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Objectives: The recent Flare-OA questionnaire measuring flare in knee and hip osteoarthritis (OA) (19 items in 5 domains, numerical rating scale) showed good psychometric properties along with classical test theory. This study aimed to determine its scaling properties by Rasch analysis and to present evidence for a refined scalable version., Study Design and Setting: The participants were 398 subjects (mean age 64 years [standard deviation = 8.1], 70.4% women) recruited from Australia, France, and the United States, with clinically and radiologically symptomatic knee or hip OA, who completed an online survey. The sample was split into derivation and validation subsamples, stratified by country and joint. Rasch analysis examined differential item functioning (DIF) for sex, age, country, and joint. A confirmatory factor analysis and an analysis of convergent validity were performed to document the psychometric properties of the short version., Results: To fit the Rasch model, we reordered thresholds of answering modalities when necessary. Two items were removed. A local dependency between 2 items was solved by combining items modalities into a super-item. A uniform DIF (expected and nonremoved) was identified for one item that was split by joint, and a nonuniform DIF for one item for age and country (removed). The person-item threshold distribution showed a well-focused scale; the confirmatory factor analysis and the analysis of convergent validity showed good fit indicators for the short version., Conclusion: The Rasch analysis was helpful in guiding the decision to refine the measurement instrument. After analysis, the 16-item Flare-OA self-report questionnaire is available for use in clinical research., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interest., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Objectives: This study investigated patient reported outcomes, and associations with improvement in quality of life 12-months after total hip arthroplasty (THA)., Materials and Methods: PARTICIPANTS: Adults (n = 433) undergoing THA for osteoarthritis between January 2017 and October 2020 in a large publicly funded tertiary hospital in New Zealand. Participants completed patient reported outcome measures of pain, function and quality of life (QOL) preoperatively, 6- and 12-months following THA., Results: Clinically significant changes in domains of pain and function were associated with improved QOL, even when pre-operation scores were controlled for. The largest gains in all three domains occurred in the pre-to 6-month post-operation period. Baseline demographic variables such as gender and comorbidities were not associated with change in QOL pre-to post-operation. However, although modest, age at surgery was negatively correlated with change in QOL., Conclusions: THA contributes to substantial improvements in QOL, pain and function outcomes, and although possibly tempered by age, these relationships are likely to be inter-related and mutually reinforcing. Future QOL outcomes research should also consider the impacts on QOL improvement of other aspects of functioning such as psychological and social wellbeing., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: To determine the changes produced by dry needling in active myofascial trigger points in hip muscles compared to a sham needling on pain intensity, main pain area, pressure pain threshold and psychological distress in patients with hip osteoarthritis., Design: Secondary analysis of a single-centre, randomized, double-blinded, clinical trial., Intervention: 30 participants with mild to moderate hip osteoarthritis were randomly assigned to DN group (n = 15) or sham DN group (n = 15). DN group received three sessions of penetrating DN, and sham DN group received three sessions of non-penetrating DN in hip muscles., Main Outcome Measures: Pain intensity (Visual Analogue Scale), main pain area (body chart), pressure pain threshold (algometry), psychological distress (Hospital Anxiety and Depression Scale) and self-reported improvement (Global Rate of Change) were measured before and after treatment., Results: DN group showed statistically significant improvements with large effect sizes for pain intensity (p < 0.001; E.S: 2.7), pressure pain thresholds (p < 0.05; E.S: 1.3-1.8) and psychological distress (p = 0.002; E.S: 1.5) compared to sham DN group. The DN group described a self-reported improvement categorised as quite a bit, great or very great deal better (n = 12, 80%). No statistically significant differences were found between baseline and postintervention in the sham DN group in any variable (p > 0.05)., Conclusions: Three sessions of dry needling were more effective than sham dry needling for improving pain intensity, pressure pain threshold and psychological distress in patients with mild to moderate hip osteoarthritis in the short term., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Objectives: To map the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) onto the EQ-5D-5L in patients with hip or knee osteoarthritis (OA)., Methods: A prospective observational study was conducted on 758 patients with hip or knee OA who completed the EQ-5D-5L and WOMAC questionnaires, of whom 644 completed them both again 6 months later. Baseline data were used to derive mapping functions. Generalized additive models were used to identify to which powers the WOMAC subscales should be raised to achieve a linear relationship with the response. For the modeling, general linear models (GLM), Tobit models, and beta regression models were used. Age, sex, and affected joints were also considered. Preferred models were selected based on Akaike and Bayesian information criteria, adjusted R 2 , mean absolute error (MAE), and root mean squared error (RMSE). The functions were validated with the follow-up data using MAE, RMSE, and the intraclass correlation coefficient., Results: The preferred models were a GLM with Pain 2 +Pain 3 +Function+Pain·Function as covariates and a beta model with Pain 3 +Function+Function 2 +Function 3 as covariates. The adjusted R 2 were similar (0.6190 and 0.6136, respectively). The predictive performance of these models in the validation sample was similar and both models showed an overprediction for health states worse than death., Conclusion: To our knowledge, these are the first functions mapping the WOMAC onto the EQ-5D-5L in patients with hip or knee OA. They showed an acceptable fit and precision and could be very useful for clinicians and researchers when cost-effectiveness studies are needed and generic preference-based health-related quality of life instruments to derive utilities are not available., (Copyright © 2019 ISPOR–The Professional Society for Health Economics and Outcomes Research. Published by Elsevier Inc. All rights reserved.)

