# Physiotherapists’ Experiences with the Hip Disability and Knee Injury Osteoarthritis Outcome Score Following Total Hip and Knee Arthroplasty: A Qualitative Interview Study

## TL;DR

This study explores how physiotherapists use the HOOS/KOOS score in daily practice after hip and knee surgeries, finding that it helps track patient progress and is most useful when integrated into electronic health records.

## Contribution

The study provides new insights into physiotherapists' practical use and perceptions of the HOOS/KOOS in post-surgery care.

## Key findings

- Physiotherapists use HOOS/KOOS for history-taking and monitoring patient progress.
- Items related to daily life and psychosocial factors are seen as most valuable.
- Electronic health records enhance the use of HOOS/KOOS, while administrative rules can limit it.

## Abstract

Background: Clinical guidelines for physiotherapy following total hip and knee arthroplasty (THA/TKA) recommend using Patient-Reported Outcome Measures (PROMs) like the Hip disability and Knee injury Osteoarthritis Outcome Score (HOOS/KOOS). However, it remains unclear how physiotherapists use these PROMs in daily clinical practice. Objective: To explore primary care physiotherapists’ experiences with the HOOS/KOOS in daily clinical practice following THA and TKA. Methods: Thirteen physiotherapists in the Netherlands were recruited via convenience sampling. Data were collected through semi-structured interviews, which explored HOOS/KOOS use in clinical practice, administrative regulations, and applications beyond patient care, as well as think-aloud interviews to capture perceptions of the content of these PROMs and interpretations of hypothetical patient scores. Interviews were analysed using reflexive thematic analysis. Results: The physiotherapists’ ages ranged from 25 to 54y, with annual THA/TKA volumes from 5 to 50 patients. Three themes emerged, as follows: (1) “Physiotherapists use the HOOS/KOOS for various purposes in daily clinical practice”, including complementing history taking and monitoring patient progress; (2) “Perceptions of the relevance of the HOOS/KOOS for daily clinical practice vary per item, domain, and version,” with items related to daily life activities and psychosocial factors being perceived as more valuable; and (3) “Practical aspects of HOOS/KOOS administration influence their use in daily clinical practice,” with electronic health records (EHRs) that facilitate PROM administration enhancing their use, while administrative regulations limit this. Conclusions: Physiotherapists experience HOOS/KOOS items related to daily life activities and psychosocial factors useful for history-taking and monitoring patient progress, particularly when embedded in EHRs that facilitate PROM administration.