Hoang-Kim Amy, Schemitsch Emil, Kulkarni Abhaya V, Beaton Dorcas
St. Michael`s Hospital, 30 Bond Street (193-6T Yonge Street), Toronto, ON, M5B 1W8, Canada,
Arch Orthop Trauma Surg. 2014 Feb;134(2):219-28. doi: 10.1007/s00402-013-1824-4. Epub 2013 Aug 10.
The prevalence of hip-specific outcome measures in randomized trials reflects what directs our outcome assessment following a hip fracture. The present study provides an overview on the most commonly-used hip-specific outcome instruments used for postoperative assessment of hip fracture with respect to their covered contents. This can facilitate the selection of appropriate items for specific purposes in clinical as well as research settings.
We used the International Classification of Functioning, Disability and Health (ICF) model to distinguish concepts within the instrument. All items from the questionnaires were categorized into one of three categories using the ICF linking rules for a standardized approach. The hip-specific composites measures were also compared to other types of prevalent measures: generic and patient-based instruments.
All of the items in the instruments could be mapped to the ICF. We report the highest frequency of ICF activity and participation (71%) within the Harris hip score (HHS) which is similar to the frequency of ICF content found in the generic measures (82%). Hip-specific composites focused mostly on walking and moving long and short distances, while in patient-reported measures there was a concentration on the concept of sensation of pain and pain in body parts.
The prevalent use of the HHS, over the other hip-specific instruments, could be attributed to its likeness in concept to other generic measures. The dominance of the ICF category of activity and participation reflects what is important to clinicians treating a hip fracture. Composite scores remain problematic as they cut across different ICF concepts. As long as the popularity of composite scoring systems continues, an overall score may not represent the true patient preferences and concerns in clinical trials. Future studies could apply the results from this study for the creation of an ICF category-based item banking or investigators could operationalize the ICF categories within these candidate measures for specific interventions.
随机试验中特定髋关节结局测量指标的流行程度反映了我们在髋部骨折后进行结局评估的导向。本研究概述了用于髋部骨折术后评估的最常用的特定髋关节结局工具及其涵盖的内容。这有助于在临床和研究环境中为特定目的选择合适的项目。
我们使用国际功能、残疾和健康分类（ICF）模型来区分工具中的概念。使用ICF链接规则将问卷中的所有项目分为三类之一，以采用标准化方法。还将特定髋关节综合测量指标与其他类型的流行测量指标进行了比较：通用指标和基于患者的工具。
工具中的所有项目都可以映射到ICF。我们报告了Harris髋关节评分（HHS）中ICF活动和参与的最高频率（71%），这与通用测量指标中发现的ICF内容频率（82%）相似。特定髋关节综合指标主要关注长距离和短距离行走及移动，而在患者报告的测量指标中，则集中在疼痛感觉和身体部位疼痛的概念上。
与其他特定髋关节工具相比，HHS的广泛使用可能归因于其在概念上与其他通用测量指标相似。ICF活动和参与类别的主导地位反映了治疗髋部骨折的临床医生所关注的重要方面。综合评分仍然存在问题，因为它们跨越了不同的ICF概念。只要综合评分系统继续流行下去，总分可能无法代表临床试验中患者的真实偏好和关注点。未来的研究可以应用本研究的结果来创建基于ICF类别的项目库，或者研究人员可以在这些候选测量指标中针对特定干预措施实施ICF类别。