Background: Patients with hip osteoarthritis may be severely depressed preoperatively due to pain and limited daily-living activities. Hence, evaluating their expectations preoperatively might underestimate their true hopes regarding the upcoming total hip arthroplasty (THA)., Aim: We aimed to assess changes in patients' level of depression, understand their expectations and fulfillment, and identify factors affecting fulfillment., Method: We performed a longitudinal study of 366 Japanese patients who had undergone THA during 2005-2006. Those with THA of the contralateral hip were excluded. Patients' expectations, fulfillment, depression, and physical function were assessed perperative and at 6 weeks and one year postoperatively using our own questionnaire, the Arthritis Impact Measurement Scale 2, and by the Oxford Hip Score . Logistic regression analysis was applied to identify independent predictors of expectation fulfillment., Results: At 6 weeks, 78.1% expressed expectation fulfillment and drastic alleviation of depression. Preoperative depression and fulfillment of patient expectations at 6 weeks were significant predictors of expectation fulfillment at 1 year (95% confidence intervals: 1.01-2.48 and 2.30-9.92, respectively., Conclusions: It is worthwhile for health providers to investigate patients' expectations early in the postoperative period by considering their preoperative depression to confirm fulfillment of expectations., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Objectives: To evaluate the use of decision aids for hip and knee osteoarthritis (OA) regarding the potential risks and benefits of different treatment options., Methods: A prospective, randomized controlled trial was conducted of 147 patients with advanced hip or knee OA to compare the effect of two decision aids (booklet-only vs. booklet with DVD)., Results: Both decision aid programs were well received and demonstrated improvements in patient knowledge and willingness to participate in treatment decisions. The decision aids, however, had a marginal effect on patient willingness to participate in OA management, with an increase of 0.11 and 0.6 on a scale of 2 (P = 0.58) between groups., Conclusions: The decision aids were accepted for most patients and effective in improving patient knowledge and willingness to participate in the decision process. Nevertheless, the addition of a more expensive DVD to the booklet program did not improve patient acceptance or knowledge., (Copyright © 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.)

Background: Hip osteoarthritis, a common age-associated condition, produces considerable disability that may be influenced by a variety of factors other than age. This study examines the magnitude and impact of the presence of comorbid and/or concurrent depression and anxiety symptoms on the disability experienced before and immediately after total hip replacement surgery for end-stage osteoarthritis-a very understudied, albeit potentially important area for improving the health and well-being of adults with this disabling condition., Methods: The available records of 1,000 hip osteoarthritis surgical candidates were examined for any historical/concurrent evidence of depression/anxiety. Additional data on medical comorbidities, pain, function, and discharge destination were extracted. Selected subgroup comparisons between those with depression and anxiety disorder histories and those with no such history and their preoperative and immediate postoperative functional outcomes were conducted., Results: (1) Nine percent (90 patients) of the cohort reported having a prior mood disorder. An additional 9% reported anxiety symptoms and 0.8% reported feeling depressed prior to surgery. (2) Those with depression and anxiety histories were more impaired before surgery and tended to recover more slowly than those with no such history (p < .001). (3) Discharge destination, a surrogate functional measure, varied with the presence or absence of a depression or anxiety history., Conclusion: Almost 20% of end-stage hip osteoarthritis cases undergoing replacement surgery may have mood disorder histories and/or prevailing symptoms of emotional distress that may exaggerate preoperative hip osteoarthritis disability and slow the postoperative recovery process. Examining the cognitive as well as the physical status of adults undergoing hip replacement surgery for osteoarthritis and individualizing, rather than promoting generic intervention approaches, is indicated in efforts to optimize outcomes and minimize impairments and disability for adults with this condition.

