evaluates pain intensity, mobility challenges, and activities of daily living (ADLs) during therapeutic processes, particularly post-THA. Furthermore, unlike broader osteoarthritis tools, its targeted approach ensures relevance for patients undergoing hip replacement, enabling clinicians to monitor treatment efficacy and researchers to study functional outcomes.
Target Population
The HOOS-JR is tailored for adults aged 45 and older including:
- Older Adults (45-64 years)
- Seniors (65+ years)
- Patients with hip osteoarthritis or undergoing total hip arthroplasty (THA)
However, it is not validated for younger populations, children, adolescents, or those undergoing hip preservation surgery.
Questionnaire Details
The HOOS-JR comprises six items, making it a concise yet robust tool for assessing hip function. Specifically, these items are divided into three key areas:
- Pain (e.g., “How much pain do you feel walking on a flat surface?”)
- Functional limitations (e.g., “Difficulty rising from sitting?”)
- Activities of daily living (ADLs)
Each item is scored on a 5-point Likert scale, ranging from 0 (none) to 4 (extreme), allowing patients to provide clear and standardized responses. Moreover, this streamlined design, derived from the original 40-item HOOS, focuses on the most clinically relevant aspects of hip disability and osteoarthritis, ensuring ease of use while maintaining precision.
Scoring and Interpretation
The HOOS-JR uses a 5-point Likert scale (0 = none, 4 = extreme), with raw scores from its 6 items summed and transformed to a 0–100 scale,(0 representing total disability and 100 representing perfect hip health. Specifically, key thresholds guide interpretation:
- Minimal Clinically Important Difference (MCID): 5–10 points for post-THA improvement.
- Pass/Fail Threshold: ≥77 predicts successful THA outcomes.
- Severe Dysfunction: <50/100.
- Successful Outcome (Post-THA): ≥80/100.
For example, a pre-THA score below 55/100 may indicate a higher 90-day readmission risk, enabling clinicians to prioritize interventions. Additionally, researchers can leverage these cut-offs to design studies or evaluate treatment efficacy.
Administration Format
The HOOS-JR is designed for ease of use in diverse settings, requiring approximately 5-10 minutes to complete, which makes it ideal for time-sensitive clinical environments. In fact, it can be administered in multiple formats to suit varying needs including:
- Paper-based forms
- Digital platforms
- Interviews (In-person)
Notably, the questionnaire is self-administered, requiring no specialized training for administration or interpretation, which enhances its practicality in busy orthopedic clinics and research studies.
Applications of Hip Disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS-JR)
The HOOS-JR offers versatile applications in clinical and research settings:
- Screening: Identifies patients with significant hip dysfunction requiring intervention.
- Monitoring: Tracks functional improvements across treatment phases.
- Treatment Planning: Guides tailored rehabilitation based on pain and ADL scores.
- Research: Supports studies on THA outcomes and osteoarthritis management.
For example, clinicians may use a low ADL score to prioritize physical therapy, while researchers analyze trends to refine surgical protocols
Other Versions And Related Questionnaires
The HOOS-JR is part of the HOOS family, with other versions including:
- HOOS (40 items): Comprehensive, covering pain, symptoms, ADLs, sports, and quality of life.
- HOOS-PS (5 items): Focuses on physical function.
- HOOS-12: Balances brevity and comprehensive assessment.
Additionally, related tools include:
- KOOS-JR: Knee-specific equivalent.
- WOMAC: Assesses osteoarthritis broadly.
- PROMIS-PF: General physical function measure.
- Oxford Hip Score: Alternative hip-specific tool.
Language and availability
To enhance global accessibility, the HOOS-JR is available in over 15 validated languages, including:
- English
- Spanish
- French
- Dutch
- German
- Swedish
- Persian
Importantly, thee HOOS-JR does not require a license and it is free to use.
Reliability and Validity
The HOOS-JR boasts strong psychometric properties, making it a highly reliable and valid tool for assessing hip function. For instance, validation studies, such as Lyman et al. (2016) and Gandek et al. (2019), confirm its sensitivity to THA outcomes and its ability to detect clinically meaningful changes. Moreover, with a Cronbach’s alpha ranging from 0.86 to 0.92, the questionnaire demonstrates high internal consistency, ensuring dependable results across diverse patient groups.
- Original validation study study link
- Validation of a 12-item short form of the Hip disability and Osteoarthritis Outcome Score (HOOS-12) study link
Limitations and Considerations
Despite its strengths, the HOOS-JR has a few limitations:
- Self-Report: Responses may be influenced by personal interpretation or social desirability bias.
- Moderate Ceiling Effects: 4.2% of patients may score near the maximum, limiting sensitivity.
- Excludes Sports/Recreation Domains: Not suitable for assessing athletic function.
- Less Sensitive in Non-Surgical OA: May not capture subtle changes in early osteoarthritis.
- Limited for Bilateral Hip Pain: Scores may not fully reflect dual-hip issues.
Additional Resources
For more information on the HOOS-JR:
- Original Validation Study study link.
- Download the HOOS-JR questionnaire as a PDF.
- The development of a short measure of physical function for hip OA HOOS-Physical Function Shortform (HOOS-PS) study link
For inquiries, contact the American Academy of Orthopaedic Surgeons (AAOS) at outcomes@aaos.org
Frequently Asked Questions (FAQ)
- Who can use the HOOS-JR?
Clinicians, researchers, and healthcare providers use the HOOS-JR for patients aged 45+ with hip osteoarthritis or undergoing THA. - How long does it take to complete the HOOS-JR?
Patients typically complete it in 5-10 minutes, suitable for clinical and research settings. - How is the HOOS-JR administered?
It can be administered via paper-based forms, digital platforms, or in-person interviews. - Is there any cost to using the HOOS-JR?
The HOOS-JR is is free and in the public domain, requiring no permission for use.
A word from ResRef about Hip Disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS-JR)
The Hip Disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS-JR) delivers efficient, clinically actionable insights for hip OA/THR populations. However, while its brevity enhances compliance, clinicians should supplement with performance tests for comprehensive mobility assessment.
References
- Lyman, S., Lee, Y. Y., Franklin, P. D., Li, W., Cross, M. B., & Padgett, D. E. (2016). Validation of the HOOS, JR: A short-form hip replacement survey. Clinical Orthopaedics and Related Research, 474(6), 1472–1482. link
- Gandek, B., Roos, E. M., Franklin, P. D., & Ware, J. E. (2019). A 12-item short form of the Hip disability and Osteoarthritis Outcome Score (HOOS-12): Tests of reliability, validity and responsiveness. Osteoarthritis and Cartilage, 27(5), 754–761. link
- Davis, A. M., Perruccio, A. V., Canizares, M., Tennant, A., Hawker, G. A., Conaghan, P. G., Roos, E. M., Jordan, J. M., & Maillefert, J. F. (2008). The development of a short measure of physical function for hip OA HOOS-Physical Function Shortform (HOOS-PS): An OARSI/OMERACT initiative. Osteoarthritis and Cartilage, 16(5), 551–559. link
