Updated: 5/19/2019

Outcome Measure Tools

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https://upload.orthobullets.com/topic/9087/images/sf-36 scoring system.jpg
https://upload.orthobullets.com/topic/9087/images/hhs.jpg
https://upload.orthobullets.com/topic/9087/images/constant score.jpg
https://upload.orthobullets.com/topic/9087/images/ucla score.jpg
https://upload.orthobullets.com/topic/9087/images/oswestry scoring.jpg
MULTI-SUBSPECIALTY
SF-36
  • Overview
    • a generic, multi-purpose, short-form health survey consisting of 36 questions
    • useful for
      • surveys of general and specific populations
      • comparing the relative burden of diseases
      • differentiating the health benefits produced by a wide range of different treatment
    • example
      • polytrauma patients with foot injury have lower SF-36 scores than polytrauma patients without foot injury 
      • SF-12 (shortened version with 12 questions)
        • Self-rated preinjury pain-related disability is a predictor of moderate to severe pain 6 months after musculoskeletal injury as measured by SF-12 
  • Structure
    • consists of 8 scaled scores, which are the weighted sums of the questions in their section
    • each scale is directly transformed into a 0-100 scale on the assumption that each question carries equal weight
    • 8 scales include
      1. vitality
      2. physical functioning
      3. bodily pain
      4. general health perceptions
      5. physical function
      6. emotional role functioning
      7. social role functioning
      8. mental health
Veterans Rand 12-Item Health Survey (VR-12) 
  • Overview
    • a shorter version developed from the SF-36
    • may be useful if only physical and mental health summary scores are of interest
    • used to assess HRQOL and estimate disease burden
Patient-Reported Outcomes Measurement Information System (PROMIS) 
  •  Overview
    • assesses disease-specific and general health questions
    • adult and pediatric versions available
    • utilizes computer adaptive testing software (CAT)
  • Subspecialties
    • validated for use in 
      • foot and ankle
      • upper extremity
      • spine patients 
  • Outcome domains
    • domains include
      • physical
      • mental
      • social health
  • Scoring 
    • results reported as T-scores
EuroQol-5D (EQ-5D)
  • Overview
    • assesses generic health status/quality of life
    • two components
      • health state description: health status measured in 5 dimensions (mobility, self-care, usual activities, pain/discomfort, anxiety/depression)
      • health state evaluation: overall health assessed using the visual analog scale
    • strong reliability and validity for numerous health conditions (disease non-specific)
    • available in 170+ languages
  • Scoring
    • answers correlate to 243 health states or can be converted into the EQ-5D index/utility scores corresponding to 0 for death and 1 for perfect health
Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)                                                        
  • Overview
    • designed to evaluate and compare the inpatient experience in U.S. hospitals
    • developed by the Centers for Medicare & Medicaid Services (CMS) and the Agency for Healthcare Research and Quality (AHRQ)
    • for hospitals participating in the Hospital Value-Based Purchasing Program, HCAHPS performance may affect Medicare payments by 2% positively or negatively
    • administered to a random sample of patients continuously throughout the year (between 48 hours and 6 weeks after discharge)
    • 32 questions long
      • composite topics
        • nurse communication
        • doctor communication 
        • responsiveness of hospital staff
        • communication about medicines
        • discharge information
        • care transition
      • individual topics
        • cleanliness of hospital environment
        • quietness of hospital environment
      • global topics
        • hospital rating
        • willingness to recommend hospital
  • Scoring
    • CMS creates star ratings for each of the 10 HCAHPS measures to easily compare hospitals, as well as a summary star rating averaging each of the 10 measures
ADULT RECON
Harris Hip Score
  • Tool for evaluating patient after total hip replacement 
    • scored 0-100
      • score is reported as 
        • 90-100: excellent 
        • 80-90: good
        • 70-79: fair
        • 60-69: poor
        • below 60: a failed result
  • Four categories
    • pain
      • no pain given 44 points
    • function
      • no limp, walks without aid, and can walk more than six blocks given 33 points
    • function activities
      • no disabilities given 14 points
    • physical exam 
      • based on range of motion with maximum score of 9
  • Score does not allow for individual differences based on age, health, or other personal issues that may affect the total score
Knee Injury and Osteoarthritis Outcome Score (KOOS)
  • Overview
    • measures patients' opinions about their knee and related problems 
    • allows for short- and long-term follow-up
    • intended for young and middle-aged individuals with post-traumatic osteoarthritis or traumatic conditions that may lead to OA; also applied to TKA patients 
    • 5 domains (pain frequency and severity during functional activities, symptoms including the severity of stiffness, swelling, mechanical symptoms, and range of motion, difficulty with ADLs, difficulty with sport and recreational activities, QOL)
  • Scoring
    • 42 items are scored 0-4 and the 5 domains are scored separately as the sum of all corresponding items
    • scores are converted to a 0-100 scale, where 0 = extreme knee problems and 100 = no knee problems
Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)
  • Overview
    • designed to evaluate patients with hip and knee arthritis, including pain, stiffness, and joint function/mobility; also has been applied to patients with back pain, RA, JRA, SLE, and fibromyalgia
      • one of the most widely used tools in arthritis research
    • consists of 24 items divided into 3 subscales; measures 5 items for pain, 2 for stiffness, and 17 for physical function
  • Scoring
    • most commonly, the sum of the scores in all 3 subscales are added (0-20 for pain, 0-8 for stiffness, and 0-68 for physical function)
    • higher WOMAC scores correlate with worse pain, stiffness, and function
FOOT & ANKLE
Foot and Ankle Outcome Score
  • Developed to assess the patients opinion about a variety of foot and ankle related problems
    • commonly used in patients with
      • lateral ankle instability
      • Achilles tendinosis
      • plantar fasciitis
  • Consists of 5 subscales:
    • pain
    • other symptoms
    • function in daily living (ADL)
    • function in sport and recreation 
    • foot and ankle-related Quality of Life (QOL)
  • Scoring
    • last week is taken into consideration when answering the questionnaire
    • each question gets a score from 0 to 4
      • normalized score (100 indicating no symptoms and 0 indicating extreme symptoms) is calculated for each subscale.
      • the result can be plotted as an outcome profile
SHOULDER & ELBOW
Constant Shoulder Outcome Score
  • Scoring
    • scored from 0-100
    • consists of four variables that are used to assess the function of the shoulder; right and left shoulders are assessed separately 
  • 4 variables include
    • pain score
      • subjective measurement, score for no pain is 15
    • functional assessment
      • subjective measurement, score for no functional deficit is 20 
    • range of motion
      • objective measurement, full range of motion score is 40
    • strength measures
      • objective measurement, full strength score is 25
UCLA Shoulder Score
  • Overview
    • a shoulder scoring system
  • Categories
    • consists of 5 sections:
      • pain
      • function
      • active forward flexion
      • strength of forward flexion
      • satisfaction of patient
  • Scoring
    • score of >27 indicates good or excellent results
    • maximum score is 35 
Disabilities of the Arm, Shoulder, and Hand (DASH) Score
  • Overview
    • 30-item, self-report questionnaire 
    • measures physical function and symptoms in people with musculoskeletal disorders of the upper limb
  • Scoring
    • scored in two components
      • disability/symptom section (30 items, scored 1-5) 
      • optional high-performance sport/music or work section (4 items, scored 1-5)
    • DASH disability/symptom score = [(sum of n responses/n) - 1] x 25
      • n is equal to the number of completed responses
      • a DASH score may not be calculated if there are greater than 3 missing items
    • optional module scoring
      • add up assigned values for each response; divide by 4 (number of items); subtract 1; multiply by 25
      • an optional module score may not be calculated if there are any missing items
Quick DASH  
  • Overview
    • an abbreviated version of the original DASH consisting of 11 items
    • assesses an individual's ability to complete tasks, absorb forces, and severity of symptoms
    • utilizes a 5-point Likert scale
  • Scoring
    • cannot be completed if more than 1 item is missing
    • scored the same as DASH, with higher scores correlating with a greater level of disability/severity (0-100)
Oxford Shoulder Instability Score (OSIS) 
  • Overview
    • short, shoulder-specific PRO
    • consists of 12 questions (each with 5 response alternatives ranked least to most difficult) related to ADLs specifically relevant to patients with shoulder instability
    • validated for measuring surgical and non-surgical therapeutic outcomes of patients with uni- and multi-directional shoulder instability
  • Scoring
    • responses from each question are added for a score ranging from 12 (best function) to 60 (worst function)
 SPINE
ASIA Classification
  • Clinical condition
    • spinal cord injury
Oswestry Disability Index (ODI)
  • Clinical condition
    • all conditions that affect low back pain
  • Overview
    • important tool that researchers and disability evaluators use to measure a patient's permanent functional disability
    • considered the ‘gold standard’ of low back functional outcome tools
  • Scoring
    • consists of 10 sections, and for each section the total possible score is 5
    • if all 10 sections are completed the score is calculated as follows:
      • Example: 16 (total scored), 50 (total possible score) x 100 = 32%
    • if one section is missed or not applicable the score is calculated:
      • 16 (total scored) 45 (total possible score) x 100 = 35.5% 
    • interpretation of scores 
Neck Disability Index (NDI) 
  • Overview
    • modification of the ODI
    • 10 item questionnaire 
    • most commonly used self-reported measure for neck pain
    • intended for patients with chronic neck pain, musculoskeletal neck pain, whiplash, and cervical radiculopathy 
  • Scoring
    • each of the 10 sections are added together (each section has a possible score of 0-5), divided by 50, and multiplied by 100 to determine a percentage
    • 0 points or 0% correlates with no activity limitations, whereas 50 points or 100% correlates with complete activity limitation/disability
mJOA
  • Clinical conditions
    • cervical myelopathy
  • A point scoring system (17 total) based on function in the following categories 
    • upper extremity motor function
    • lower extremity motor function
    • sensory function
    • bladder function
Nurick Classification
 

