How to Assess Patient’s Outcome?

  • Yuichi Hoshino
  • Alfonso Barnechea


This chapter illustrates the variety of patient’s reported outcomes and how to choose the best possible one for each research. Patient’s reported outcome is an enormously important evaluation for clinical orthopedic research, because it is directly reflected by the patient’s “subjective” feeling whose improvement is the ultimate goal of our clinical care in general. However, each outcome measure has specific areas of assessment, and the researchers should select one or more which appropriately address their predetermined research questions. In order to design a clinically relevant and informative research study, an appropriate selection of optimal outcome measures is of utmost importance. The choice should be primarily done in consideration of the study purpose. Frequently used outcome measures in the specific research area would be preferable because its result can be compared to previous reports. Language and/or financial problems might limit the selection of the outcome measure especially in non-English speaking countries. Researchers should be aware of the reliability, validity, and responsiveness of their selected outcome measures, and it should be confirmed if they are acceptable for each specific research.


  1. 1.
    Ansari NN, Naghdi S, Hasanvand S, Fakhari Z, Kordi R, Nilsson-Helander K. Cross-cultural adaptation and validation of Persian Achilles tendon Total Rupture Score. Knee Surg Sports Traumatol Arthrosc. 2016;24(4):1372–80.CrossRefGoogle Scholar
  2. 2.
    Barber-Westin SD, Noyes FR, McCloskey JW. Rigorous statistical reliability, validity, and responsiveness testing of the Cincinnati Knee Rating System in 350 subjects with uninjured, injured, or anterior cruciate ligament-reconstructed knees. Am J Sports Med. 1999;27:402–16.CrossRefGoogle Scholar
  3. 3.
    Beaton DE, Katz JN, Fossel AH, Wright JG, Tarasuk V, Bombardier C. Measuring the whole or the parts? Validity, reliability, and responsiveness of the Disabilities of the Arm, Shoulder and Hand outcome measure in different regions of the upper extremity. J Hand Ther. 2001;14:128–46.CrossRefGoogle Scholar
  4. 4.
    Bellamy N, Watson Buchanan W, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: A health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988;15:1833–40.PubMedGoogle Scholar
  5. 5.
    Black N, Varaganum M, Hutchings A. Relationship between patient reported experience (PREMs) and patient reported outcomes (PROMs) in elective surgery. BMJ Qual Saf. 2014;23:534–42.CrossRefGoogle Scholar
  6. 6.
    Brophy RH, Beauvais RL, Jones EC, Cordasco FA, Marx RG. Measurement of shoulder activity level. Clin Orthop Relat Res. 2005;439:101–8.CrossRefGoogle Scholar
  7. 7.
    Budiman-Mak E, Conrad KJ, Roach KE. The Foot Function Index: a measure of foot pain and disability. J Clin Epidemiol. 1991;44:561–70.CrossRefGoogle Scholar
  8. 8.
    Dawson J, Doll H, Boller I, Fitzpatrick R, Little C, Rees J, et al. The development and validation of a patient-reported questionnaire to assess outcomes of elbow surgery. J Bone Joint Surg Br. 2008;90(4):466–73.CrossRefGoogle Scholar
  9. 9.
    Domsic RT, Saltzman CL. Ankle Osteoarthritis Scale. Foot Ankle Int. 1998;19:466–71.CrossRefGoogle Scholar
  10. 10.
    Fairbank JCT, Couper J, Davies JB, O’Brien JP. The Oswestry low back pain disability questionnaire. Physiotherapy. 1980;66:271–3.PubMedGoogle Scholar
  11. 11.
    Greco NJ, Anderson AF, Mann BJ, Cole BJ, Farr J, Nissen CW, et al. Responsiveness of the International Knee Documentation Committee Subjective Knee Form in comparison to the Western Ontario and McMaster Universities Osteoarthritis Index, modified Cincinnati Knee Rating System, and Short Form 36 in patients with focal articular cartilage defects. Am J Sports Med. 2010;38(5):891–902.CrossRefGoogle Scholar
  12. 12.
    Irrgang JJ, Anderson AF, Boland AL, Harner CD, Kurosaka M, Neyret P, et al. Development and validation of the International Knee Documentation Committee Subjective Knee Form. Am J Sports Med. 2001;29:600–13.CrossRefGoogle Scholar
  13. 13.
    Irrgang JJ, Anderson AF, Boland AL, Harner CD, Neyret P, Richmond JC, et al. International Knee Documentation Committee. Responsiveness of the International Knee Documentation Committee Subjective Knee Form. Am J Sports Med. 2006;34(10):1567–73.CrossRefGoogle Scholar