Background: The Nottingham Adjustment Scale-Japanese version (hereinafter referred to as NAS-J) was developed to measure psychological adaptation to visually impairment. Several disease-specific modified versions have been developed in Japan. The purpose of this study was to develop and test the reliability, validity, and responsiveness of the NAS-J for hip osteoarthritis patients., Methods: Patients with osteoarthritis of the hip managed as outpatients at the Department of Orthopaedic Surgery of one university hospital gave informed written consent to be enrolled in this study. Subjects were asked to complete a questionnaire consisting of the NAS-J--Hip edition (hereinafter referred to as NAS-J-HIP), health-related QOL (Short Form 36). Subjects' medical and treatment histories, and the Japanese Hip Society's Evaluation Chart of Hip Joint Functions (hereinafter referred to as the JOA score) were also collected from their medical records. Psychometric analyses were conducted to test reliability, validity, and responsiveness., Results: A total of 231 patients agreed to participate in the survey, and responses were obtained from 168 (72.7%). Their mean +/- SD age was 52.5 +/- 12.4 years, and the mean JOA score was 80.9 points. By factor analysis using the principal factor method, seven factors were extracted: (1) anxiety/depression, (2) self-esteem, (3) attitude, (4) locus of control, (5) acceptance, (6) self-efficacy, and (7) attributional style. Concurrent validity was the result according to the near hypothesis. Cronbach's alpha-coefficient ranged from 0.68 to 0.83, indicating high internal consistency., Conclusions: For hip osteoarthritis patients, construct validity was confirmed for NAS-J-HIP. Furthermore, seven factors comprising 27 items with high internal consistency were incorporated into NAS-J-HIP. This scale can be used to assess the psychological adaptation of hip osteoarthritis patients.

Objective: To develop a questionnaire with which to measure quality of life (QoL) in patients with knee and hip osteoarthritis (OA)., Study Design and Setting: Thirty-two caregivers and 96 OA patients were interviewed individually (using cognitive and face-to-face techniques) and in focus groups. A group of experts working independently at first and then consensually used the interview transcripts to generate a 46-item questionnaire., Results: Analysis of questionnaires completed by 263 patients with hip or knee OA resulted in the exclusion of three items (two because of low reliability and one because of a low response rate). Principal component analysis revealed four factors: physical activity, mental health, social functioning, and social support. A pain dimension was individualized. Preliminary testing showed the reliability of the five dimensions to be satisfactory (intraclass correlation coefficients: 0.70-0.85), construct validity was adequate when correlated with the SF36 (Spearman correlation coefficients: 0.43-0.75), and discrimination was satisfactory. The osteoarthritis knee and hip quality of life questionnaire (OAKHQOL) consists of 43 items in five dimensions and three independent items., Conclusion: The OAKHQOL is the first specific knee and hip OA quality of life instrument. Its development followed an a priori structured strategy to ensure content validity. It meets psychometric requirements for validity and reliability.

It is becoming apparent that the disease process of osteoarthritis should be regarded separately from the clinical syndrome of joint pain, use-related stiffness and disability. The latter may best be approached as a chronic regional pain disorder that requires attention to physical, psychological and social factors as well as those related to the disease process. This chapter sets out to look at some of the practical implications of taking this view for the clinical assessment. Starting with the syndrome of hip, knee or hand pain in older adults in the community, we consider what leads people to consult, what the important features to assess might be, the role of imaging in the clinical assessment of osteoarthritis, and finally how a management plan could be formulated. The usefulness of assessing clinical osteoarthritis as a regional pain disorder is uncertain. Even if this were demonstrated, the concept of osteoarthritis as a structural disease should be retained as an integral part., (Copyright 2001 Harcourt Publishers Ltd.)