Materials and Methods Questionnaire Development

Recognizing the importance of the aforementioned scoring systems, yet realizing their limitations, we created a new system to measure preoperative and postoperative hip pain and function in a younger, more athletic population. The scoring system is self-administered so that patients can complete it without physician or nursing bias. The score is symptom-related only, requiring no physical examination parameters that could introduce bias to the score. Only unweighted questions were included, because weighting the questions automatically introduces a preconceived bias from the medical staff. The questionnaire is concise in order to maximize patient compliance. It also is easily computed by the medical staff to maintain usefulness and accuracy. Patients are given clear choices that are mutually exclusive, collectively exhaustive, and ordered in a hierarchical manner to cut down on patient confusion and improve accuracy.3

Input from patients, surgeons, physical therapists, and epidemiologists was synthesized to understand what was necessary to create an appropriate scoring system. Ultimately, a modified Western Ontario and McMaster Universities Os-teoarthritis Index was created called the nonarthritic hip score. (See Appendix 1.) This scoring system includes 20 multiple-choice questions, each having the same five responses. Similar to the Western Ontario and McMaster Universities Osteoarthritis Index, each of the answers corresponds to a particular numerical value, and the values are added up at the end of the test and multiplied by 1.25 to arrive at a final score. The maximum score is 100, indicating normal hip function. This score is divided into four domains: pain, mechanical symptoms, physical function, and level of activity. All 10 questions measuring pain and physical function come directly from the Western Ontario and McMaster Universities Osteoarthritis Index. Four additional questions deal exclusively with mechanical symptoms involving the hip, because it has been reported that painful clicks and locking episodes of the hip are associated with labral injuries and loose bodies.12 The fourth set of questions measures activity level. In this section, the levels of activity that the patient participates in before and after intervention are identified.

The nonarthritic hip score is designed to be extremely sensitive in order to discriminate among high levels of activity. This scoring scheme is aimed at 20- to 40-year-old patients with hip pain without obvious radiographic diagnosis.

Pilot testing initially was done with the questionnaire being given to patients of varying educational levels, and to health professionals. The questions and answers were then discussed with the participants to ensure that all the questions were clear. This preliminary testing affected the manner in which a few of the questions were asked, but it did not affect the content of the questionnaire. The results of this pilot phase are not included in this report.

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