Use of Condition-Specific Patient-Reported Outcome Measures in Clinical Trials among Patients with Wrist Osteoarthritis: A Systematic Review Accurately measuring the quality and effectiveness of cervical spine surgery in registry efforts: determining the most valid and responsive instruments. Comparative Evaluation of the Measurement Properties of Various Shoulder Outcome Instruments Validity and responsiveness of the ankle function score after acute ankle injury. Acceptability of the method of administration of a patient-reported outcome measure (PROM) with stroke survivors, a randomised controlled trial protocol Assessing the performance of the EQ-VAS in the NHS PROMs programme Criteria for Success after Surgery for Cervical Radiculopathy; Estimates for a Substantial Amount of Improvement in Core Outcome Measures. Analysis of outcome measures for persons with patellofemoral pain: which are reliable and valid? Reliability and validity of shoulder function outcome measures in people with a proximal humeral fracture OBSERVER VARIATION IN THE ASSESSMENT OF OUTCOME IN TRAUMATIC BRAIN INJURY: EXPERIENCE FROM A MULTICENTER, INTERNATIONAL RANDOMIZED CLINICAL TRIAL Responsiveness of the short form-36, disability of the arm, shoulder, and hand questionnaire, patient-rated wrist evaluation, and physical impairment measurements in evaluating recovery after a distal radius fracture. INFANT GROWTH AND HUMAN MILK REQUIREMENTS: A Fresh Approach How do doctors refer to patient-reported outcome measures (PROMS) in oncology consultations? Responsiveness and validity of three dexterous function measures in stroke rehabilitation. Performance of a Patient Reported Outcomes Measurement Information System (PROMIS) Short Form in Older Adults with Chronic Musculoskeletal Pain. Responsiveness of six outcome assessment instruments in total shoulder arthroplasty. Minimal clinically important differences of 3 patient-rated outcomes instruments.
Background . This paper aim ed to identify condition-specific patient-reported outcome measures used in clinical trials among people with wrist osteoarthritis and summarise empirical peer- review ed evidence supporting their reliability , validity , and responsiveness to change . Methods . A systematic review of r and omised controlled trials among people with wrist osteoarthritis was undertaken . Studies reporting reliability , validity , or responsiveness were identified using a systematic reverse citation trail audit procedure . Psychometric properties of the instruments were examined against predefined criteria and summarised . Results . Thirteen clinical trials met inclusion criteria . The most common patient-reported outcome was the disabilities of the arm , shoulder , and h and question naire ( DASH ) . The DASH , the  Michigan H and Outcomes Question naire ( MHQ ) , the  Patient Evaluation Measure ( PEM ) , and the  Patient-Reported Wrist Evaluation ( PRWE ) had evidence supporting their reliability , validity , and responsiveness . A post-hoc review of excluded studies revealed the AUSCAN Osteoarthritis H and Index as another suitable instrument that had favourable reliability , validity , and responsiveness . Conclusions . The DASH , MHQ , and AUSCAN Osteoarthritis H and Index instruments were supported by the most favourable empirical evidence for validity , reliability , and responsiveness . The PEM and PRWE also had favourable empirical evidence reported for these elements . Further psychometric testing of these instruments among people with wrist osteoarthritis is warranted BACKGROUND CONTEXT There is a growing dem and to measure the real-world effectiveness and value of care across all specialties and disease states . Prospect i ve registries have emerged as a feasible way to capture real-world care across large patient population s. However , the proven validity of more robust and cumbersome patient-reported outcome instruments ( PROi ) must be balanced with what is feasible to apply in large-scale registry efforts . Hence , commercial registry efforts that measure quality and effectiveness of care in an attempt to guide quality improvement , pay for performance , or value-based purchasing should incorporate measures that most accurately represent patient-centered improvement . PURPOSE We set out to establish the relative validity and responsiveness of common PROi in accurately determining effectiveness of cervical