COSMIN database

Patient-reported outcome measures in older people with hip fracture: a systematic review of quality and acceptability

Haywood, K. L., Brett, J., Tutton, E., and Staniszewska, S.
PURPOSE: Hip fracture is the most common serious injury of older people, often resulting in reduced mobility and loss of independence. However, guidance for the use of patient-reported outcome measures (PROMs) does not exist: we describe the first review to apply internationally endorsed criteria in support of PROM quality and acceptability in this group, and make recommendations for future applications.

METHODS: Systematic literature searches of major databases (1980-2015) to identify published evidence of the application and quality of clearly defined measures. Evidence of measurement and practical properties, and the extent of active patient involvement, was sought. Study and PROM quality was assessed against recommended criteria.

RESULTS: Seventy-one articles relating to 28 PROMs (Generic n = 12; Specific n = 16) were included. The SF-36 (v1) and EuroQoL EQ-5D 3L were the most widely evaluated measures with acceptable evidence of measurement properties, but limited evaluations of practical properties or relevance to this group. Evidence was mostly limited for the remaining measures. Hypothesized associations between variables were infrequently evaluated. Evidence of data quality, test-retest reliability, responsiveness, interpretation, acceptability and feasibility was also limited. Active patient involvement in PROM development or evaluation was not reported. There was limited evaluation of proxy completions.

CONCLUSIONS: The paucity of robust evaluations is disappointing and prevents clear recommendations for PROM-based assessment. Further research must urgently seek to identify which outcomes really matter to this group. Future PROM selection must be underpinned by research which focuses on methodological quality, including issues of acceptability, relevance, feasibility of application, and proxy completion, whilst seeking to actively incorporate the perspective of patients and their advocates.
Qual Life Res
Publication year:
Biological and physiological variables:
Biological and physiological variables
Symptom status:
Emotional state
Physical state
Functional status:
Physical functioning
Role functioning
Social functioning
General health perceptions / HRQoL:
Health-related quality of life
Overall quality of life:
Overall quality of life
Seniors (65+)
Diseases of and symptoms related to the musculoskeletal system and connective tissue
PRO / non-PRO:
Patient Reported Outcome
Type of measurement instrument:
1 - Questionnaires
BI - Barthel Index   [see: ZUYD (NL)]
Charnley Hip Score
COOP/WONCA charts - COOP/WONCA Functional Healh assessment charts   [see: ZUYD (NL)]
EQ-5D - EuroQoL-5 Dimensions   [see: ZUYD (NL)]
EQ-VAS - EuroQol Visual Analogue Scale
FAI - Functional Activities Index
FIM - Functional Independence Measure (Also modified version exists)
FSQ - Functional Status Questionnaire
GDS - Geriatric Depression Scale   [see: ZUYD (NL)]
HAM-D - Hamilton Rating Scale for Depression   [see: ZUYD (NL)]
HHS - Harris Hip Score   [see: ZUYD (NL)]
HUI-2 - Health Utilities Index Mark 2
HUI-3 - Health Utilities Index-Mark 3
ICECAP-O - ICEpop CAPability measure for Older people,
Katz ADL - Katz’ Index Of Independence In Activities Of Daily Living   [see: proqolid, ZUYD (NL)]
Lawton IADL - Lawton Instrumental Activities of Daily Living Scale   [see: ZUYD (NL), also see: See IADL]
MBI - Modified Barthel Index
NHP - Nottingham Health Profile   [see: ZUYD (NL)]
OHS - Oxford Hip Score   [see: ZUYD (NL)]
OMFAQ - Older Americans Resources and Services (OARS) Multi-dimensional Functional Assessment Questionnaire
OPAQ-2 - Osteoporosis Quality of Life Questionnaire (version 2)
QoLS - Quality of Life Scale
SDS - Zung Self-rating Depression Scale
SF-12 - 12-item Short Form Health Survey
SF-36 - 36-item Short Form Health Survey   [see: proqolid, ZUYD (NL)]
SF-6D - Short-Form 6D (derived from SF-36 or F-12)
WHO-QOL BREF - World Health Organization Quality of Life assessment instrument-short version (See also: WHOQOL-BREF)
WOMAC - Western Ontario and McMaster Universities Osteoarthritis Index (Also I-WOMAC - Individualized WOMAC)   [see: ZUYD (NL)]