Outcome Measures to Evaluate Upper and Lower Extremity: Which Scores are Valid?
Darwich, A., Schuttler, V., Obertacke, U., and Jawhar, A.
OBJECTIVE: In orthopaedics and trauma surgery scores are frequently used to assess treatment outcomes. The purpose of the review is to create an overview analysing the content of validity studies of frequently utilized scores for upper and lower extremity.
METHODS: Commonly used outcome measures to assess clinical outcome of upper (n = 19) and lower (n = 22) extremity were included. For each of the scores a comprehensive search in several databases (Medline, PubMed, google scholar) were performed to identify validation studies. The COSMIN-Checklist (
COSMIN: Consensus-based Standards for the selection of health Measurement Instruments) introduced by Mokkink et al. were used to analyse systematically the methodological quality of the validation studies.
RESULTS: Validity, objectivity and reliability were not routinely considered and addressed in validation studies. The score related validation studies did not include all defined criteria of the COSMIN-Checklist. Six scores of the upper extremity and four scores of the lower extremity are not adequately validated. The best validated scores of the upper extremity is Oxford Shoulder Score (OSS) and for the lower extremity Hip Disabilities and Osteoarthritis Outcome Score (HOOS) as well as Western Ontario and McMaster Universities Score (WOMAC).
CONCLUSION: There is no gold standard for the content-comprehension of validation studies due to the structure of the original study. The more criteria were tested the more informative and significant the outcome measure is. However some scores, such as Neer and Castaing Score, that lack validation are still being successfully used in research and clinical practice. The present review provides an overview of frequently used score in orthopaedics and trauma surgery and their grade of validity.