Defining The Patient Acceptable Symptom State For The 12-Item Hip Disability And Osteoarthritis Outcome Score One Year After Total Hip Arthroplasty For Hip Joint Osteoarthritis.

Abstract

Patient-reported outcome measures (PROMs) are valuable for evaluating treatment success from the patient's perspective. The 12-item Hip disability and Osteoarthritis Outcome Score (HOOS-12) is a PROM scored from 0 to 100, worst to best, that assesses pain, function, and quality of life (QOL). Interpreting PROMs to determine patient satisfaction with treatment can be challenging. The Patient Acceptable Symptom State (PASS) defines the PROM value beyond which patients consider their condition satisfactory. This study aimed to establish PASS values for the HOOS-12 one year after primary elective total hip arthroplasty (THA) for osteoarthritis. Data were drawn from a private Australian joint registry, including adults who underwent THA between January 2020 and December 2022. A single-item satisfaction measure served as the anchor, and participants were categorized as satisfied or dissatisfied. PASS values were estimated using three methods: two predictive modeling methods (one with adjustment for unequal proportions of satisfied/dissatisfied participants and one without) and the receiver operating characteristic (ROC) method. Non-parametric bootstrapping of confidence intervals was performed. Among 746 participants, 96% reported satisfaction with the surgical outcome. The HOOS-12 PASS values derived from the three methods were lowest for QOL (range, 61.2 to 71.5), followed by pain (70.1 to 77.3), summary score (73.2 to 77), and function (74.7 to 81.8). Predictive modeling adjusted for unequal proportions generated the narrowest confidence interval (CI) (7.7 to 12.2 points) and the highest true positive rates (80 to 93%). Predictive modeling with adjustment for unequal proportions was the primary method used and generated the following PASS values for the HOOS-12: pain 70.1, function 74.7, QOL 61.2, and summary score 69.9. Establishment of PASS values gives clinicians and researchers a framework on which to interpret HOOS-12 scores in a way that is patient-centered. Future research should validate these findings in independent cohorts.