surgery for neck and arm pain in registry efforts . STUDY DESIGN Prospect i ve cohort study . PATIENT SAMPLE Eighty-eight patients undergoing primary anterior cervical discectomy and fusion ( ACDF ) for neck and arm pain . OUTCOME MEASURES Patient-reported outcome measures for pain ( numeric rating scale for neck pain [ NRS-NP ] and arm pain [ NRS-AP ] ) , disability ( neck disability index [ NDI ] ) , general health ( short-form 12-item survey physical component summary [ SF-12 PCS ] and mental component summary [ SF-12 MCS ] ) , and quality of life ( Euro-Qol-5D [ EQ-5D ] ) were assessed . METHODS Eighty-eight patients undergoing primary ACDF for neck and arm pain were entered into a Web-based prospect i ve registry . Baseline and 12-month patient-reported outcomes ( NRS-NP , NRS-AP , NDI , SF-12 PCS , SF-12 MCS , and EQ-5D ) were assessed . Patients were also asked whether they experienced a level of improvement after ACDF that met their expectation ( meaningful improvement ) . To assess the validity of NRS-NP , NRS-AP , and NDI ( measures of pain and disability ) to discriminate between meaningful and nonmeaningful improvement and the validity of SF-12 PCS , SF-12 MCS , and EQ-5D ( measures of general health and quality of life ) to discriminate between meaningful and nonmeaningful improvement , receiver-operating characteristic curves were generated for each outcome instrument . The greater the area under the curve ( AUC ) , the more valid the discriminator . The difference between st and ardized response means ( SRMs ) in patients reporting meaningful improvement versus not was calculated to determine the relative responsiveness of each outcome instrument to changes in  pain and QOL after surgery . RESULTS For pain and disability , both NDI ( AUC=0.75 ) and NRS-AP ( AUC=0.74 ) were valid discriminators of meaningful improvement . Numeric rating scale for neck pain ( AUC=0.69 ) was a poor discriminator . Neck disability index was also most responsive to postoperative improvement ( SRM difference 0.78 ) , followed by NRS-AP ( SRM difference 0.59 ) and NRS-NP ( SRM difference 0.46 ) . For general health and quality of life , SF-12 PCS ( AUC=0.79 ) was the only valid discriminator of meaningful improvement . Euro-Qol-5D ( AUC=0.68 ) and SF-12 MCS ( AUC=0.44 ) were poor discriminators . Short-form 12 physical component summary ( SRM difference 1.08 ) was also most responsive compared with EQ-5D ( SRM difference 0.89 ) and SF-12 MCS ( SRM difference 0.01 ) . CONCLUSIONS For pain and disability , NDI is the most valid and responsive measure of improvement after surgery for neck and arm pain . Numeric rating scale for neck pain and NRS-AP are poor substitutes for NDI when measuring effectiveness of care in registry efforts . For health-related quality of life , only SF-12 PCS could accurately discriminate meaningful improvement after cervical surgery and was found to be most valid and responsive . Large-scale registry efforts aim ed at measuring effectiveness of cervical spine surgery should use NDI and SF-12 to accurately assess improvements in pain , disability , and quality of life Background Various shoulder outcome instruments have been used despite lack of information on their measurement properties ; reliability , responsiveness , and validity ; and correlation with health-related quality of life . Hypothesis Most shoulder outcome instruments have poor correlation with Short Form−36 , a general measure of health-related quality of life , and with each other . Study Design Cohort study ( diagnosis ) ; Level of evidence , 2 . Methods A consecutive group of 285 patients who had undergone shoulder surgery completed several shoulder outcome instruments — Short Form−36 ; University of California , Los Angeles shoulder score ; American Shoulder and Elbow Surgeons shoulder evaluation form ; Constant score ; Simple Shoulder Test ; Western Ontario Shoulder Instability Index ; and the rating sheet for Bankart repair ( Rowe score)—preoperatively and at 3 , 6 , 9 , and 12 months postoperatively . Internal consistency , st and ardized response mean , effect size , and Pearson correlation were used to evaluate reliability , responsiveness , and validity . Results The American Shoulder and Elbow Surgeons form , Simple Shoulder Test , and Western Ontario Shoulder Instability Index displayed good internal consistency . The University of California , Los Angeles shoulder score and American Shoulder and Elbow Surgeons form exhibited good responsiveness , whereas Short Form−36 showed the least responsiveness . Pearson correlation coefficients between the shoulder outcome instruments and Short Form−36 were less than excellent ( r < .60 ) . Pearson correlation coefficients between the outcome instruments were generally low except for the Constant score and University of California , Los Angeles shoulder score ( r = .673 , P < .01 ) . Conclusion There was no single shoulder outcome instrument that was superior to the others in terms of the measurement properties . Most of the tested shoulder outcome instruments did not reflect health-related quality of life well and poorly correlated with each other . This meant that the comparison of a given surgical result with different outcome instruments might be of little practical utility . Further prospect i ve and serial studies should be conducted to develop better shoulder outcome instruments that have significant reliability , responsiveness , validity , and correlation with health-related quality of life . A careful combination of outcome instruments might be necessary to compensate the current evaluation systems The purpose of this study was to examine prognostic validity , concurrent validity and responsiveness of ankle function score ( AFS ) for patients with acute ankle injury . In a prospect i ve cohort study , AFS was compared with Olerud and Mol and er ankle score ( OMAS ) , patient-specific complaints ( PSC ) , and global perceived effect . Sensitivity and specificity were calculated to estimate prognostic validity ; correlation was calculated for concurrent validity . Effect Size , St and ardized Response Mean , and Responsiveness Ratio were calculated to estimate responsiveness . The sensitivity of AFS was 76 % and the specificity was 57 % . Correlation between AFS and OMAS at baseline , end of treatment and difference was 0.82 , 0.70 and 0.79 , respectively . Outcomes for responsiveness of AFS were comparable to outcomes for OMAS and PSC . This study found limited evidence for the AFS as a prognostic and evaluative instrument . The AFS is a simple instrument based on basic functional outcomes ( pain , stability , weight bearing , swelling and gait ) and may be used in addition to subjective clinical judgment as a prognostic and evaluative tool for recovery after acute ankle injury Background UK-wide national clinical guidelines promote routine 6-month post-stroke follow-up assessment . However , as part of this 6-month assessment little information is gathered from the patient ’s perspective . The means of collecting this patient-centred information might be served best by a patient-reported outcome measure ( PROM ) at the 6-month assessment time point . Currently , four different methods of 6-month follow-up assessment occur ; the most common being face-to-face interview followed by telephone interview , postal question naire and online question naire . Therefore , this study will investigate if the acceptability of telephone , online or postal administration of a PROM at the 6-month post-stoke time point is not inferior to face-to-face administration . Methods / design A UK multicentre , blinded ( analyst and research er ) , pragmatic , non-inferiority study , with 80 % power using a 2.5 % non-inferiority margin was design ed to compare the acceptability of three modes of administration ( telephone interview , postal question naire and online question naire ) compared with face-to-face interview administration of a PROM . We plan to approach and r and omise a minimum of 808 potentially eligible participants , 202 participants per group . Discussion The aim of this ongoing research is to underst and if there is a difference between face-to-face administration and the other three methods of administering a PROM as a patient-centred supplement to the 6-month review for stroke survivors . In utilising a pragmatic design , it is believed that this study will offer UK wide generalisable results , of the acceptability of the methods under investigation , to inform clinicians and commissioners of stroke services . Trials registration Clinical Trials.gov : NCT03177161 . Registered on 6 June 2017 Objectives The study aims to increase knowledge about the performance of the EuroQol-visual analogue scales ( EQ-VAS ) in the UK NHS patient-reported