REVIEWOutcome instruments for the assessment of the upper extremity following trauma: a review
Introduction
Orthopaedic injuries to the extremities are common in trauma patients1 and can result in long-term problems, such as functional deficits, disability and high pain levels.37 Whilst much has been published detailing the outcomes following lower extremity orthopaedic trauma,9, 30, 31, 34, 36, 41 very little information is available regarding patient outcomes following upper extremity orthopaedic trauma. This is in spite of the importance of the upper extremity in performing activities of daily living (ADL).11
A previous study of patients, 5 years after severe injury (ISS > 15), found that upper extremity fractures resulted in chronic pain, disability, and functional problems.40 However, only the presence, or absence, of pain, functional problems and disability were reported. Information was not collected regarding the degree of difficulty experienced and the types of activities affected. Overall, there is a dearth of detailed outcome data relating to upper extremity trauma, so necessary for monitoring long term outcomes, evaluating treatment options, and informing resource allocation (e.g., outpatient treatment, support services, etc.) for these patients.
A full understanding of functional outcomes following upper extremity trauma could be hindered by the fact that upper extremity outcome assessment instruments have not been designed specifically for use in trauma populations, limiting the development of a standardised approach. This review provides an overview of outcome assessment instruments for use in upper extremity and orthopaedic trauma populations, with a particular focus on their reliability, validity and ease of use.
Section snippets
Assessing the suitability of an instrument
The design and validation of outcome assessment instruments has been driven by psychometric theory, which deals with the design, administration, and interpretation of quantitative tests.55 The evaluation of outcome measures has previously been described in detail.4, 14, 18, 21, 38 In summary, the key properties of outcome measures are reliability, validity and responsiveness.
Reliability refers to the ability of an instrument to yield consistent and reproducible results. Test–retest analyses
Search strategy and selection criteria for reviewed outcome measures
A search of the Medline database (from January 1966 to February 2004) was performed. The keywords used to identify potential measures of interest (either in isolation, or in combination) were: orthopaedic*; outcome measure*; trauma; upper extremity; upper limb; arm injury*; instrument; assessment; function. Only articles published in English were included. A hand search was conducted of six medical journals from 1998 to 2003 that regularly published papers using outcome measures in orthopaedic
Features of the outcome assessment instruments for evaluation of the upper extremity
The instruments reviewed could be specific to a joint, or to a disease, be applicable to the whole upper extremity, or to both the upper and lower extremities. Kinesiological theory suggests that the upper extremity operates as a single functional unit.11, 25 Therefore, whole instruments and individual items designed to be specific to a joint of the upper extremity may still be able to detect disability in another area of the upper extremity. The difficulty in designing items specific for a
Conclusions
Upper extremity orthopaedic trauma outcomes research lacks an instrument specifically designed for use in these populations. While instruments designed for use in non-trauma populations may exhibit content validity for use in trauma, no quantitative evaluation has been conducted. Additionally, because the upper extremity is considered to operate as a single functional unit,11 many of the instruments that are designed for use in patients with specific upper limb joint injuries may detect
Acknowledgements
The preparation of this article forms part of a larger project, the Victorian Orthopaedic Trauma Outcomes Registry, funded by the Victorian Trauma Foundation. Dr. Gabbe was supported by a Public Health Fellowship from the National Health and Medical Research Council, Australia.
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