The Normal Hip Score Following Hip Fracture: Preliminary Validation of a Single-Item Patient-Reported Outcome Measure
- 1Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh EH16 4SA, UK
- 2Usher Institute, School of Population Health Sciences, University of Edinburgh, Edinburgh EH16 4UX, UK
Abstract
Background: Patient-reported outcome measures (PROMs) are important after hip fracture but can impose respondent burden. A simple global measure may provide complementary information about a patient’s overall perception of hip normality. The Normal Hip Score (NHS) is a single-item 0–100 measure of perceived hip normality. This study evaluated preliminary evidence of construct validity for the NHS following hip fracture surgery. Methods: This was a prospective observational study with cross-sectional validation analyses based on a single postoperative PROM assessment. Paired NHS–OHS and NHS–EQ-5D-5L data were available for 80 participants. The mean age was 79.3 years (SD 10.8), and 46 (57.5%) of these participants were female. Assessment occurred at a mean of 3.47 months (SD 0.75; range 2–7 months) following fracture surgery. The NHS was assessed in relation to the OHS and EQ-5D-5L index and dimensions. Convergent validity was assessed using Pearson and Spearman correlations, with exploratory analyses of individual OHS items and EQ-5D-5L dimensions. Known-groups validity was examined across OHS quartiles, and multivariable linear regression was performed. Results: The mean NHS was 60.4 (SD 25.4). NHS demonstrated a moderate correlation with OHS (Pearson r = 0.657, 95% CI 0.511–0.766; p < 0.001) and with the EQ-5D-5L index (r = 0.541, 95% CI 0.365–0.680; p < 0.001). All 12 OHS items and all five EQ-5D-5L dimensions were significantly associated with NHS. The strongest OHS item associations were pain when rising from a chair, pain, work/housework interference, limping, and washing/bathing. Mobility showed the strongest EQ-5D-5L dimension association. NHSs increased across OHS quartiles (Kruskal–Wallis H = 35.77; p < 0.001). In multivariable analysis, OHS remained associated with NHS (β = 1.54, 95% CI 0.80–2.28; p < 0.001). Conclusions: The NHS demonstrated preliminary evidence of cross-sectional construct and known-groups validity following hip fracture surgery. The findings support the NHS as a potentially useful complementary global measure of perceived hip normality, but do not establish test–retest reliability, responsiveness, clinically meaningful change, or suitability for standalone clinical use.
Related
- Preliminary Clinical Observations Following Multiwavelength Diode Laser Treatment for Facial Rejuvenation: A Three‐Patient Case Series
- Contralateral atypical femoral fracture following a single dose of denosumab after incomplete teriparatide therapy in a patient with long-term bisphosphonate exposure: A case report
- The Stanmore Limb Reconstruction Score : validation of a novel patient-reported outcome measure
- Subsequent Knee Arthroplasty Does Not Influence Patient-Reported Outcomes Following Lumbar Fusion
- The Impact of Hip Osteoarthritis on Patient Reported Outcomes Following Lumbar Fusion
BibTeX
@article{lim2026normal,
title = {{The Normal Hip Score Following Hip Fracture: Preliminary Validation of a Single-Item Patient-Reported Outcome Measure}},
author = {Brian Z. H. Lim and Gillian C. Leitch and Thomas R. Williamson and Andrew D. Duckworth and Nick D. Clement},
journal = {Journal of Clinical Medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15208078},
url = {https://www.mdpi.com/2077-0383/15/20/8078},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - The Normal Hip Score Following Hip Fracture: Preliminary Validation of a Single-Item Patient-Reported Outcome Measure
AU - Brian Z. H. Lim
AU - Gillian C. Leitch
AU - Thomas R. Williamson
AU - Andrew D. Duckworth
AU - Nick D. Clement
PY - 2026
DA - 2026/10/01
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15208078
UR - https://www.mdpi.com/2077-0383/15/20/8078
AB - Background: Patient-reported outcome measures (PROMs) are important after hip fracture but can impose respondent burden. A simple global measure may provide complementary information about a patient’s overall perception of hip normality. The Normal Hip Score (NHS) is a single-item 0–100 measure of perceived hip normality. This study evaluated preliminary evidence of construct validity for the NHS following hip fracture surgery. Methods: This was a prospective observational study with cross-sectional validation analyses based on a single postoperative PROM assessment. Paired NHS–OHS and NHS–EQ-5D-5L data were available for 80 participants. The mean age was 79.3 years (SD 10.8), and 46 (57.5%) of these participants were female. Assessment occurred at a mean of 3.47 months (SD 0.75; range 2–7 months) following fracture surgery. The NHS was assessed in relation to the OHS and EQ-5D-5L index and dimensions. Convergent validity was assessed using Pearson and Spearman correlations, with exploratory analyses of individual OHS items and EQ-5D-5L dimensions. Known-groups validity was examined across OHS quartiles, and multivariable linear regression was performed. Results: The mean NHS was 60.4 (SD 25.4). NHS demonstrated a moderate correlation with OHS (Pearson r = 0.657, 95% CI 0.511–0.766; p < 0.001) and with the EQ-5D-5L index (r = 0.541, 95% CI 0.365–0.680; p < 0.001). All 12 OHS items and all five EQ-5D-5L dimensions were significantly associated with NHS. The strongest OHS item associations were pain when rising from a chair, pain, work/housework interference, limping, and washing/bathing. Mobility showed the strongest EQ-5D-5L dimension association. NHSs increased across OHS quartiles (Kruskal–Wallis H = 35.77; p < 0.001). In multivariable analysis, OHS remained associated with NHS (β = 1.54, 95% CI 0.80–2.28; p < 0.001). Conclusions: The NHS demonstrated preliminary evidence of cross-sectional construct and known-groups validity following hip fracture surgery. The findings support the NHS as a potentially useful complementary global measure of perceived hip normality, but do not establish test–retest reliability, responsiveness, clinically meaningful change, or suitability for standalone clinical use.
SN - 2077-0383
ER -