outcome measures ( PROMs ) programme , which covers groin hernia , hip and knee replacement and varicose vein surgery , and make suggestions for improved collection , coding and analysis of data . Methods Four hundred scanned images of matched before- and -after EQ-VAS PROMs responses were selected at r and om . These were classified according to the different ways in which they were completed . Patient-level PROMs programme data linked to Hospital Episode Statistics for all patients from April 2009 to February 2011 were used to analyse the relationship between the EQ-VAS and the EQ-5D profile , index-weighted profile and condition-specific instruments . The linked PROMs and HES data comprise 331,951 anonymised patient records . Results A large majority ( 95 % ) of EQ-VAS responses were completed in an unambiguous way , but only a minority ( 45 % ) conformed strictly to the instructions given , posing challenges for data coding . The EQ-VAS data have a predictable and consistent relationship with the EQ-5D profile , although the correlations between the EQ-VAS and other measures of patient-reported health , both before and after surgery and in the change between them , are weak . Conclusions EQ-VAS data might be improved by providing better guidance on collection and coding . It is argued that the observed differences in results from EQ-VAS and other measures of health reflect the fact that it measures a broader underlying construct of health , arguably providing a means of summarising overall health that is closer to the patient ’s perspective IMPORTANCE Defining clinical ly meaningful success criteria from patient-reported outcome measures ( PROMs ) is crucial for clinical audits , research and decision-making . PURPOSE We aim ed to define criteria for a successful outcome 3 and 12 months after surgery for cervical degenerative radiculopathy ( CDR ) on recommended PROMs . STUDY DESIGN Prospect i ve cohort study with 12 months follow-up . PATIENT SAMPLE Patients operated at one or two levels for cervical radiculopathy included in the Norwegian Registry for Spine Surgery ( NORspine ) from 2011 to 2016 . OUTCOME MEASURES Neck Disability Index ( NDI ) , Numeric Rating Scale for neck pain ( NRS-NP ) and arm pain ( NRS-AP ) , health-related quality -of-life EuroQol 3L ( EQ-5D ) , general health status ( EQ-VAS ) . METHODS We included 2868 consecutive CDR patients operated for cervical radiculopathy in one or two levels and included in the Norwegian Registry for Spine Surgery ( NORspine ) . External criterion to determine accuracy and optimal cut-off values for success in the PROMs was the Global Perceived Effect Scale ( GPE ) . Success was defined as " much better " or " completely recovered " . Cut-off values were assessed by analyzing the area under the receiver operating curves ( ROC ) for follow-up scores , mean change scores , and percentage change scores . RESULTS All PROMs showed high accuracy in defining success and non-success and only minor differences were found between 3- and 12-month scores . At 12 months , the area under the ROC for follow-up scores were 0.86 - 0.91 , change scores were 0.74 - 0.87 , and percentage change scores were 0.74 - 0.91 . Percentage scores of NDI and NRS-AP showed the best accuracy . The optimal cut-off values for each PROM showed considerable overlap across those operated due to disc herniation and spondylotic foraminal stenosis . CONCLUSIONS All PROMs , especially NDI and NRS-AP , showed good to excellent discriminative ability in distinguishing between a successful and non-successful outcome after surgery due to cervical radiculopathy . Percentage change scores are recommended for use in research and clinical practice OBJECTIVE To examine the test-retest reliability , validity , and responsiveness of several outcome measures in the treatment of patellofemoral pain . DESIGN Evaluation of the clinimetric properties of individual outcome measures for patellofemoral pain treatment , using data collected from a previously published r and omized controlled trial ( RCT ) . SETTING General community and private practice . PARTICIPANTS The data from 71 persons enrolled in an RCT of a conservative intervention for patellofemoral pain were used to evaluate the measures ' validity and responsiveness . A subset of this cohort ( n=20 ) was used to assess reliability . