The result demonstrated that the correlation between OHS-C and HHS (0.89, p < 0.01) was excellent. The OHS-C also correlated well with the VAS (−0.79, p < 0.01) and the Physical Functioning (0.79, p < 0.01) and Bodily Pain (0.70, p < 0.01) domains of the SF-36. These data indicated convergent validity. A correlation between OHS-C and Role-Physical (0.52, p < 0.01), General Health (0.55, p < 0.01), and Social Functioning (0.51, p < 0.01) domains of the SF-36 was moderate. However, the correlation between the OHS-C and Vitality (0.31, p < 0.01), Role-Emotional (0.31, p < 0.01), and Mental Health (0.29, p < 0.01) domains of the SF-36 was weak, indicating divergent validity. We also observed that the OHS-C showed a better correlation with SF-36 than HHS (Table 5).
The Chinese version of the OHS showed good responsiveness to treatment. The responsiveness of the OHS-C was evaluated by comparison of the pre- and postoperative scores of the THA group. The mean score of OHS-C improved from 15 ± 5 to 34 ± 4 (p < 0.01). The mean of changes was 19 ± 5. The effect size and standardized response mean for OHS-C were 3.52 and 3.31, respectively.
In China, clinical surgeons are paying more attention to self-reported outcome assessment. Several hip-specific instruments have been translated and crossculturally adapted into Chinese, including the Hip Disability and Osteoarthritis Outcome Score . At present, there is no agreement for which questionnaire should be used to evaluate the status of patients with hip OA. The OHS is widely used as a joint-specific measure for patients with hip OA , but to our knowledge, this widely used tool has not been validated in a Chinese population. The purpose of this study therefore was to interculturally adapt the OHS into Chinese and to evaluate the psychometric properties of the OHS-C in a Chinese population with hip OA undergoing THA. We found the Chinese version of the OHS to be a valid tool, demonstrating a high degree of reliability, validity, and responsiveness.
Before discussing our results further, there are some limitations of our study that should be considered. First, the participants did not represent the entire Chinese population with hip OA. Most of the patients recruited had severe hip OA and intended to undergo THA. However, there was enough variability in the population to demonstrate responsiveness, and no floor or ceiling effects were observed. Second, we translated the OHS into a standard simplified Chinese language, the official language of China, but traditional Chinese language was also widely used in several southern areas in China. So it is necessary to translate and validate the OHS into traditional Chinese language in the future. Third, all of the participants underwent THA. We did not assess the responsiveness in patients receiving conservative treatments. Thus, more validation research in patients with hip OA with other treatments would be required.
The Cronbach's alpha correlation coefficient for the OHS-C (0.914) indicated excellent internal consistency, which was equivalent to other studies of OHS [6, 7, 10, 17, 20, 24]. The Pearson coefficients of item total (ranging from 0.427 to 0.770) also indicated good correlation between item and overall score. As for the test-retest reliability, ICC for the OHS-C (0.937; 95% confidence interval, 0.909-0.957) and Bland-Altman plot (Fig. 2) was considered of good reproducibility. It was in accordance with other validation studies [10, 17, 20].
Construct validity was demonstrated by calculating the correlation between OHS-C scores and HHS, VAS, and eight individual domains of SF-36 scores. The OHS-C correlated significantly with HHS (0.890) and VAS (−0.788), which suggested the OHS-C measured similar aspects to HHS and VAS. We also observed that OHS-C showed a significant correlation with Physical Functioning (0.79, p < 0.01) and Bodily Pain (0.70, p < 0.01) domains of the SF-36 and a weak correlation with Vitality(0.31, p < 0.01), Role-Emotional (0.31, p < 0.01), and Mental Health (0.29, p < 0.01) domains of the SF-36 (Table 5). The result of construct validity was consistent with previous validation studies [6, 7, 10, 17, 24]. No floor or ceiling effects were observed in the pre- and postoperative patients, similar to previous studies [10, 17].
The responsiveness, or sensitivity to clinical change, is the most important characteristic in prospective outcome study. The result showed that the OHS-C was able to detect change after surgical treatment with excellent responsiveness. The effect size of the OHS-C was 3.52. Compared with those who received hyaluronic injection (effect size 1.98), patients who received a THA showed a better effect size of the OHS . It was also better than the effect size of patients receiving a THA in other studies of OHS [6, 10]. Our explanation was that the participants in our study were in worse health status than those of other validation studies, which might lead to better responses to surgical treatment.
In summary, we found that the OHS could be interculturally adapted into Chinese with good psychometric properties. As a self-reported questionnaire, the Chinese version of the OHS is a joint-specific, reliable, valid instrument for a Chinese population with hip OA undergoing THA. Therefore, we suggest that the OHS-C can be used by surgeons in practice to evaluate the impact of hip OA and its treatments on patients’ pain and function.
We thank the staff from our outpatient clinics and the patients participating in the study. We also thank Yang Jiao, Francis Aaron, and Gregory Dole for help with the translation process.
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