Implications for research and clinical use from a Rasch analysis of the HOOS-12 and KOOS-12 instruments

Soh, Sze‐Ee; Harris, Ian A.; Cashman, Kara; Heath, Emma; Lorimer, Michelle; Graves, Stephen E.; Ackerman, Ilana N.

doi:10.1016/j.joca.2021.02.568

Cited by 10 publications

(12 citation statements)

References 20 publications

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“…Favourable features of the HOOS-12 and KOOS-12 include the ability to generate separate domain scores for three constructs highly relevant to joint replacement as well as a summary impact score; in contrast, the OHS and OKS provide summary scores only. We note that current evidence does not support unidimensionality of the HOOS-12 and KOOS-12 summary scores 17 and this likely reflects their inclusion of three distinct constructs. The HOOS-12 and KOOS-12 have a low administrative burden (unlike the Oxford and EQ-5D-5L instruments, no user license is required) and the items and scoring guides are freely available online.…”

Section: Table V Responsiveness To Changecontrasting

confidence: 79%

“…We report measurement properties for the HOOS-12 and KOOS-12 summary scores based on their current use in clinical practice and research, and their inclusion in the initial validation studies by Gandek et al 8,10 . We note that our investigation using Rasch analysis 17 did not support unidimensionality of the HOOS-12 and KOOS-12 summary scores and that both instruments were developed using a two-parameter item response theory model where only unidimensionality of the domain scores was assessed 7 .…”

Section: Statistical Analysesmentioning

confidence: 64%

“…Osteoarthritis andCartilage challenging (for example, ascending/descending stairs is not included in the function domains) and this may explain why many patients in this study scored the best possible HOOS-12 and KOOS-12 function scores. Further investigation examining whether the HOOS-12 and KOOS-12 are appropriately targeted for this population (to determine whether the items adequately span the full continuum of ability levels or if item refinement is required) has been recently undertaken 17 .…”

Section: Table V Responsiveness To Changementioning

confidence: 99%

“…We found that the HOOS-12 and KOOS-12 domains and summary scores demonstrated slightly better internal consistency reliability than initially reported (range of Cronbach alpha 0.81e0.93 for THR vs 0.77e0.92 8 ; 0.82e0.92 for TKR vs 0.75e0.90 10 ). The high alpha for the HOOS-12 and KOOS-12 summary scores may signal item redundancy, which we have recently examined using Rasch analysis 17 . While the magnitude of correlation between the HOOS-12 or KOOS-12 and other PROMs instruments is not unexpected given construct overlap (particularly for the OHS and OKS), the correlation coefficients also indicate that the HOOS-12 and KOOS-12 provide different information.…”

Section: Table V Responsiveness To Changementioning

confidence: 99%

See 3 more Smart Citations

Performance of the HOOS-12 and KOOS-12 instruments for evaluating outcomes from joint replacement surgery

Ackerman

Soh

Harris

et al. 2021

Osteoarthritis and Cartilage

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Section: Table V Responsiveness To Changecontrasting

confidence: 79%

Section: Statistical Analysesmentioning

confidence: 64%

Section: Table V Responsiveness To Changementioning

confidence: 99%

Section: Table V Responsiveness To Changementioning

confidence: 99%

See 2 more Smart Citations

Performance of the HOOS-12 and KOOS-12 instruments for evaluating outcomes from joint replacement surgery

Ackerman

Soh

Harris

et al. 2021

Osteoarthritis and Cartilage

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“…W e previously investigated the validity, reliability, and responsiveness to change 5 of the HOOS-12 and KOOS-12, as well as the structural validity and item performance of those instruments using Rasch analysis 6 . Our current analyses provide pragmatic information that will be highly relevant to those using these instruments for clinical, research, or registry purposes.…”

Section: Discussionmentioning

confidence: 99%

Minimal Clinically Important Changes in HOOS-12 and KOOS-12 Scores Following Joint Replacement