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Three  10-cm visual analog scales ( VASs ) for usual pain ( VAS-U ) , worst pain ( VAS-W ) , and pain on 6 aggravating activities ( walking , running , squatting , sitting , ascending and descending stairs ) ( VAS-activity ) ; the Functional Index Question naire ( FIQ ) ; the Anterior Knee Pain Scale ( AKPS ) ; and the global rating of change . RESULTS The test-retest reliability ranged from poor ( intraclass correlation coefficient [ICC]=.49 ) to good ( ICC=.83 ) , and the measures correlated moderately with each other ( r range,.56-.72 ) . Median change scores differed significantly between improved and unimproved persons for all measures . The effect sizes for VAS-U ( .79 ) , VAS-W ( .88 ) , and the AKPS ( .98 ) were large , indicating greater responsiveness than the FIQ ( .37 ) and VAS-activity ( .66 ) . Similarly , the AKPS and VAS-W were the most efficient measures for detecting a treatment effect when compared with a reference measure ( VAS-U , which was assigned a value of 1 ) . The minimal difference that patients or clinicians consider clinical ly important for the AKPS is 10 ( out of 100 ) points and for the VAS it is 2 cm ( out of 10 cm ) . CONCLUSIONS The AKPS and VAS for usual or worst pain are reliable , valid , and responsive and are therefore recommended for future clinical trials or clinical practice in assessing treatment outcome in persons with patellofemoral pain Abstract Purpose : Investigate test -- retest reliability and validity of five shoulder outcome measures in people during their active rehabilitation after a shoulder fracture . Method : This prospect i ve longitudinal study assessed shoulder function in 20 people ( 16 women , mean age 68.1 years ) with surgical or conservative management at 6 , 12 and 13 weeks post proximal humeral fracture using three patient-reported ( Disabilities of Arm , Shoulder and H and ; Oxford Shoulder Score ; Subjective Shoulder Value ) and two clinician-administered ( Constant Score ; UCLA Shoulder score ) outcome measures . Results : Content analysis categorised items into multiple domains of functioning for each outcome measure . Construct validity testing between measures found moderate to strong correlations ( r = 0.43–0.92 ) . Longitudinal validity ( responsiveness ) , represented by correlations between change scores , was moderate to strong ( r = 0.44–0.83 ) . Although ICCs2,1 for test – retest reliability ranged from 0.75 to 0.93 , Limits of Agreement between measurements were relatively wide ( 10–23 % of available range of scores ) . Minimal clinical ly important difference estimates varied between anchor- and distribution-based methods . Conclusions : The five outcome measures assessing shoulder function provided values for reliability and validity that meet measurement requirements for use in groups of people after a proximal humeral fracture . However , the use of these outcome measures might be limited by low absolute agreement between measurements and their content covering multiple domains of functioning . Implication s for Rehabilitation Linking the International Classification of Functioning , Disability and Health ( ICF ) to the content of common shoulder function outcome measures showed that multiple domains of functioning are combined into a single score . This might not be preferred for measurement of the single construct of “ shoulder function ” . Currently available shoulder function outcome measures may not be sufficiently reliable to monitor change in an individual after a proximal humeral fracture during the rehabilitation phase OBJECTIVE Accurate and consistent outcome assessment is essential to r and omized clinical trials . We aim ed to explore observer variation in the assessment of outcome in a recently completed trial of dexanabinol in head injury and to consider steps to reduce such variation . METHODS Eight hundred sixty-one patients with severe traumatic brain injury who were admitted to 86 centers were included in a multicenter , placebo-controlled , Phase III trial . Outcome was assessed at 3 and 6 months postinjury using the extended Glasgow Outcome Scale ; st and ardized assessment was facilitated by the use of a structured interview . Before initiation of trial centers , outcome ratings were obtained for sample cases to establish initial levels of agreement . Training sessions in outcome assessment were held , and problems in assigning