Original Articles
The Harris hip score: Comparison of patient self-report with surgeon assessment*,**

https://doi.org/10.1054/arth.2001.23716Get rights and content

Abstract

Abstract: Outcome evaluations are of primary concern in contemporary medical practice. Questionnaires are being used increasingly to provide input data for such outcomes evaluation. This study comprised 50 primary total hip arthroplasties in 36 patients who had undergone the procedure at least 12 months before enrollment. Each patient completed a self-report Harris Hip Score (HHS) 30 days before a formal evaluation by an independent orthopaedic surgeon that included a HHS. Comparison was made between the completed responses to the individual items on the self-report HHS and surgeon-assessed HHS. Concordance of item response and κ statistic were calculated. Overall the self-report and surgeon-assessed HHS showed excellent concordance. The results of this study support the use of the HHS as a self-report instrument.

Section snippets

Materials and methods

This study is based on a cohort of 36 patients with 50 primary THAs who were a minimum of 1 year postsurgery. These were consecutive patients returning for routine annual follow-up who had undergone THA by a single senior surgeon. No cases were excluded. Patients were seen between November 1994 and June 1995.

All patients were surveyed by mailed questionnaire before the clinical follow-up appointment. The mean time between completion of questionnaires and clinical follow-up was 30 days. During

Statistical analysis

The primary analysis focused on the comparison of responses to the individual items in the self-report HHS as completed by patients and the physician-assessed HHS. These items included pain, limp, support, distance walked, sitting, putting on shoes and socks, and climbing stairs. For each item, we calculated the unweighted distribution of responses, degree of concordance, and κ statistic [26]. The κ statistic is a measure of reproducibility between repeated assessments of the same categorical

Results

There were 11 men and 25 women, with a mean age of 69 years (Table 2).

. Cohort Demographics (n = 36)

Age (y)69 ± 12
Gender
 Men11 (31%)
 Women25 (69%)
Education
 Completed high school12 (33%)
 Completed college9 (25%)
 Postgraduate schooling15 (42%)
Side
 Left22 (44%)
 Right28 (56%)
Total hip arthroplasty
 Unilateral22 (61%)
 Bilateral14 (39%)
Primary diagnosis (no. hips)
 Congenital hip dysplasia24 (48%)
 Osteoarthritis8 (16%)
 Avascular necrosis3 (6%)
 Rheumatoid arthritis3 (6%)
 Other12 (24%)
The most frequent primary diagnosis

Discussion

This study compared the performance of a self-report HHS with that of the traditional physician-administered HHS. Our results show that the self-report format was easy to use by patients, with 6 of the 7 items having a response rate of >85%. The correlation between the overall score from the 2 formats was 0.99 and exceeded that of the correlation between the 2 self-administrations of the WOMAC and SF36. The agreement between the 2 formats was excellent with concordance rates ranging from 85% to

Acknowledgements

We thank Bob Lew and Liz Wright, for their help with the statistical analysis.

References (32)

  • JH Ware et al.

    SF-36 health survey: manual and interpretation guide

    (1993)
  • N Bellamy et al.

    A preliminary evaluation of the dimensionality and clinical importance of pain and disability in osteoarthritis of the hip and knee

    Clin Rheumatol

    (1986)
  • N Bellamy et al.

    Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee

    J Rheumatol

    (1988)
  • N Bellamy

    WOMAC Osteoarthritis Index: a users guide

    (1995)
  • N Bellamy

    Osteoarthritis clinical trials: candidate variables and clinimetric properties

    J Rheumatol

    (1997)
  • C Bombardier et al.

    Comparison of a generic and a disease-specific measure of pain and physical function after knee replacement surgery

    Med Care

    (1995)
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    *

    Funds were received in partial or total support of the research material described in this article from the William H. Harris Foundation, Health Services Research Fellowship from the Orthopaedic Research and Education Foundation and American Academy of Orthopaedic Surgeons, and Research Fellowship from the Canadian Arthritis Society.

    **

    Reprint requests: Nizar N. Mahomed, MD, Toronto Western Hospital, 399 Bathurst Street, ECW 1-002, Toronto, Ontario, M5T 2S8.

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