265OA, asking patients about their relationship with their partner or their sexual activ-
ity may be irrelevant to others, or viewed as intrusive [ 37 ]. Clinicians should par-
ticularly consider the cultural implications of these items [ 39 ]. Because these items
are not involved in the calculation of subscale scores, they can be omitted when not
relevant for particular patients.
As with other PROMs discussed in this chapter, current information suggests that
the OAKHQOL and Mini-OAKHQOL may not be suffi ciently reliable for use in indi-
vidual patients. For the full version of the OAKHQOL, the physical activities and
mental health subscales show confl icting fi ndings, whereas the pain subscale shows
reliability values consistently below the cut-off deemed adequate for use in individuals.
For the Mini-OAKHQOL, none of these three subscales are adequate for use in indi-
vidual patients, although they can be used reliably in groups of patients. Clinicians
should be aware that the reliability of the social functioning and social support sub-
scales is consistently low for both the full and short versions of OAKHQOL, for use in
individual patients and groups of patients. This may be due to the small number of
items in the social subscales. This means that clinicians need to look for large changes
in scores for individual patients to be confi dent that a real change in condition has
occurred. Unfortunately, there is no data available at this time regarding the magnitude
of these changes. This should be seen as an important limitation of the OAKHQOL.
The full version of the OAKHQOL demonstrates no fl oor effects, and only the
social support subscale demonstrates ceiling effects. This means that the OAKHQOL
is able to detect deterioration and, generally, improvement in a patient’s condition
over time. However, the subscales of the OAKHQOL differ in their ability to detect
improvements following total joint replacement. While the physical activities and
pain subscales, and to a lesser extent the mental health subscale, show reasonably
large effects following total hip or knee replacement, the social functioning and social
support subscales demonstrate small to minimal effects. Clinicians should consider
that this might refl ect the intention of joint replacement surgery (i.e., to improve pain
and function), rather than a limitation of the measure itself. The responsiveness of the
OAKHQOL to nonsurgical treatments has not been evaluated. At present, there is no
information regarding these properties for the Mini-OAKHQOL.
While the OAKHQOL covers a wide variety of domains that are important to
patients with knee and/or hip OA [ 40 ], clinicians should be aware of the limitations
of both the full and short versions of the OAKHQOL in terms of their measurement
properties. Further studies may help to clarify this in the future.
Patient-Reported Outcome Measures Specifi c for Total Joint
Replacement
Oxford Knee Score (OKS) and Oxford Hip Score (OHS)
The Oxford Knee and Hip Scores ( Appendix 2 ) were developed specifi cally to assess
the outcome of total knee or total hip replacement, respectively. Both PROMs consist
of 12 items covering symptoms and function, wit h a recall period covering the
10 PROMs for Osteoarthritis