Cultural Adaptation and Validation of the International Hip Outcome Tool-33 for Arabic-Speaking Populations With Hip-Related Pathologies

Background The International Hip Outcome Tool-33 (iHOT-33) is a widely used patient-reported outcome measure designed to assess symptoms, functional limitations, activity participation, and quality of life in young and active patients with hip-related pathologies. However, a validated Arabic version has not previously been available, limiting its applicability among Arabic-speaking populations. Methods This prospective cross-sectional validation study translated and culturally adapted the iHOT-33 into Arabic (iHOT-33-AR) following standardized guidelines, including forward translation, reconciliation, back-translation, expert committee review, and pilot testing. Adults aged ≥ 18 years presenting with hip pain and/or dysfunction were recruited from outpatient clinics and completed the iHOT-33-AR and the Arabic version of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC-AR). A clinically stable subgroup completed the iHOT-33-AR again after 5–10 days. Psychometric evaluation included assessment of internal consistency, test–retest reliability, floor and ceiling effects, content validity, structural validity using principal component analysis, convergent validity, and measurement error. Results A total of 500 patients were enrolled, of whom 100 clinically stable participants completed the retest. Score distributions covered the full theoretical range, with no significant floor or ceiling effects. Internal consistency was excellent (Cronbach’s α = 0.959). Test–retest reliability was outstanding, with an ICC(2,1) of 0.992 (95% CI 0.988–0.995). Structural validity analyses demonstrated a dominant underlying construct with excellent sampling adequacy and strong factor loadings. Convergent validity was supported by good inverse correlations between the iHOT-33-AR Total Score and WOMAC-AR domains (Spearman ρ = −0.527 to − 0.608). Conclusion The iHOT-33-AR demonstrates excellent reliability, strong internal consistency, and robust structural and convergent validity. It represents a reliable, valid, and culturally appropriate instrument for assessing hip-related outcomes in Arabic-speaking populations and supports its use in both clinical practice and hip-focused orthopedic research.