267were not involved in the development of the HHS, meaning that content validity
cannot be assumed. The HHS is also associated with high ceiling effects in patients
undergoing total hip replacement [ 45 ].
The mHHS evolved from the HHS to remove the items assessed by the clinician.
Thus, in comparison to the HHS, the mHHS can be patient-reported. However, the
measurement properties of the mHHS have not been evaluated in patients with OA
or those who have undergone total hip replacement. Rather, studies have evaluated
its measurement properties in patients who have undergone hip arthroscopy, whereof
a proportion have chondropathy [ 46 ]. On this basis, it is diffi cult to recommend the
use of the HHS or mHHS in patients with hip OA at this time.
Patient-Reported Outcome Measures for Hand Osteoarthritis
Hand OA is a heterogeneous and often polyarticular condition consisting of several
phenotypes , including interphalangeal OA, thumb base OA, and erosive OA [ 12 ].
The high burden of disease and reduced QOL in people with hand OA is attributable
to its impact on dexterity and ability to perform daily and occupational tasks that
involve the upper limb [ 47 ]. There is a paucity of evidence for effective manage-
ment of hand OA, with pharmacological interventions providing only symptomatic
relief, and limited surgical options [ 48 ].
As for knee and hip OA, the OMERACT core domains for hand OA are pain,
physical function, and patient global assessment [ 49 ]. Although health-related QOL
is also specifi ed as a core domain for hand OA, at this time there is no reliable, valid,
or disease-specifi c instrument available. This domain can be left out of patient eval-
uation, or alternatively, clinicians may choose to use a generic QOL measure, as
mentioned earlier. The other core domains specifi ed for hand OA are joint activity
and hand strength [ 49 ]. As these cannot be evaluated using PROMs, they will not be
considered further in this chapter.
Because the disability associated with hand OA is distinctly different to knee and
hip OA, the content of PROMs appropriate for use in patients with hand OA should
also differ. Although general PROMs for rheumatic diseases, such as the Health
Assessment Questionnaire (HAQ) and Arthritis Impact Measurement Scales
(AIMS-2), are widely used to assess patients with hand OA, it is unlikely that their
content will be suffi cient to capture the extent to which patients can use their hands
[ 50 ]. Similarly, PROMs intended for use in various hand conditions, such as the
Michigan Hand Outcomes Questionnaire, may not adequately capture symptoms
associated with OA. Thus, we recommend the use of disease-specifi c PROMs for
patients with hand OA. However, clinicians should keep in mind that the PROMs
discussed were developed more than 10 years ago. As such, their content may not
adequately refl ect common daily tasks performed today, such as using a smartphone
or computer keyboard or mouse. This should be a priority of future PROM develop-
ment for this patient population.
10 PROMs for Osteoarthritis