  14. 14.
    Irrgang JJ, Lubowitz JH. Measuring arthroscopic outcome. Arthroscopy. 2008;24(6):718–22.CrossRefGoogle Scholar
  15. 15.
    Kemp JL, Collins NJ, Roos EM, Crossley KM. Psychometric properties of patient-reported outcome measures for hip arthroscopic surgery. Am J Sports Med. 2013;41(9):2065–73.CrossRefGoogle Scholar
  16. 16.
    Kocher MS, Steadman JR, Briggs KK, Sterett WI, Hawkins RJ. Reliability, validity, and responsiveness of the Lysholm knee scale for various chondral disorders of the knee. J Bone Joint Surg Am. 2004;86-A(6):1139–45.CrossRefGoogle Scholar
  17. 17.
    Lyman S, Lee YY, Franklin PD, Li W, Cross MB, Padgett DE. Validation of the KOOS, JR: a short-form knee arthroplasty outcomes survey. Clin Orthop Relat Res. 2016;474(6):1461–71.CrossRefGoogle Scholar
  18. 18.
    Lysholm J, Gillquist J. Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med. 1982;10:150–4.CrossRefGoogle Scholar
  19. 19.
    MacDermid JC, Turgeon T, Richards RS, Beadle M, Roth JH. Patient rating of wrist pain and disability: a reliable and valid measurement tool. J Orthop Trauma. 1998;12(8):577–86.CrossRefGoogle Scholar
  20. 20.
    Martin RL, Philippon MJ. Evidence of validity for the Hip Outcome Score in hip arthroscopy. Arthroscopy. 2007;23:822–6.CrossRefGoogle Scholar
  21. 21.
    Martin RL, Irrgang JJ, Burdett RG, Conti SF, Van Swearingen JM. Evidence of validity for the Foot and Ankle Ability Measure (FAAM). Foot Ankle Int. 2005;26:968–83.CrossRefGoogle Scholar
  22. 22.
    Marx RG, Jones EC, Allen AA, Altchek DW, O’Brien SJ, Rodeo SA, et al. Reliability, validity, and responsiveness of four knee outcome scales for athletic patients. J Bone Joint Surg Am. 2001;83-A(10):1459–69.CrossRefGoogle Scholar
  23. 23.
    Mohtadi NG, Griffin DR, Pedersen ME, Chan D, Safran MR, Parsons N, et al. Multicenter Arthroscopy of the Hip Outcomes Research Network. The Development and validation of a self-administered quality-of-life outcome measure for young, active patients with symptomatic hip disease: the International Hip Outcome Tool (iHOT-33). Arthroscopy. 2012;28(5):595–605.CrossRefGoogle Scholar
  24. 24.
    Nilsdotter AK, Lohmander LS, Klässbo M, Roos EM. Hip disability and osteoarthritis outcome score (HOOS)—validity and responsiveness in total hip replacement. BMC Musculoskelet Disord. 2003;4:10.CrossRefGoogle Scholar
  25. 25.
    Papou A, Hussain S, McWilliams D, Zhang W, Doherty M. Responsiveness of SF-36 Health Survey and Patient Generated Index in people with chronic knee pain commenced on oral analgesia: analysis of data from a randomised controlled clinical trial. Qual Life Res. 2017;26(3):761–6.CrossRefGoogle Scholar
  26. 26.
    Richards RR, An KN, Bigliani LU, Friedman RJ, Gartsman GM, Gristina AG, et al. A standardized method for the assessment of shoulder function. J Shoulder Elb Surg. 1994;3:347–52.CrossRefGoogle Scholar
  27. 27.
    Roos EM, Lohmander LS. The Knee injury and Osteoarthritis Outcome Score (KOOS): from joint injury to osteoarthritis. Health Qual Life Outcomes. 2003;1:64.CrossRefGoogle Scholar
  28. 28.
    SooHoo NF, Li Z, Chenok KE, Bozic KJ. Responsiveness of patient reported outcome measures in total joint arthroplasty patients. J Arthroplast. 2015;30(2):176–91.CrossRefGoogle Scholar
  29. 29.
    Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res. 1985;198:43–9.Google Scholar
  30. 30.
    Walton MK, Powers JH III, Hobart J, Patrick D, Marquis P, Vamvakas S, et al. International Society for Pharmacoeconomics and Outcomes Research Task Force for Clinical Outcomes Assessment. Clinical Outcome Assessments: Conceptual Foundation-Report of the ISPOR Clinical Outcomes Assessment—Emerging Good Practices for Outcomes Research Task Force. Value Health. 2015;18(6):741–52.CrossRefGoogle Scholar
  31. 31.
    Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30:473–83.CrossRefGoogle Scholar

Copyright information

© ISAKOS 2019

Authors and Affiliations

  • Yuichi Hoshino
    • 1
  • Alfonso Barnechea
    • 2
  1. 1.Department of Orthopaedic Surgery, Graduate School of MedicineKobe UniversityKobeJapan
  2. 2.Department of Orthopedic SurgeryEdgardo Rebagliati Martins National HospitalLimaPeru

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