Psychometric Analysis of the Hip Disability and Osteoarthritis Outcome Score (HOOS)

Abstract

Hip Disability and Osteoarthritis Outcome Survey (HOOS) was developed as a region- and disease-specific outcome to assess hip disability. Despite the use of the HOOS in clinical practice and research, psychometric analyses of the scale in a large dataset of patients have not been performed. As such, the purposes of this study were to assess the structural validity of the HOOS in patients who underwent a total hip arthroplasty. Data were obtained from the Surgical Outcome System (SOS) global registry. Confirmatory factor analysis (CFA) was conducted to assess the scale structure of the 40-item HOOS and exploratory factor analysis (EFA) was conducted to identify a parsimonious scale structure. The parsimonious model identified was subjected to multi-group and longitudinal invariance testing and LGC modeling. The original five-factor, 40-item HOOS did not meet recommended model fit indices values (CFI = 0.822, TLI = 0.809, IFI = 0.822, RMSEA = 0.085). Alternate model generation identified an alternative model (i.e., HOOS-9). Sound model fit was identified for the HOOS-9 (CFI = 0.974, TLI = 0.961, RMSEA = 0.046). Invariance testing criteria were also met between groups (i.e., age and sex) and across time. Lastly, a nonlinear growth trajectory was identified in responses pertaining to hip disability. The original scale structure of the 40-item HOOS was not supported. The HOOS-9 met contemporary model fit recommendations, along with multi-group and longitudinal invariance testing. Our findings support the preliminary use of the HOOS-9 to assess hip function and disability in research and clinical practice.

Keywords: confirmatory factor analysis; latent growth-curve modeling; multi-group invariance testing; total hip arthroplasty.

Figure 1

Confirmatory Factor Analysis of the 40-item HOOS. Chisq = Chi Square (χ²); df = degrees of freedom, p = alpha level; CFI = Comparative Fit Index; TLI = Tucker–Lewis Index; IFI = Bollen’s Incremental Fit Index; RMSEA = Root Mean Square Error of Approximation; SRMR = Standardized Root Mean Square Residual.

Figure 2

Scree plot of initial EFA Extraction of the 40-item HOOS in Sample n1.

Figure 3

Confirmatory Factor Analysis in Sample n2 of the Modified 9-item HOOS. Chisq = Chi Square (χ²); df = degrees of freedom, p = alpha level; CFI = Comparative Fit Index; TLI = Tucker-Lewis Index; IFI = Bollen’s Incremental Fit Index; RMSEA = Root Mean Square Error of Approximation; SRMR = Standardized Root Mean Square Residual.

Figure 4

Linear Latent Growth Model of the 9-item HOOS. Chisq = Chi Square (χ²); df = degrees of freedom, p = alpha level; CFI = Comparative Fit Index; TLI = Tucker–Lewis Index; IFI = Bollen’s Incremental Fit Index; RMSEA = Root Mean Square Error of Approximation.

Figure 5

Exploratory Latent Growth Model of the 9-item HOOS. Chisq = Chi Square (χ²); df = degrees of freedom, p = alpha level; CFI = Comparative Fit Index; TLI = Tucker–Lewis Index; IFI = Bollen’s Incremental Fit Index; RMSEA = Root Mean Square Error of Approximation.