gms | German Medical Science

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2013)

22.10. - 25.10.2013, Berlin

How user-friendly and valid are outcomes measures and instruments for the lower extremity?

Meeting Abstract

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  • presenting/speaker Beate Hanson - AO Documentation and Publishing Foundation, AO Foundation, AOCID, Dübendorf, Switzerland
  • Michael Suk - Geisinger Health System, Danville, United States
  • Diarmuid De Faoite - AO Documentation and Publishing Foundation, AO Foundation, AOCID, Dübendorf, Switzerland
  • David Helfet - Hospital for Special Surgery, New York, United States

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2013). Berlin, 22.-25.10.2013. Düsseldorf: German Medical Science GMS Publishing House; 2013. DocIN22-661

doi: 10.3205/13dkou010, urn:nbn:de:0183-13dkou0106

Published: October 23, 2013

© 2013 Hanson et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

Text

Background: This review investigates if published outcomes measures for the lower extremity have been validated for clinical use and are sufficiently user-friendly.

Methods: A total of 166 lower extremity - foot (30), calcaneus (10), ankle (41), knee (54), pelvis (3) and hip (28) - outcomes measures and instruments were identified in the literature.

An outcome measure was deemed to be valid (i.e. it measures what it was designed to measure) if:

Content: the content was developed by a team of professionals or through statistical modeling

Construct: the instrument was validated against a generic instrument or correlated with hypothesized subscales from another instrument

Criterion: the instrument was validated against a gold standard instrument or is predictive of a future outcome

No points were awarded if a validation study had not been carried out, and no points were awarded in any of the 3 categories if they were found to be not valid. 1 point was awarded if the category was deemed valid, yielding a maximum possible score of 3 points.

Clinical utility was assessed by awarding points for both patient-friendliness (acceptability) and clinician-friendliness (feasibility) of the tool. Patient-reported and mixed patient-reported and clinician-based instruments were awarded 2 points if < 10 questions were asked, 1 point for 11-25 questions, and no points for >25 questions. All clinician-based outcomes were automatically awarded 2 points for patient-friendliness.

Results:

Element examined: Number

Lower extremity outcome measures and instruments: 166
Patient-reported: 82/166
Clinician-based: 84/166

Maximum validation & clinical utility score of 7: 4/166

Maximum clinical utility score of 4: 30/166
Patient-reported: 30/30
Clinician-based: 0/30

Validated (at all): 108/166
Patient-reported: 73/108
Clinician-based: 35/108

Validated across 3 categories: 26/108
Patient-reported: 24/26
Clinician-based: 2/26

Validated across 2 categories: 48/108
Patient-reported: 34/48
Clinician-based: 14/48

Validated across 1 category: 34/108
Patient-reported: 15/34
Clinician-based: 19/34

Conclusions: Published outcome measures should be used with caution. It is advisable for surgeons wishing to use one:

  • to check if it has been previously validated
  • to ascertain to what extent the measure was validated
  • and against which previously published instrument(s) it was validated as available instruments can vary in methodological strength

While there is no "magic formula", patient-reported instruments on average recorded higher scores for methodological strength and clinical utility than clinician-based instruments.