outcome were investigated . During the trial , a process of central review was established to monitor performance . Interobserver variation was analyzed using the κ statistic . RESULTS Substantial observer variation was found in the rating of sample cases ( weighted κ , 0.72 ; confidence interval , 0.68–0.75 ) and in assigning outcome based on completed structured interviews ( weighted κ , 0.61 ; confidence interval , 0.57–0.64 ) . In the early stages of the trial , a relatively large number of discrepancies ( 29–37 % ) were identified on central review . This number declined as the trial progressed and coincided with investigator training and feedback from central review . Centers with higher enrollment rates showed better performance . CONCLUSION Observer variation in outcome assessment is a significant problem for head injury trials . Consistency can be improved by st and ardizing procedures , training assessors , and monitoring the quality of assessment s and providing feedback to interviewers We evaluated the responsiveness of  patient question naires and physical testing in the assessment of recovery after distal radius fracture . Patients ( n = 59 ) were assessed at their baseline clinic visit and again 3 and 6 months after injury . At each visit patients completed a short form-36 , Disability of the Arm , Shoulder , and H and question naire , and  patient-rated wrist evaluation  ( PRWE ) . At 3 and 6 months grip strength , range of motion , and dexterity were analyzed . St and ardized response means ( SRM ) and effects sizes were calculated to indicate responsiveness . The PRWE was the most responsive . Both the PRWE ( SRM = 2.27 ) and the Disability of the Arm , Shoulder , and H and ( SRM = 2.01 ) question naire were more responsive than the short form-36 ( SRM = 0.92 ) . The physical component summary score of the short form-36 was similar to that of the physical component subscales . Question naires were highly responsive during the 0- to 3-month time period when physical testing could not be performed . Of the physical tests , grip strength was most responsive , followed by range of motion . Responsive patient-rating scales and physical performance evaluations can assist with outcome evaluation of patients with distal radius fracture Abstract The relationship between growth and the breast-milk plus complementary food intake of a group of British babies has been studied prospect ively up to 8 months . From the data the human milk needs of  solely breast-fed children to grow along the 5th , 50th , and 95th Gentile of the NCHS st and ard have been predicted using multiple regression analysis . The values obtained are substantially lower than previous estimates and they may form a more practical guideline for the evaluation of lactational adequacy within a community . Individual variation is important . It is futile to identify a single age when breast-feeding becomes inadequate as the sole source of food Purpose We conducted a secondary qualitative analysis of consultations between oncologists and their patients to explore how  patient-reported outcome measures ( PROMs ) data were referred to in the process of ( 1 ) eliciting and exploring patients ’ concerns ; ( 2 ) making decisions about supportive treatment and ( 3 ) making decisions about chemotherapy and other systemic treatments . Methods We purposively sample d audio recordings of 18 consultations from the intervention arm and 4 from the attention control arm of a previous UK r and omised controlled trial of the feedback of PROMs data to doctors ( Velikova et al. in J Clin Oncol 22(4):714–724 [ 1 ] ) . We used a combination of content and conversation analysis to examine how opportunities for discussion of health-related quality of life issues are opened up or closed down within the consultation and explore why this may or may not lead to changes in patient management . Findings Explicit reference to the PROMs data provided an opportunity for the patient to clarify and further elaborate on the side effects of chemotherapy . High scores on the PROMs data were not explored further if the patient indicated they were not a problem or were not related to the cancer or chemotherapy . Symptomatic treatment was more often offered for problems like nausea , constipation , pain and depression but much less so for fatigue . Doctors discussed fatigue by providing a cause for the fatigue ( e.g. the chemotherapy ) , presenting this as ‘ something to be expected ’ , minimising its impact or moving on to another topic . Chemotherapy regimens were not changed on the basis of the PROMs data alone , but PROMs data were sometimes used to legitimise changes . Conclusions Explicit mention of PROMs data in the consultation may strengthen opportunities for patients to elaborate on their problems , but doctors may not always know how to do this . Our findings have informed the development of a training package to enable doctors to optimise their use of PROMs data within the consultation In this study , we compared the responsiveness and validity of the Box and Block Test ( BBT ) , the Nine-Hole Peg Test ( NHPT ) , and the Action Research Arm Test ( ARAT ) .  We r and omized 59 patients with stroke into one of three rehabilitation treatments for 3 weeks . We administered six outcome measures  ( BBT , NHPT , ARAT , Fugl-Meyer Assessment [ FMA ] , Motor Activity Log [ MAL ] , and Stroke Impact Scale [ SIS ] h and function domain ) pretreatment and posttreatment . We used the st and ardized response mean ( SRM ) to examine responsiveness and the Spearman rank correlation coefficient ( rho ) to examine concurrent validity . The BBT , NHPT , and ARAT were moderately responsive to change and not significantly different ( SRM = 0.64 - 0.79 ) . The correlations within the BBT , NHPT , and ARAT were moderate to good at pretreatment ( rho = -0.55 to -0.80 ) and posttreatment ( rho = -0.57 to -0.71 ) . The BBT and ARAT showed fair to moderate correlations with the FMA , MAL , and SIS h and function domain at pretreatment and posttreatment ( rho = 0.31 - 0.59 ) , whereas the NHPT demonstrated low to fair correlations with the FMA and MAL ( rho = -0.16 to -0.33 ) and moderate correlations with the SIS h and function domain ( rho = -0.58 to -0.66 ) . Our results indicate that the BBT , NHPT , and ARAT are suitable to detect changes over time . While simultaneously considering the responsiveness and validity attributes , the BBT and ARAT can be considered more appropriate for evaluating dexterous function than the NHPT . Further studies with larger sample s are needed to vali date these findings OBJECTIVE To assess reliability , validity , and responsiveness of a 29-item short-form version of the Patient Reported Outcomes Measurement Information System ( PROMIS ) and a novel “ impact score ” calculated from those measures . DESIGN Prospect i ve cohort study . SETTING Rural primary care practice s. SUBJECTS Adults aged ≥ 55 years with chronic musculoskeletal pain , not currently receiving prescription opioids . METHODS Subjects completed the PROMIS short form at baseline and after 3 months . Patient subsets were compared to assess reliability and responsiveness . Construct validity was tested by comparing baseline scores among patients who were or were not applying for Worker 's Compensation ; those with higher or lower catastrophizing scores ; and those with or without recent falls . Responsiveness was assessed with mean score changes , effect sizes , and st and ardized response means . RESULTS Internal consistency was good to excellent , with Cronbach 's alpha between 0.81 and 0.95 for all scales . Among patients who rated their pain as stable , test-retest scores at 3 months were around 0.70 for most scales . PROMIS scores were worse among patients seeking or receiving worker 's compensation , those with high catastrophizing scores , and those with recent falls . Among patients rating pain as “ much less ” at 3 months , absolute effect sizes for the various scales ranged from 0.24 ( Depression ) to 1.93 ( Pain Intensity ) . CONCLUSIONS Results indicate that the PROMIS short 29-item form may be useful for the study of patients with chronic musculoskeletal pain . Our findings also support use of the novel “ impact score ” recommended by the National Institutes of Health ( NIH ) Task Force on Research St and ards for Chronic Low Back Pain OBJECTIVE To assess the responsiveness ( sensitivity to change ) of 6 shoulder outcome instruments . METHODS In a prospect i ve cohort study of 153 total shoulder arthroplasties , outcome was measured by the Short Form 36 ( SF-36 ) ; Disabilities of the Arm , Shoulder , and H and question naire ( DASH ) ; Shoulder Pain and Disability Index ( SPADI ) ; American Shoulder and Elbow Surgeons question naire for the shoulder ( ASES ) ;  and the Constant ( Murley ) Score ( CS ) .  