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(OBQ11.182) Which of the following factors has NOT been found to be a significant independent predictor of moderate or severe pain 6 months after musculoskeletal injury? Review Topic

QID: 3605
1

Failure to complete high school

14%

(301/2139)

2

Self-reported preinjury pain-related disability

3%

(63/2139)

3

Disability compensation

3%

(62/2139)

4

Male gender

54%

(1147/2139)

5

Moderate or severe pain at discharge from the acute hospital

26%

(564/2139)

ML 4

Select Answer to see Preferred Response

PREFERRED RESPONSE 4

(OBQ06.217) A 45-year-old male trauma patient presents with multiple extremity injuries including the foot injury shown in Figure A. The foot fracture is treated surgically, and heals without any initial complications. At a minimum of 12 months, this patient will be expected to have which of the following scores compared to a matched polytrauma patient without a foot injury? Review Topic

QID: 228
FIGURES:
1

Lower mean Short Form 36 (SF-36) score

72%

(1112/1549)

2

Higher mean score on the AAOS lower limb and foot and ankle outcomes questionnaire

7%

(106/1549)

3

Equivalent score on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)

7%

(109/1549)

4

Lower Constant score

8%

(119/1549)

5

Higher score on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)

5%

(81/1549)

ML 2

Select Answer to see Preferred Response

PREFERRED RESPONSE 1
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