266
previous 4 weeks. Patient completion time has been reported to be 5–10 min for the
OKS and 2–15 min for the OHS. The OKS and OHS were intended for patient com-
pletion. Although one study has shown that paper and telephone methods of comple-
tion are equivalent at the group level, this is not the case for use at the individual level
[ 41 ]. Hence, clinicians should use one method consistently to monitor an individual
patient and avoid using two methods interchangeably. Calculation of a single score
takes clinicians less than 5 min to complete manually. Using the revised scoring sys-
tem [ 42 ], scores range from 0 to 48, with higher scores indicating better outcomes.
Generally, low rates of missing data are reported (Table 10.1 ). The revised scor-
ing guidelines suggest that if only one or two items of the 12 are unanswered, the
mean of all other responses can be entered [ 42 ]. A total score should not be calcu-
lated if more than two items are unanswered. If a patient selects two answers to one
item, clinicians should select the response indicating a worse health state.
The OKS and OHS are available in a number of different language versions.
Clinicians should visit the Website listed in Table 10.2 to obtain a copyright license
for use. No fees apply for the use of the OKS or OHS in public or private clinical
settings, although support materials (e.g., comprehensive user manual) may need to
be purchased. Patient-completed versions are available in computer, smartphone,
and tablet platforms.
Both the OKS and OHS were intended to be single scores, and evaluation of
measurement properties has been conducted on single scores. However, subsequent
analysis of all 12 items of the OHS revealed two distinct factors: pain and functional
impairment [ 43 ]. Thus, clinicians may choose to calculate an overall score, or report
as two individual scores (OHS-pain and OHS-functional impairment), but should
consider that the measurement properties of the two subscales are not yet estab-
lished. It is not clear whether the OKS can be reported as two subscales, and so this
should be avoided at this time.
Nearly all studies evaluating the reliability of the OKS and OHS demonstrate ade-
quate reliability for use in individual patients. For the OKS, changes in individual
patient scores greater than 6.1 points (scored using the old scale 12–60) can be consid-
ered to represent real changes in the patient’s condition. Values for the OHS are
unknown. The OHS is able to detect deterioration in symptoms prior to total hip
replacement [ 44 ], as well as improvement with hyaluronic acid injection and total hip
replacement. The OKS can detect improvement following total knee replacement.
Responsiveness of the OKS and OHS to other interventions has not been evaluated.
Harris Hip Score (HHS) and Modifi ed Harris Hip Score (mHHS)
The HHS was developed as a clinician-administered tool to evaluate patients under-
going total hip replacement, and is commonly used in the literature and clinical
practice. While it cont ains eight items that can be answered by the patient (relating
to pain and function), there are also two items regarding the presence of deformity
and hip range of motion that are performed by the clinician. Thus, the HHS cannot
be a solely patient-reported measure. Patients undergoing total hip replacement
N.J. Collins and E.M. Roos