Outcome Measures in Orthopaedics and Orthopaedic Trauma PDF

Preface

‘Outcome' is defined by The Oxford English Dictionary as ‘a visible or practical result'. Outcome measures play an important rôle in medical practice. They should provide the basis for both clinical audit and research. The principal object of this book is to provide references to sources of instruments and techniques used for outcome measurement in orthopaedics and trauma and to advise on the optimum choice of instrument. It will become clear to any student of this topic that it is not an easy subject and there remain many areas without adequate outcome measures.

The text is aimed at medical staff in orthopaedic units, trauma centres and accident and emergency departments. The book may also be of value to physiotherapists, metrologists, research nurses and others involved in clinical research into orthopaedics and trauma. There is a medico-legal dimension to this topic. Outcome measures are vital to the setting of standards of care and their measurement, as well as in the assessment of disease or injury severity. This is of relevance to both lawyers and clinicians in this area, who will find in this book a reference to the most appropriate outcome measures for their purpose. The setting of standards of care and the assessment of the quality of care is also of concern to doctors in public health medicine, purchasers and government. It is important for the clinician to maintain an interest in this field, not least to ensure that managers are receiving accurate and relevant clinical information about his or her activities.

The British Paediatric Association Outcome Measures Working Group (British Paediatric Association 1992) has presented a number of definitions:

• A Health Status Measurement is a direct measure of some aspect of health in which improvement is sought, whether or not its relationship to any intervention, social or environmental circumstance is understood. An example is infant mortality rate.
• An Outcome Measurement is a sub-type of health status measurement where changes in the measure are known (or at least believed) to be largely attributable to a health service intervention. An example, in the field of paediatrics is life expectancy for people with cystic fibrosis.
• An Implied Outcome Measurement is an indirect indicator of health that can be used as a valid proxy for an outcome measurement. Examples are immunization coverage, and coverage of a screening programme of proven effectiveness. In our view, the health status measurement may also be described as ‘functional status measurement' and a ‘quality of life measure'. These measurements can be made without necessarily seeking improvement.

The Editors of this book have all had a longstanding interest in outcome measures. Each has contributed both to the original development of outcome instruments and to studies to establish their validity, reliability and responsiveness. We have collaborated to produce collections of outcome measures for orthopaedics (Pynsent et al. 1993) and for trauma (Pynsent et al. 1994) in separate texts, and also in a text on methodology (Pynsent et al. 1997). We have also collected classification systems in trauma (Pynsent et al. 1999).

In this book, we have combined orthopaedic and trauma outcome measures in a single volume. In our original texts we used a conference based on the Dahlem model to review draft chapters (Dixon 1987) but on this occasion we have asked authors to collect, classify and - where possible - to tabulate outcome measures. We also asked them to rank outcome measures according to a formula laid out below. This has not always been achieved but we believe that the results will be of value to both clinical research and audit. There may be some circumstances where instruments can be used to evaluate individual patients as an aid to clinical assessment and decision making.