title: The Development and validation of a self-administered quality-of-life outcome measure for young, active patients with symptomatic hip disease: the International Hip Outcome Tool (iHOT-33).
abstract: OBJECTIVE
  The purpose of this study was to develop a self-administered evaluative tool to measure health-related quality of life in young, active patients with hip disorders.
  
  
  METHODS
  This outcome measure was developed for active patients (aged 18 to 60 years, Tegner activity level ≥ 4) presenting with a variety of symptomatic hip conditions. This multicenter study recruited patients from international hip arthroscopy and arthroplasty surgeon practices. The outcome was created using a process of item generation (51 patients), item reduction (150 patients), and pretesting (31 patients). The questionnaire was tested for test-retest reliability (123 patients); face, content, and construct validity (51 patients); and responsiveness over a 6-month period in post-arthroscopy patients (27 patients).
  
  
  RESULTS
  Initially, 146 items were identified. This number was reduced to 60 through item reduction, and the items were categorized into 4 domains: (1) symptoms and functional limitations; (2) sports and recreational physical activities; (3) job-related concerns; and (4) social, emotional, and lifestyle concerns. The items were then formatted using a visual analog scale. Test-retest reliability showed Pearson correlations greater than 0.80 for 33 of the 60 questions. The intraclass correlation statistic was 0.78, and the Cronbach α was .99. Face validity and content validity were ensured during development, and construct validity was shown with a correlation of 0.81 to the Non-Arthritic Hip Score. Responsiveness was shown with a paired t test (P ≤ .01), effect size of 2.0, standardized response mean of 1.7, responsiveness ratio of 6.7, and minimal clinically important difference of 6 points.
  
  
  CONCLUSIONS
  We have developed a new quality-of-life patient-reported outcome measure, the 33-item International Hip Outcome Tool (iHOT-33). This questionnaire uses a visual analog scale response format designed for computer self-administration by young, active patients with hip pathology. Its development has followed the most rigorous methodology involving a very large number of patients. The iHOT-33 has been shown to be reliable; shows face, content, and construct validity; and is highly responsive to clinical change. In our opinion the iHOT-33 can be used as a primary outcome measure for prospective patient evaluation and randomized clinical trials.
authors.affiliation: University of Calgary Sport Medicine Centre, Calgary, Alberta, Canada. mohtadi@ucalgary.ca
authors.forename: Nicholas G H
authors.initials: NG
authors.lastname: Mohtadi
authors.forename: Damian R
authors.initials: DR
authors.lastname: Griffin
authors.forename: M Elizabeth
authors.initials: ME
authors.lastname: Pedersen
authors.forename: Denise
authors.initials: D
authors.lastname: Chan
authors.forename: Marc R
authors.initials: MR
authors.lastname: Safran
authors.forename: Nicholas
authors.initials: N
authors.lastname: Parsons
authors.forename: Jon K
authors.initials: JK
authors.lastname: Sekiya
authors.forename: Bryan T
authors.initials: BT
authors.lastname: Kelly
authors.forename: Jason R
authors.initials: JR
authors.lastname: Werle
authors.forename: Michael
authors.initials: M
authors.lastname: Leunig
authors.forename: Joseph C
authors.initials: JC
authors.lastname: McCarthy
authors.forename: Hal D
authors.initials: HD
authors.lastname: Martin
authors.forename: J W Thomas
authors.initials: JW
authors.lastname: Byrd
authors.forename: Marc J
authors.initials: MJ
authors.lastname: Philippon
authors.forename: Robroy L
authors.initials: RL
authors.lastname: Martin
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Guanche
authors.forename: John C
authors.initials: JC
authors.lastname: Clohisy
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Sampson
authors.forename: Mininder S
authors.initials: MS
authors.lastname: Kocher
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Larson
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001168:Arthritis / Q000150:complications / Q000628:therapy; D005260:Female; D057925:Femoracetabular Impingement / Q000150:complications / Q000628:therapy; D025981:Hip Injuries / Q000150:complications / Q000628:therapy*; D006621:Hip Joint / Q000473:pathology*; D006802:Human Activities; D006801:Humans; D007592:Joint Diseases / Q000150:complications / Q000628:therapy*; D007593:Joint Instability / Q000150:complications / Q000628:therapy; D008297:Male; D008875:Middle Aged; D059352:Musculoskeletal Pain / Q000209:etiology / Q000628:therapy; D010020:Osteonecrosis / Q000150:complications / Q000628:therapy; D011788:Quality of Life; D015203:Reproducibility of Results; D057566:Self Report; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult