Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire Research Articles

Preoperative medications is one of the factor affecting patient-reported outcomes after total hip arthroplasty

Although the reported clinical outcomes of total hip arthroplasty (THA) for hip osteoarthritis are satisfactory, not all patients are completely satisfied. Thus, there is interest in predicting postoperative satisfaction before surgery. The influence of comorbidities and preoperative medications on the incidence of complications and duration of hospitalization following THA has become apparent. However, studies about the associations of preoperative medication with clinical outcomes of THA are limited. Therefore, this study aimed to clarify the relationship between preoperative medications and postoperative patient-reported outcomes. This retrospective cross-sectional multicenter study enrolled post-THA patients (79 patients, 90 hips) who were examined from February to March 2019 in eight general hospitals. Outcome measures included patient-reported outcome as Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ) score. Preoperative medications were investigated from medical records. Medications were categorized, and analgesics were categorized into non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen, pregabalin, duloxetine, neurotropin (an extract from inflammatory rabbit skin inoculated by vaccinia virus), and opioid. To identify the factors associated with JHEQ score, the patients were divided into lower (<55 score) and higher (≥55) JHEQ score groups. Spearman rank correlation coefficient (r) showed significant difference between the total number of preoperative medications and postoperative JHEQ movement subscale (r = −0.37, p < 0.01), mental subscale (r = −0.29, p < 0.01), and JHEQ (r = −0.30, p < 0.01) scores. In the multiple logistic regression analysis, only the total number of preoperative medications was identified as a risk factor for lower JHEQ score (p < 0.01). This study clarified an inverse correlation between the total preoperative medication count and postoperative outcomes and found that larger total count of preoperative medications is a risk factor of poor postoperative patient-reported outcomes of THA.

The influence of anterior and posterior knot placement on hip function after total hip arthroplasty using a modified Dall's approach: a prospective non-randomised comparative study.

The direct lateral modified Dall's approach for total hip arthroplasty (THA) provides an excellent vision of the hip joint by osteotomising the greater trochanter (GT). A robust method for the reattachment of osteotomised fragments is essential to prevent complications around the GT. Ultra-high molecular weight polyethylene cables are reported to be useful for reattachment; but the optimal suture method of these cables is unknown. The purpose of this study was to investigate the influence of the knot position on hip function after primary THA. In a prospective non-randomised study 216 primary THA were included, being scheduled for an operation with a modified Dall's approach. They were divided into 2 groups, anterior (A) and posterior (P) according to the knot position for the GT. Hip function was assessed using the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ), pain visual analogue scale (VAS), satisfaction VAS and Merle d'Aubigne-Postel hip score at 3 and 6 months postoperatively. A logistic regression analysis was used to investigate factors influenced by the knot position. Patient demographics were comparable between the 2 groups. Differences of the knot position did not affect the radiological failure rate of GT reattachment. Regression analysis showed a significantly positive impact on pain VAS and flexion range at 6 months postoperatively for posterior knot position. For the reattachment of osteotomised fragments, the posterior knot may be superior to the anterior knot.

Validity of the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ) for Japanese patients with labral tear.

The Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ) was created for patient-reported outcome measures (PROMs) and to evaluate the conditions of patients with hip disease. Nevertheless, the validity of the JHEQ for patients with hip labral tears remains unclear. Therefore, we validated the JHEQ in patients with labral tears. There were 51 patients (mean age 44.5, range 18–60 years; 31 women). Thirty-two patients had right-sided tears, 29 underwent hip arthroscopy, 32 had femoroacetabular impingement and 15 had developmental hip dysplasia. Five PROMs included in the JHEQ were evaluated using test–retest methods. Statistical analysis was performed using SPSS software according to the COnsensus-based Standards for the selection of health status Measurement Instruments checklist. The intra-class correlation coefficient (1, 2) of all JHEQ scores (84 points) was 0.88 and Cronbach’s α was 0.94. Bland–Altman analysis revealed good test–retest reliability for the JHEQ. The Spearman’s rank test, including the SF-36 subscale, showed a high correlation with physical functioning [1, 0.67 (P < 0.01); 2, 0.65 (P < 0.01)], body pain [1, 0.54 (P < 0.01); 2, 0.53 (P < 0.01)] and physical component summary [1, 0.55 (P < 0.01); 2, 0.55 (P < 0.01)]. The value of minimal important change (22.9) was higher than that of smallest detectable change (3.21), suggesting that the JHEQ has adequate responsiveness. We demonstrated the reliability, validity and responsiveness of the JHEQ in Japanese patients with hip labral tears. JHEQ is a valid assessment tool not only for patients with hip osteoarthritis or osteonecrosis but also for those with hip labral tears.

Factors associated with health-related quality of life in Japanese patients with hip osteoarthritis: A cross-sectional study

Background/Purpose:Chronic symptoms related with hip osteoarthritis (OA) can negatively affect health-related quality of life (HRQoL). The purpose of this study was to examine factors related to a HRQoL measure that considers an Asian lifestyle in Japanese patients with hip OA.Methods:Forty-seven female subjects participated. The dependent variable was the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ), which assessed HRQoL. Potential factors were measured as independent variables. After screening, potential variables were entered into a multiple regression analysis to determine which variables were related to HRQoL.Results:In the regression model, knee extension muscle strength on the unaffected side and hip flexion range of motion (ROM) on the affected side were associated with HRQoL. Higher strength and higher ROM were related to greater HRQoL.Conclusion:Results can help health-care providers develop appropriate rehabilitation programs for improving HRQoL in patients with hip OA.

The effects of patient characteristics and stem alignment on distal femoral cortical hypertrophy after cemented polished tapered stem implantation.

The objective of this study was to evaluate the results of over 10years of total hip arthroplasty (THA) practice with ExeterTM stems and the clinical relevance of distal femoral cortical hypertrophy (DFCH). We retrospectively reviewed 127 hips (120 patients) that had undergone THA with ExeterTM stems between 2004 and 2007. Kaplan-Meier survival analyses for the stem of all 127 hips were performed using different endpoints. Of 127 hips, 100 (94 patients) had complete 10-year follow-up data, including the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ) as the patient-reported outcomes, and the clinical relevance of DFCH was analyzed using multivariable logistic regression analysis. The survival of the stem with the endpoint of re-operation for loosening, > 5-mm subsidence, and re-operation for any reason were 100%, 99.1% (95% CI 97.5-100%), and 98.3% (95% CI 96.0-100%), respectively. Of 100 hips followed completely for 10years, DFCH occurred in 20 hips (20%). The satisfaction and pain visual analog scale of JHEQ revealed high satisfaction and less pain in patients with DFCH. By multivariate logistic regression analysis, body weight > 55kg (odds ratio: 2.88, p = 0.035) and varus stem alignment (odds ratio: 6.56, p = 0.003) were found to be predictors for DFCH. The incidence of DFCH with the ExeterTM stem was 20%. A body weight > 55kg and varus stem alignment are predictors for future DFCH. DFCH with the ExeterTM stem indicates a good outcome with less hip pain.

The relationship between radiographic findings and patient-reported outcomes in adult hip dysplasia patients: A hospital cross-sectional study

IntroductionThis study aimed to clarify the relationship of individual radiographic parameters and features with the patient-reported outcome measurements (PROMs) of patients with developmental dysplasia of the hip (DDH) in a hospital-referred cross-sectional analysis. MethodsThis cross-sectional study included 108 Japanese DDH patients (female, n = 88; male, n = 20; mean age, 43.4 years). We recorded the CE angle, angle of Sharp, ARO, ADR, AHI, crossover sign, pistol grip deformity, and femoral head-neck ratio, which were measured on the AP view, and the α-angle, which was measured on the Lauenstein view. We also recorded cyst formation and osteophytes on either view. We used the Japanese Orthopaedic Association hip disease evaluation questionnaire (JHEQ) to assess the PROMs. The PROMs of patients with and without cysts or osteophytes and those of patients with or without cam or pincer deformity were compared. The relationships between specific PROMs and radiographic features were evaluated with a linear regression analysis and independent associations between PROMs and radiographic features were assessed with a multiple regression analysis using various independent variables. ResultsThe JHEQ movement and mental values in patients with cyst formation were significantly lower in comparison to those in patients without cyst formation. The JHEQ subscale values did not differ according to the presence or absence of osteophytes, cam deformity or pincer deformity. The CE angle was found to be associated with the JHEQ movement score in the linear regression analysis. To identify radiographic features that were independently associated with each of the JHEQ subscale scores, we performed a multiple regression analysis with age, body mass index, sex and the number of affected hip joints (bilateral or unilateral) included as independent variables. The CE angle was found to be independently associated with JHEQ movement. ConclusionThe CE angle was independently associated with the JHEQ movement value.

Measurement of equivalence between the web and paper versions of the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire

Objectives: Digitised patient-reported outcome may be beneficial for physicians and patients. The Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ) can only be completed with paper and pencil (pJHEQ). We newly developed a web version of the JHEQ (wJHEQ). This study aimed to determine whether the scores obtained with the wJHEQ are equivalent to those from the pJHEQ, how much the wJHEQ would decrease missing answers, and which JHEQ the participants preferred to use.Methods: To measure equivalence between the pJHEQ and wJHEQ, we evaluated the mean score difference for each subscale (pain, movement, mental) and Visual Analogue Scale (VAS; satisfaction, right hip pain, left hip pain) and then assessed the intraclass correlation coefficients (ICC) between the two scores. ICC values ≥0.75 were defined as excellent agreement. We used Bland–Altman analysis to assess level of agreement between the values of the two questionnaires. We compared the number of incomplete forms and amount of missing data between the two questionnaires. We investigated ease of use by asking the participants which format was easier to use.Results: This study comprised 113 patients (mean age 58.1 years, 81% female) with hip disease. Mean score differences for each subscale between the wJHEQ and pJHEQ were not significantly different. The values of ICC for each subscale and each VAS were all >0.75. All 113 participants completed the wJHEQ questionnaire, whereas nine patients did not complete the pJHEQ form. There was a significant statistical difference between the completion rate of the wJHEQ and that of the pJHEQ (p = .0017). Fifty-seven participants (55%) preferred the wJHEQ, whereas 33 participants (32%) preferred the pJHEQ.Conclusion: The wJHEQ was found to be equivalent to the original pJHEQ. The wJHEQ significantly decreased the numbers of missing answers and incomplete forms. The participants felt ease of use was nearly equivalent. The wJHEQ might help facilitate more complete assessments in clinical trials and research.

Do femoral head collapse and the contralateral condition affect patient-reported quality of life and referral pain in patients with osteonecrosis of the femoral head?

The objectives of this study were to investigate patient-reported outcomes and referral pain at the first visit in patients with osteonecrosis of the femoral head (ONFH) and to clarify the influence of collapse of the femoral head and the contralateral condition. The study included 105 patients (130 hips) with ONFH at the first visit, who were divided into two groups based on the presence of bilateral walking hip pain (bilateral group 25 patients, 50 hips) and unilateral hip pain (unilateral group 80 patients, 80 hips). We compared the Short Form-36 (SF-36), Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ), and visual analog scale (VAS) responses for hip, knee, and low back pain between the groups to investigate the influence of the contralateral condition. Regarding the influence of femoral head collapse, we investigated these subjects based on the stage classification in the unilateral group. The physical component summary (PCS) of the SF-36 and all domains of the JHEQ were poorer in the bilateral group than in the unilateral group. In addition, the VAS score for low back pain was significantly poorer in the bilateral group than in the unilateral group. Regarding the collapse of the femoral head, the SF-36 for the PCS and JHEQ for pain had a significant relationship in the ONFH stage. The VAS scores for hip and knee pain had a significant relationship in the ONFH stage. Collapse of the femoral head and the contralateral condition of ONFH strongly affect patients' activities of daily life.

Posterior versus direct anterior approach in total hip arthroplasty: difference in patient-reported outcomes measured with the Forgotten Joint Score-12

Introduction: When the postoperative outcome of primary total hip arthroplasty (THA) was compared with the direct anterior approach (DAA) and the posterior approach (PA), there was no significant difference of the clinical outcome at 6 months to 1 year after surgery in many studies. This study was performed to compare the medium-term outcome of THA via the DAA or PA and clarify which approach achieves better quality of life (QOL).Methods: We investigated 61 hips receiving primary THA (30 via DAA and 31 via PA), using hip function scores such as the Harris Hip Score (HHS) and patient-reported outcomes such as the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ), and the Forgotten Joint Score-12 (FJS).Results: The mean duration of postoperative follow-up was 36.8 months in the DAA group and 40.5 months in the PA group. There was no difference in preoperative or postoperative HHS between the two groups. Although there was no difference of postoperative WOMAC and JHEQ, the postoperative FJS-12 score was significantly higher in the DAA group than in the PA group (75.2 ± 15.9 versus 60.1 ± 24.4, p = 0.01).Conclusion: When forgetting the artificial joint in daily life is the target, better QOL can be achieved by performing THA via the DAA.

Clinical Outcomes of Patients Who Perform High-Load Activities after Total Hip Arthroplasty in Snowy Agricultural Areas

Background: In snowy agricultural areas, weeding and snow shoveling are essential activities, and sports activities are common recreational activities. Clarifying the relationships between the degrees of these activities after total hip arthroplasty (THA) and the clinical outcomes may enable us to predict the results of THA for high-load activity patients. Methods: The subjects were 227 post-THA patients who were followed up between 2012 and 2014. Patient-reported outcomes were investigated by the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ) and a questionnaire on postoperative activity. In addition, the Japanese Orthopaedic Association Hip Score (JOA score) was used to quantify hip function. Results: Patients who resumed activities had significantly higher JOA and JHEQ scores than patients who had given up their activities. However, 25.8% of patients had not resumed weeding with a squatting posture. Furthermore, 20% had not resumed sports activities. The most common reason for giving up these activities was fear of implant failure. Conclusions: If the patients were informed that there is no problem restarting their activities after THA, the patients could resume activities and their clinical outcomes may be improved.

Relationship between clinical results of total hip replacement and postoperative activities including weeding and snow shovelling.

Weeding or snow shovelling is indispensable for life in farm villages of northern countries. Clarifying the relationships between the degrees of these activities after total hip replacement (THR) and the clinical results of THR may enable us to predict the results of THR for high-level activity patients. The relationships between work activities after THR and the results were investigated. The subjects were 95 post-THR patients, who consulted 6 hospitals in August 2012. First, the Japanese Orthopaedic Association Hip-Disease Evaluation Questionnaire (JHEQ) and a questionnaire on postoperative activity were administered. Then, the Japanese Orthopaedic Association hip score (JOA score) was evaluated. The subjects' average age was 68 years. The average period after surgery was 4 years and 5 months. Weeding and snow shovelling were performed after THR in 44.2% and 40.0% of cases, respectively. The rate of farming after surgery (25.6%) was greater than that of swimming (21.1%). Both the JOA score and JHEQ were higher in those who played sports after THR than in those who did not (p = 0.003, p = 0.0046). The JOA score of those who performed work activities after THR was higher than that of those who did not (p = 0.0295). Nearly half of patients performed weeding or snow shovelling after THR, and about 1/4 of the patients engaged in farming after THR. The clinical results in cases doing sports and work activities after THR were better than those of cases not doing such activities. Therefore, these activities may be positively recommended.

Influence of the contralateral hip state after total hip arthroplasty on patient-reported outcomes measured with the Forgotten Joint Score-12.

The purpose of this study was to examine the influence of the contralateral hip state on postoperative assessment using the Forgotten Joint Score-12 (FJS-12) in comparison with the McMaster Universities Osteoarthritis Index (WOMAC) and the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ). One hundred and thirty-four hips underwent total hip arthroplasty (THA) between 2014 and 2015. Of these, the subjects were 106 hips with degenerative hip arthrosis as a primary disease for whom initial THA was performed on the affected side. The WOMAC and JHEQ were investigated before surgery and 1month, 6months, and 1year after surgery. The FJS-12 was examined 1month, 6months, and 1year after surgery. We divided the subjects into three groups based on the state of the contralateral hip, which was not surgically treated in this study: healthy (n=43), THA (n=31), and OA (n=31) groups. One year after surgery, the mean FJS-12 scores in the healthy, THA, and OA groups were 69.1, 52.8, and 68.0 points, respectively. In the THA group, the score was significantly lower than in the healthy and OA group. There were no significant differences in WOMAC and JHEQ scores among the three groups. The FJS-12 score in the presence of an arthroplasty on the contralateral side was more markedly influenced by the contralateral hip state compared with that in the presence of contralateral painful OA. This result suggests that it is necessary to understand the characteristics of PROs and utilize them for post-THA assessment.

Effects of perioperative factors and hip geometry on hip abductor muscle strength during the first 6 months after anterolateral total hip arthroplasty.

[Purpose] The importance and effect of hip joint geometry on hip abductor muscle strength are well known. In addition, other perioperative factors are also known to affect hip abductor muscle strength. This study examined the relative importance of factors affecting hip abductor muscle strength after total hip arthroplasty. [Subjects and Methods] The subjects were 97 females with osteoarthritis scheduled for primary unilateral THA. The following variables were assessed preoperatively and 2 and 6 months after surgery: isometric hip abductor strength, radiographic analysis (Crowe class, postoperative femoral offset (FO)), Frenchay Activities Index, compliance rate with home exercise, Japanese Orthopaedic Association Hip-Disease Evaluation Questionnaire (JHEQ), and demographic data. Factors related to isometric hip abductor muscle strength 2 and 6 months after surgery were examined. [Results] Significant factors related to isometric hip abductor muscle strength at 2 and 6 months after surgery were, in extraction order: 1. isometric hip abductor muscle strength in the preoperative period; 2. BMI; and 3. the JHEQ mental score at 2 and 6 months after surgery. [Conclusion] Preoperative factors and postoperative mental status were related to postoperative isometric hip abductor strength. FO was not extracted as a significant factor related to postoperative isomeric hip abductor strength.

Validity of a tablet computer version of the Japanese Orthopaedic Association hip disease evaluation questionnaire: a pilot study.

The Japanese Orthopaedic Association hip disease evaluation questionnaire (JHEQ) was established as a new patient-reported outcome for patients with hip disease. We developed a JHEQ application beta version for tablet computers. The application has a slider system to input visual analogue scale (VAS) measurements. The purposes of this study were 1) to test whether the VAS that was acquired from this slider system was equal to the value recorded on paper and 2) to evaluate the validity and agreement of the JHEQ tablet version. A total of 57 patients were analyzed in the study (mean age, 60.2 years; range, 29-81 years). They received either the paper-and-pencil version (paper version) or the tablet computer version (tablet version). To evaluate the validity of the tablet version, we analyzed differences in the VAS and total scores between the paper version and tablet computer version. In addition, we calculated Cronbach's alpha, the intraclass correlation coefficient (ICC), and the Pearson's correlation coefficient (CC). The VAS scores in the tablet version were significantly lower than those in the paper version (22.3 ± 5.4 vs. 17.0 ± 4.5 and 28.1 ± 6.1 vs. 23.5 ± 5.3, respectively; all P < 0.05). Values of Cronbach's alpha, the ICC, and the CC among subscales ranged from 0.90 to 0.95. In conclusion, the total JHEQ score on the tablet computer beta version was in agreement with the score on the paper version. However, the VAS on the tablet version, which used a slider bar system, proved unreliable.

Comparison of patient satisfaction after unilateral or simultaneous bilateral total hip arthroplasty through a direct anterior approach: Evaluation using the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire

The aim of this study was to compare patients' perception of treatment outcome after unilateral or simultaneous total hip arthroplasty (THA) using the newly developed Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ). This study included 429 patients treated with primary THA using a direct anterior approach, namely 304 cases of in the unilateral THA (58 males and 246 females; mean age, 62.3 years) and 125 cases of in the simultaneous bilateral THA (24 males and 101 females; mean age, 58.3 years). Items for evaluation included clinical outcomes and all four aspects of the JHEQ score, namely visual analog scale (VAS), pain, movement, and mental status. The mean operative time per hip was 51.3±19.4min (range, 22-180min) in unilateral group and 46.2±15.1min (range, 26-106min) in simultaneous bilateral group. The mean operative blood loss per hip was 421.2ml±232.1ml (range, 70-1300ml) in unilateral group and 200.8±149.8ml (range, 30-1040ml) in simultaneous bilateral group. The total JHEQ score (pain/motion/mental status) improved from 26.5±13.6 (preoperative, 10.1/6.8/9.6) to 69.4±14.8 (1 year postoperatively, 25.1/20.5/23.8) in unilateral group and from 21.0±8.2 (preoperative, 11.9/2.3/6.9) to 74.9±9.5 (1 year postoperatively, 27.2/22.6/25.0) in simultaneous bilateral group. These results demonstrated a significant improvement before and after surgery for patients in both groups. There were not major complications such as dislocation, bone fracture, nerve palsy or symptomatic pulmonary embolism were observed. In this study, we observed greater improvement in JHEQ in patients treated with bilateral simultaneous THA than in those treated with unilateral THA. These findings demonstrated that bilateral simultaneous THA was related to high patient satisfaction as well as high safety.

Lateral femoral cutaneous nerve injury with the direct anterior approach for total hip arthroplasty.

Although injury of the lateral femoral cutaneous nerve (LFCN) is a known complication after total hip arthroplasty (THA) via the direct anterior approach (DAA), the impact of this complication on postoperative quality of life (QOL) is unclear. This study aims to investigate the incidence of LFCN injury after DAA for THA, and to determine the impact of LFCN injury on QOL and hip function. We prospectively investigated 122 hips operated upon using the DAA regarding the incidence of LFCN injury using self-reported questionnaires, hip functional scores such as the Harris Hip Score (HHS) and the Japanese Orthopaedic Association (JOA) score, and patient-reported outcomes such as the Western Ontario and McMaster Universities Osteoarthritis Index, the Japanese Orthopaedic Association Hip disease Evaluation Questionnaire (JHEQ), and the Forgotten Joint Score-12 (FJS). LFCN injury was seen in 39 hips (31.9%). In affected hips, the leading symptom was hypo-aesthesia (46.2%), followed by tingling or jolt-like sensation (28.2%). There was no difference in the HHS and JOA score between those with LFCN injury and those without. There was a significant difference in the FJS-12 between the two groups (50.9 ± 25.3 for hips with LFCN injury vs 64.3 ± 25.7 without, p = 0.01). There was a non-significant tendency for patients with LFCN injury to have a lower JHEQ than those without (63.6 ± 19.6 for hips with LFCN injury vs 70.8 ± 22.9 without, p = 0.13). The incidence of LFCN injury decreased QOL but not hip function after DAA for THA.

Clinical assessment after total hip arthroplasty using the Japanese Orthopaedic Association Hip-Disease Evaluation Questionnaire

AimsThe aim of this study was to evaluate clinical outcomes using the Japanese Orthopaedic Association Hip-Disease Evaluation Questionnaire (JHEQ). Methods100 consecutive patients at 6 months after total hip arthroplasty (THA) were evaluated. ResultsThe improvement rate for the pain subscale was significantly higher than that for the movement and mental subscales. Preoperative scores on the JHEQ movement and mental subscales were positively correlated to scores on the same subscales at 6 months after surgery. ConclusionWe conclude that the most predictable aspect of THA is pain relief and preoperative hip-joint ROM and mental status influence 6-month postoperative outcomes.

Reliability and validity of the Japanese Orthopaedic Association hip disease evaluation questionnaire (JHEQ) for patients with hip disease

BackgroundThe Japanese Orthopaedic Association hip disease evaluation questionnaire (JHEQ) was developed to evaluate the quality of life (QOL) in patients with hip disease. This questionnaire consists of three subscales: pain; movement; and mental. The purpose of this study was to assess the reliability and validity of the JHEQ for use as a clinical evaluation tool. MethodsWe investigated patients who visited the outpatient department at our hospital and affiliated hospital between April and May 2010. The study population comprised 286 patients (239 women) with a mean age of 56.8 years. The diagnosis was osteoarthritis of the hip in 230 patients, avascular osteonecrosis of the femoral head in 49 patients, and other conditions in 7 patients. The JHEQ questionnaire, the SF-36 questionnaire as a generic QOL scale, and the Oxford hip score (OHS) as a disease-specific scale, were filled out by the patient while waiting in the outpatient department. ResultsPearson’s correlation coefficients of 0.6 were observed between JHEQ pain and SF-36 bodily pain (BP) subscales, and between JHEQ movement and SF-36 physical functioning (PF) subscales. The JHEQ mental subscale correlated with SF-36 social functioning (SF) and BP subscales. A strong negative correlation was seen between JHEQ pain and OHS pain subscales (r=−0.817). JHEQ movement subscale also showed a strong negative correlation with the OHS function subscale (r=−0.715). These results indicated the convergent validity of JHEQ. The internal consistency of pain, movement, and mental subscales of JHEQ was satisfactory, indicated by Cronbach’s α coefficients of 0.92, 0.91, and 0.94, respectively. Each subscale also showed high test–retest reliability with intra-class correlation coefficients of 0.89, 0.93, and 0.85, respectively. ConclusionsWe determined the reliability and validity of JHEQ as a self-administered questionnaire that evaluates hip disease. JHEQ is useful as a tool for evaluating patients with hip disease.

Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ): a patient-based evaluation tool for hip-joint disease. The Subcommittee on Hip Disease Evaluation of the Clinical Outcome Committee of the Japanese Orthopaedic Association

BackgroundThe Japanese Orthopaedic Association Hip Score is widely used in Japan, but this tool is designed to reflect the viewpoint of health-care providers rather than that of patients. In gauging the effect of medical therapies in addition to clinical results, it is necessary to assess quality of life (QOL) from the viewpoint of patients. However, there is no tool evaluating QOL for Japanese patients with hip-joint disease. MethodsWith the aim of more accurately classifying QOL for Japanese patients with hip-joint disease, we prepared a questionnaire with 58 items for the survey derived from 464 opinions obtained from approximately 100 Japanese patients with hip-joint disease and previously devised evaluation criteria. In the survey, we collected information on 501 cases, and 402 were subjected to factor analysis. From this, we formulated three categories—movement, mental, and pain—each comprising 7 items, for a total of 21 items to be used as evaluation criteria for hip-joint function. ResultsThe Cronbach’s α coefficients for the three categories were 0.93, 0.93, and 0.95, respectively, indicating the high reliability of the evaluation criteria. The 21 items included some related to the Asian lifestyle, such as use of a Japanese-style toilet and rising from the floor, which are not included in other evaluation tools. ConclusionsThis self-administered questionnaire may become a useful tool in the evaluation of not only Japanese patients, but also of members of other ethnic groups who engage in deep flexion of the hip joint during daily activities.