There are approximately 20 questionnaires currently employed to assess patient perception of hip joint diseases and their treatment, including the HHS.(17) HHS is a validated method to measure the outcome of femoral neck fracture, OA and THA.(18) This measure has demonstrated its superiority to generic health scales such as the SF36 as a more representative method for patients with total hip arthroplasty. (33) However, comparison of the HHS to other disease-specific scores did not show that any measure was significantly superior to the others. (23)
The HHS was chosen to be translated because it is one of the most widely used scores for disease-specific measure for hip joint evaluation.(23)(26) It was developed and published in 1969 by William Harris as a physician assessment tool to evaluate THA.(23) However, it has also proved to be a reliable measurement tool if completed by the patients.(29, 30) Many authors have employed this tool to evaluate patients with hip conditions such as femoral neck fracture or osteoarthritis, as well as the success of surgical interventions such as THA and have found that it is a representative measure of their condition and treatment.(19, 27, 28) HHS covers both pain and functional disability, which are also the two main factors leading to THA for patients with hip OA. As such HHS has become the most widely used measurement tool for THA outcome worldwide.(23, 29) Therefore, many scholars aim to study patients with THA by using HHS in order to compare their results to studies in the literature. HHS has the advantage of assessing the clinical improvement among patients with hip OA before and after THA, and additionally, it can predict the risk for primary THA revision.(28)
The HHS is composed of 10 items with a maximum score of 100 points, covering four major domains. Pain (1 item, 0–44 points), function (7 items 0–47 points), absence of deformity (1 item, 4 points) and range of motion (2 items, 5 points). The results are categorized as excellent, fair, or poor depending on the final score.(23)
The translators faced no difficulties in the translation nor the cultural adaptation of the items and possible responses into the Arabic language for the HHS. The forward and backwards translation of the HHS led to the development of a comprehensible Arabic HHS. This result is similar to what was reported for the Turkish, Portuguese, and Italian adaptation studies. (34–36) Moreover, the participants did not report any difficulties in answering and understanding the Arabic HHS, again similar to the other adaptation studies.(34–36)
The reliability of the Arabic HHS was evaluated by using Cronbach’s alpha and test-retest reliability to assess the reliability of this scale. Cronbach’s alpha of the total score of Arabic HHS is 0.528 and after the standardization, it changed to 0.742 which is within the recommended range (0.7–0.9). Also, this reliability is similar to the Cronbach’s Alpha reported in the Turkish, and Italian translations, which were 0.7, 0.816 respectively. (34–36)
Test-rest value was 0.7 which is considered acceptable reliability while the Italian, and Turkish results were 0975, 0.91 respectively. We think that the Turkish study has excellent reliability since the time interval for the reliability testing was short (one week only). In the current study, the time interval was three weeks which is the recommended period (34, 35, 37)
The constructive validity of the Arabic HHS and Sf-36 was identified by finding the correlation between the two scales. The correlation was r = 0.71 (p < 0.001) which represents strong correlation between Arabic HHS and SF-36. When looking to the correlation of Harris questionnaire with the subdivision of SF-36, we found a strong correlation between the Arabic Harris questionnaire with SF-36 physical role functioning, SF-36 pain and SF-36 social functioning with PCC of 0.6, 0.628 and 0.63 respectively. Compared to the Turkish study, they found a strong correlation of Turkish Harris with SF-36 pain subscales with PCC of 0.7 while a moderate correlation with SF36 social functioning and SF-36 physical role functioning with PCC of 0.53 and 0.46 respectively. Additionally, a moderate correlation was seen between Arabic HHS and SF-36 Physical function, SF-36 Role limitation due to emotional problems with PCC of 0.57 and 0.55 respectively. The Turkish study found a strong correlation with SF 36 physical function with PCC of 0.72 while a mild correlation was identified with SF 36 SF-36 Role limitation due to emotional problems with PCC of 0.37.