Measurement of patient perceptions of pain and disability in relation to total hip replacement: the place of the Oxford hip score in mixed methods

Objectives - To describe the practical difficulties experienced by patients when completing the Oxford hip score, and to highlight the need to reconsider aspects of its structure and conceptual base. Design - Qualitative study incorporating the Oxford hip score in semi-structured interviews with patients before and four months after their operation. Setting - Two hospitals in the North of England. Subjects - Osteoarthritic patients undergoing primary elective total hip replacement. Results - Use of the Oxford hip score provided quantitative data on disability in the sample, particularly about pain and immobility. It also facilitated the collection of qualitative data, serving as a useful starting point for interviews and as a prompt for indepth discussion. Concerns about the clarity, coverage, and content validity of the score were identified, however, raising questions about the measure's conceptual base. Conclusion - The Oxford hip score was found to be a useful precursor to the semi- structured interviews. However, deficiencies in instruction and lack of clarity in purpose have implications for its ongoing development and future application, both in this type of study and other, more general, contexts.