Responsiveness was mainly quantified by effect sizes before and 6 months after operation . Sensitivity analysis of the effects by receiver operating characteristic ( ROC ) curves was performed to determine the instruments ' ability to classify effects into global health change assessment categories . RESULTS Effect sizes of the self- assessment total scores were 0.71 , 1.19 , 2.10 , and 2.13 for the SF-36 , DASH , SPADI , and ASES , respectively . The clinical ASES and the CS had effect sizes of 1.87 and 2.23 , respectively . The SPADI ( effect size 2.12 ) and the CS ( effect size 2.72 ) were most responsive for pain . For functioning , the patient ASES ( effect size 2.10 ) , the CS ( effect size 1.82 ) , and the clinical ASES ( effect size 1.85 ) were almost equal . The SF-36 bodily pain scale and most scores of the condition-specific instruments showed a significant area under the ROC of up to 0.77 . CONCLUSION The SPADI and /or the CS are the most suitable for short , responsive , shoulder-specific assessment . The more expensive patient ASES can be used for most responsive shoulder-function assessment . For a comprehensive measurement of health and quality of life , the DASH and /or the SF-36 should be added to the set PURPOSE Patient-rated instruments are increasingly used to measure orthopedic outcomes . However , the clinical relevance of modest score changes on such instruments is often unclear . This study was design ed to define the minimal clinical ly important differences ( MCIDs ) of the Disabilities of the Arm , Shoulder , and H and ( DASH ) , QuickDASH ( subset of DASH ) , and Patient-Rated Wrist Evaluation ( PRWE ) question naires for atraumatic conditions of the h and , wrist , and forearm . METHODS We prospect ively analyzed 102 patients undergoing nonoperative treatment for isolated tendinitis , arthritis , or nerve compression syndromes from the forearm to the h and . By phone , patients completed the DASH , QuickDASH , and PRWE at enrollment and at 2 weeks ( n = 78 used in the analysis ) and 4 weeks ( n = 24 used in the analysis ) after initiating treatment . Patients reporting clinical improvement each contributed a single data point categorized as no change ( n = 41 ) , minimal improvement ( n = 30 ) , or marked improvement ( n = 31 ) via a vali date d anchor-based approach . We calculated the MCID as the mean change score for each outcome measure in the minimal improvement group . RESULTS The MCID ( 95 % confidence interval ) for the DASH was 10 ( 5 - 15 ) . The MCID for the QuickDASH was 14 ( 9 - 20 ) . The MCID was 14 ( 8 - 20 ) for the PRWE . The MCID values were significantly different from changes in these outcome measures at times of either no change or marked improvement . The MCID values positively correlated with baseline outcome measure scores to a greater degree than final outcome measure scores . CONCLUSIONS Longitudinal changes on the DASH of 10 points , on the QuickDASH of 14 points , and on the PRWE of 14 points represent minimal clinical ly important changes . We recommend application of these MCID values for group-level analysis when conducting research and interpreting data examining groups of patients as opposed to assessing individual patients . These MCID values may provide a basis for sample size calculations for future investigation using these common patient-rated outcome measures . TYPE OF STUDY /LEVEL OF EVIDENCE Diagnostic III
Only the DASH and PRWE have evidence of reliability , validity , and responsiveness in patients with traumatic injuries to the h and and wrist ; other measures either have incomplete evidence or evidence gathered in a nontraumatic population .
Conclusions : The DASH and PRWE both have evidence of reliability , validity , and responsiveness in a h and and wrist trauma population .
Other PROMs used to assess h and and wrist trauma patients do not .
Background : Patient-reported outcome measures ( PROMs ) are important tools for assessing outcomes following injuries to the h and and wrist .
Many commonly used PROMs have no evidence of reliability , validity , and responsiveness in a h and and wrist trauma population .
This systematic review examines the PROMs used in the assessment of h and and wrist trauma patients , and the evidence for reliability , validity , and responsiveness of each measure in this population .