COSMIN database

Reliability and validity of clinical outcome measurements of osteoarthritis of the hip and knee--a review of the literature

Sun, Y., Sturmer, T., Gunther, K. P., and Brenner, H.
High reliability and validity of clinical rating schemes is crucial for their use as outcome measurements of treatment of hip and knee osteoarthritis. In this paper, we review the empirical evidence on the reliability and validity of commonly used clinical scores. Clinical scores and related reliability and validity studies were identified by systematic literature search. Scores were classified according to the type and joint. Reliability and validity studies were characterized according to design, population, number and qualification of observers, number of measurements, time interval between repeat measurements and results. Reliability and validity studies were reported for only 6 and 15 of the 45 identified clinical scores, respectively. Although comparisons are difficult due to differences in study design, relatively high reliability was reported for most measurements of pain, stiffness, and physical function, while results are less conclusive for clinical signs. Most validity studies focused on the correlation between various scores. Correlation was generally found to be high for overall numerical ratings, but scores often differed with respect to the interpretation of these ratings. Validity has been more comprehensively studied for Lequesne's scores, WOMAC, and ILAS, and these scores have shown satisfactory responsiveness to different treatment effects. Overall, knowledge on reliability and validity of clinical scores of hip and knee osteoarthritis is limited, underlining the need for further properly designed and conducted studies.
Clin Rheumatol
0770-3198 (Print)
Publication year:
Biological and physiological variables:
Biological and physiological variables
Symptom status:
Physical state
Functional status:
Physical functioning
Adults (18-65)
Seniors (65+)
Diseases of and symptoms related to the musculoskeletal system and connective tissue
PRO / non-PRO:
Non-patient Reported Outcome
Patient Reported Outcome
Type of measurement instrument:
1 - Questionnaires
4 - Performance-based tests
6 - Clinical rating scales
7 - Observations
HSS-1 - Hospital for Special Surgery Modified
HSS-2 - Hipscore of the Hospital of Special Surgery, Nr. 2
ILAS - Iowa Level of Assistance Scale
JOA - Hipscore of the Japanese Orthopedic Association
Jones score
KSS - Kneescore of the Knee Society / Knee Society Score
LAI-hip - Lequesne Algofunctional Index for the severity of osteoarthritis of the hip [alias: LISH][alias: LISOH]   
LAI-knee - Lequesne Algofunctional Index for the severity of osteoarthritis of the knee [alias: LISK][alias: LISOK]   
LEFS - Lower Extremity Function Scale
MHS - Mayo Hip Score
UCLA hip score - University of California Los Angeles hip score
WOMAC - Western Ontario and McMaster Universities Osteoarthritis Index (Also I-WOMAC - Individualized WOMAC)