Soh

Harris

Cashman

et al. 2022

Journal of Bone and Joint Surgery

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Background:For patient-reported outcome measures (PROMs) to provide meaningful information to support clinical care, we need to understand the magnitude of change that matters to patients. The aim of this study was to estimate minimal clinically important changes (MCICs) for the 12-item Hip disability and Osteoarthritis Outcome Score (HOOS-12) and Knee injury and Osteoarthritis Outcome Score (KOOS-12) among people undergoing joint replacement for osteoarthritis.Methods:Individual-level data from the Australian Orthopaedic Association National Joint Replacement Registry’s pilot PROMs program were used for this analysis. Preoperative and 6-month postoperative HOOS-12 and KOOS-12 domain and summary impact scores plus a rating of patient-perceived change after surgery (on a 5-point scale ranging from “much worse” to “much better”) were available. Three anchor-based approaches—mean change, receiver operating characteristics (ROC) based on Youden’s J statistic, and predictive modeling using a binary logistic regression model—were used to calculate MCICs based on patient-perceived change.Results:Data were available for 1,490 patients treated with total hip replacement (THR) (mean age, 66 years; 54% female) and 1,931 patients treated with total knee replacement (TKR) (mean age, 66 years; 55% female). Using the mean change method, the MCIC ranged from 24.0 to 27.5 points for the HOOS-12 and 17.5 to 21.8 points for the KOOS-12. The ROC analyses generated comparable MCIC values (28.1 for HOOS-12 and a range of 15.6 to 21.9 for KOOS-12) with high sensitivity and specificity. Lower estimates were derived from predictive modeling following adjustment for the proportion of improved patients (range, 15.7 to 19.2 for HOOS-12 and 14.2 to 16.5 for KOOS-12).Conclusions:We report MCIC values for the HOOS-12 and KOOS-12 instruments that we derived using 3 different methods. As estimates obtained using predictive modeling can be adjusted for the proportion of improved patients, these may be the most clinically applicable. These MCIC values can be used to interpret important changes in pain, function, and quality of life from the patient’s perspective.Levels of Evidence:Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Total Knee Arthroplasty Versus Education and Exercise for Knee Osteoarthritis: A Propensity‐Matched Analysis

Young,

Zywiel,

Skou

et al. 2024

Arthritis Care & Research

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ObjectiveTo estimate the treatment effect of total knee arthroplasty (TKA) versus an education and exercise (Edu+Ex) program on pain, function, and quality of life outcomes 3‐ and 12‐months after treatment initiation for knee osteoarthritis (OA).MethodsPatients with knee OA who had undergone TKA were matched on a 1:1 ratio with participants in a Edu+Ex program based on a propensity score fitted to a range of pre‐treatment covariates. After matching, between‐group differences in improvement (the treatment effect) in Knee injury and Osteoarthritis Outcome Score 12‐item version (KOOS‐12; 0 worst to 100 best) pain, function, and quality of life from baseline to 3‐ and 12‐months were estimated using linear mixed models, adjusting for unbalanced covariates, if any, after matching.ResultsThe matched sample consisted of 522 patients (Edu+Ex n=261; TKA n=261) that were balanced on all pre‐treatment characteristics. At 12‐month follow‐up, TKA resulted in significantly greater improvements in pain (mean difference [MD] 22.8; 95% CI 19.7 to 25.8), function (MD 21.2; 95% CI 17.7 to 24.4), and quality of life (MD 18.3; 15.0 to 21.6). Even so, at least one‐third of patients receiving Edu+Ex had a clinically meaningful improvement in outcomes at 12‐months compared to 75% of TKA patients.ConclusionTKA is associated with greater improvements in pain, function, and quality of life, but these findings also suggest that Edu+Ex may be a viable alternative to TKA in a meaningful proportion of patients, which may reduce overall TKA need. Confirmatory trials are needed.

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Implications for research and clinical use from a Rasch analysis of the HOOS-12 and KOOS-12 instruments

Cited by 10 publications

References 20 publications

Performance of the HOOS-12 and KOOS-12 instruments for evaluating outcomes from joint replacement surgery

Performance of the HOOS-12 and KOOS-12 instruments for evaluating outcomes from joint replacement surgery

Minimal Clinically Important Changes in HOOS-12 and KOOS-12 Scores Following Joint Replacement

Total Knee Arthroplasty Versus Education and Exercise for Knee Osteoarthritis: A Propensity‐Matched Analysis

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