Original Article
A Short Version of the International Hip Outcome Tool (iHOT-12) for Use in Routine Clinical Practice

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Purpose

The purpose of this study was to develop and validate a shorter version of the 33-item International Hip Outcome Tool (iHOT-33) that could be easily used in routine clinical practice to measure both health-related quality of life and changes after treatment in young, active patients with hip disorders.

Methods

A development dataset (104 patients) was explored with forward-selection linear regression analysis to choose a reduced item set for the new scale. This was tested in a validation dataset (1,833 patients) and responsiveness subset (80 patients) to measure agreement between the shorter and longer versions and to test the sensitivity of the shorter instrument to change after treatment.

Results

Twelve items were chosen for a short version of the International Hip Outcome Tool (iHOT-12). The iHOT-12 showed excellent agreement with the long version (iHOT-33). It captured 95.9% (95% confidence interval, 95.0% to 96.8%) of the variation of the iHOT-33 and showed equivalent sensitivity to change with a standardized effect size of 0.98 (95% confidence interval, 0.67 to 1.28).

Conclusions

A short version of the International Hip Outcome Tool (iHOT-12) has been developed. It has very similar characteristics to the original rigorously validated 33-item questionnaire, losing very little information despite being only one-third the length. It is valid, reliable, and responsive to change. We suggest that it be used for initial assessment and postoperative follow-up in routine clinical practice.

Section snippets

Development of Short Version of iHOT

The feasibility of a short version of the iHOT was explored during a development study. During January and February 2008, active, English-speaking adults, aged 18 to 60 years, who presented as new patients to a young adult hip clinic or who were undergoing follow-up after hip-preserving treatment of hip problems were invited to take part. One hundred and four such patients completed the iHOT-33.1 Characteristics of these patients are shown in Table 1. A principal component analysis was used to

Development

Principal component analysis of the iHOT-33 for the development data showed that there were at least 4 important components (with eigenvalues >1) that we can loosely associate with the 4 domains of the iHOT-33. This analysis showed that there was some scope to shorten the iHOT-33 while retaining the main properties of the instrument. This was expected, because the iHOT-33 has been deliberately developed with a degree of innate redundancy to provide a measure that is both responsive to change

Discussion

The iHOT was developed to provide an evaluation tool for the management of nonarthritic hip problems in young, active patients. Excellent instruments already exist for patients with hip fractures, those with hip arthritis, or those undergoing hip arthroplasty.9 The iHOT-33 was designed using a rigorous methodology with a large number of active, young patients being considered for, or receiving, hip-preserving surgery, to capture their different problems, goals, and expectations of treatment.1

Conclusions

A short version of the iHOT, the iHOT-12, has been developed. It has very similar characteristics to the original 33-item questionnaire, losing very little information despite being only one-third the length. It is valid, reliable, and responsive to change. We suggest that it be used for initial assessment and postoperative follow-up in routine clinical practice.

Acknowledgment

The authors have benefited from collaboration with the Multicenter Arthroscopy of the Hip Outcomes Research Network (MAHORN), which includes J. W. Thomas Byrd, M.D.; John C. Clohisy, M.D.; Damian R. Griffin, M.A., M.Phil., F.R.C.S.(Tr&Orth); Carlos A. Guanche, M.D.; Bryan T. Kelly, M.D.; Mininder S. Kocher, M.D., M.P.H.; Christopher M. Larson, M.D.; Michael Leunig, M.D.; Hal D. Martin, D.O.; RobRoy L. Martin, Ph.D., P.T., C.S.C.S.; Joseph C. McCarthy, M.D.; Nicholas G. H. Mohtadi, M.D., M.Sc.,

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Cited by (0)

The authors report the following potential conflict of interest or source of funding in relation to this article: Professor Griffin is a paid consultant or employee for ConMed Linvatec and receives research or institutional support from Wright Medical. Dr. Mohtadi is on the Membership and Scientific Committees of the International Society of Arthroscopy, Knee Surgery & Orthopaedic Sports Medicine and is an Editorial Board Member of the American Journal of Sports Medicine, Clinical Journal of Sport Medicine, Physician and Sportsmedicine, and Journal of Sport-Orthopädie - Sport-Traumatologie. Dr. Safran is on the Executive Committee of the American Shoulder and Elbow Surgeons; is Treasurer and a Board Member of the International Society of Arthroscopy, Knee Surgery & Orthopaedic Sports Medicine; is Chair of the Council of Delegates and a member of the Education Committee and Board Member of the American Orthopaedic Society for Sports Medicine; is an Editorial Board Member of the American Journal of Sports Medicine; and is President and a Board Member of the Society for Tennis Medicine and Science. He receives royalties from Stryker Medical (shoulder anchor), Lippincott Williams & Wilkins, and Elsevier/Saunders; is a paid consultant or employee for ArthroCare; is an unpaid consultant for Biomimedica and Cradle Medical; receives fellowship support from Smith & Nephew, ConMed Linvatec, Ossur, and Zimmer; and owns stock or stock options in Biomimedica and Cradle Medical.

The members of the Multicenter Arthroscopy of the Hip Outcomes Research Network (MAHORN) are listed in the Acknowledgments section at the end of this article.

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