Related Experiment Video
Updated: Mar 24, 2026
The Transition to an Anterior-Based Muscle Sparing Approach Improves Early Postoperative Function but is Associated with a Learning Curve
Published on: September 7, 2022
Agreement of Patient Responses Between Electronic and Paper Patient-Reported Outcome Measures in Total Hip
Asha Swamy1, Meaghan Dufresne1, Kaitlyn Chambers1
1Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada.
Background:
Total hip arthroplasty (THA) outcomes are commonly assessed using patient-reported outcome measures (PROMs). As electronic PROMs (ePROMs) gain popularity, ensuring equivalence to paper PROMs (pPROMs) is essential. This study aimed to evaluate the interchangeability of ePROMs and pPROMs in patients undergoing THA.
Methods:
A prospective cohort analysis of 96 THA patients who completed preoperative ePROMs and pPROMs was conducted. Electronic Oxford Hip Score (OHS) and EuroQol 5-Dimension 5-Level (EQ-5D-5L) were completed zero to 28 weeks prior to surgery, and pPROMs were completed on the day of surgery. Correlations were assessed with Spearman's rank correlation, and agreement and bias were evaluated using intraclass correlation coefficients (ICCs) and Bland-Altman analysis. The effect of time between completion of ePROM and pPROM on score difference was assessed.
Results:
Electronic scores were lower than paper format (OHS: median 19.0 [interquartile range, 13.8 to 25.3] versus 19.0 [14.0 to 25.0]; difference -1.5; P = 0.005, EQ-5D-5L: median 0.575 [0.455 to 0.681] versus 0.597 [0.472 to 0.704]; difference -0.028; P = 0.05). Differences were below Minimal Clinically Important Differences. Agreement was good for OHS (ICC: 0.873, 95% confidence interval: 0.805 to 0.917) and moderate for EQ-5D-5L (ICC: 0.677, 95% confidence interval: 0.551 to 0.773). Minimal bias (OHS: -1.3, limits of agreement: -9.3 to 6.7; EQ-5D-5L: -0.025, limits of agreement: -0.26 to 0.20) was detected, with 14.6 and 2.1% of scores, respectively, exceeding Minimal Clinically Important Difference. The median time interval between ePROM and pPROM administration was six days (interquartile range, three to 27) and had no effect on differences. However, reduced variability was seen when ePROMs were completed within one week of surgery.
Conclusions:
Electronic and paper-based OHS and EQ-5D-5L show good agreement and can generally be used interchangeably. However, caution is required for individual scores near clinically important thresholds. Given their efficiency and scalability, we recommend a transition to ePROMs.
