Turkish Validation of the HOOS-12

Turkish Cross-cultural Adaptation, Validity, Reliability, and Responsiveness of the Hip Disability and Osteoarthritis Outcome Score-12 (HOOS-12) in Patients With Hip Osteoarthritis

The Hip Disability and Osteoarthritis Outcome Score-12 (HOOS-12) is a short patient-reported outcome measure developed to assess pain, function, and hip-related quality of life in individuals with hip osteoarthritis. Although widely used internationally, a validated Turkish version is currently unavailable. This study aims to translate and culturally adapt the HOOS-12 into Turkish and evaluate its psychometric properties, including internal consistency, test-retest reliability, construct validity, structural validity, responsiveness, and measurement error, in Turkish-speaking patients with hip osteoarthritis.

## Detailed Description

Hip osteoarthritis (HOA) is one of the leading causes of pain, disability, and reduced health-related quality of life among older adults worldwide. Patient-reported outcome measures (PROMs) are essential for evaluating symptoms, functional limitations, treatment effectiveness, and patient-centered outcomes in both clinical practice and research. The Hip Disability and Osteoarthritis Outcome Score-12 (HOOS-12) is a concise, multidimensional PROM developed to assess pain, physical function, and hip-related quality of life while substantially reducing respondent burden compared with the original HOOS questionnaire.

Although the HOOS-12 has been validated in several languages and populations, no culturally adapted and psychometrically validated Turkish version is currently available. The absence of a validated Turkish HOOS-12 limits its use in clinical practice, multicenter studies, and international research involving Turkish-speaking patients with hip osteoarthritis. Therefore, a rigorous cross-cultural adaptation and psychometric evaluation is required before the instrument can be recommended for clinical and research applications in Türkiye.

The primary objective of this study is to translate and culturally adapt the HOOS-12 into Turkish and to evaluate its psychometric properties in patients with hip osteoarthritis who are scheduled to undergo primary total hip arthroplasty. The translation and cross-cultural adaptation process will be conducted in accordance with internationally accepted guidelines for patient-reported outcome measures, including forward translation, synthesis, backward translation, expert committee review, and pilot testing to ensure semantic, idiomatic, experiential, and conceptual equivalence between the original and Turkish versions.

Following the adaptation process, the psychometric performance of the Turkish HOOS-12 will be evaluated according to the COSMIN recommendations. Internal consistency will be assessed using Cronbach's alpha, while test-retest reliability will be examined using the intraclass correlation coefficient (ICC) in clinically stable participants who complete the questionnaire twice before surgery without any therapeutic intervention between assessments. Measurement error will be determined by calculating the standard error of measurement (SEM) and the minimal detectable change (MDC). Structural validity will be evaluated using confirmatory factor analysis (CFA). Construct validity will be examined by testing predefined hypotheses regarding the relationships between the Turkish HOOS-12 and the Short Form-12 Health Survey (SF-12). Floor and ceiling effects will also be investigated.

To determine responsiveness, participants will complete the Turkish HOOS-12 and SF-12 before surgery and again three months after primary total hip arthroplasty. Changes in questionnaire scores over time will be analyzed to evaluate the instrument's ability to detect clinically meaningful improvement following surgical treatment.

The results of this study are expected to provide a reliable, valid, and responsive Turkish version of the HOOS-12 for evaluating patient-reported outcomes in individuals with hip osteoarthritis. The availability of this instrument will facilitate standardized outcome assessment in routine clinical practice, clinical trials, and multicenter research involving Turkish-speaking populations.

Inclusion Criteria:

• Age 18 years or older.
• Native Turkish speaker or able to read and understand Turkish fluently.
• Diagnosed with primary hip osteoarthritis based on clinical and radiographic evaluation.
• Scheduled to undergo primary total hip arthroplasty.
• Able to complete the study questionnaires independently or with standardized assistance.
• Clinically stable during the test-retest period.
• Willing to participate in the study and provide written informed consent.

Exclusion Criteria:

• Previous total hip arthroplasty on the affected side.
• Scheduled for revision hip arthroplasty.
• Hip arthroplasty indicated for conditions other than primary hip osteoarthritis, including hip fracture, inflammatory arthritis, avascular necrosis, congenital hip disorders, or malignancy.
• History of major lower-extremity surgery within the previous six months.
• Neurological or neuromuscular disorders that may substantially affect mobility or lower-extremity function.
• Severe cognitive impairment, psychiatric disorder, or communication difficulty that prevents reliable questionnaire completion.
• Severe visual or hearing impairment that prevents completion of the assessment procedures.
• Presence of another acute musculoskeletal condition that substantially affects pain or physical function.
• Any therapeutic intervention, significant change in medication, acute clinical deterioration, or surgery occurring between the baseline and test-retest assessments.
• Incomplete questionnaire data or inability to complete the planned follow-up assessments.