This effort was spearheaded by the director of the Research and Teaching
Centre at the Royal Orthopaedic Hospital in Birmingham, United Kingdom, and by
two well-known and experienced clinical researchers from Oxford, United
Kingdom. Outcome Measures in Orthopaedics and Orthopaedic Trauma, 2nd
ed., is the combination of these editors' two previously published efforts:
Outcome Measures in Orthopaedics (1993) and Outcome Measures in
Trauma (1994). The object of the newer, combined book is to
"provide references to sources of instruments and techniques that are
used for outcome measurement in orthopaedics and trauma and to advise on the
optimum choice of instrument." The book is directed toward medical staff
who work in orthopaedic and trauma units.
The first five chapters of the book are organized around general topics,
such as the requirements for choosing an outcome measure, the elements of an
economic evaluation of healthcare interventions, the practicalities of
performing randomized controlled trials, and the value of performing registry
studies. The rest of the textbook reflects a transition to specific clinical
entities, such as growth-plate injuries, and then to the assessment of outcome
according to anatomical regions, such as the spine, wrist, hand, and knee.
This organization is somewhat problematic because it leads to a duplication of
the description of specific outcome instruments in two or more chapters; for
example, the outcome scales that are useful in clinical research on ankle
problems are also useful in the study of patients with tibial shaft injuries.
Each chapter has either an appendix or a list of outcome instruments, and it
is in these sections that duplication of effort is apparent. Perhaps it would
have been more effective to include a single appendix to the entire textbook
so that the chapter authors could refer readers to the main appendix for
information on the instruments mentioned in each chapter. This issue
frequently occurs in multi-authored texts such as this one, which has forty
authors for twenty-three chapters.
Chapter one, on choosing an outcome instrument, by the primary editor Dr.
Pynsent, is well written and is a useful piece for any clinician who is
interested in initiating clinical research efforts. Chapter two, on
health-outcome indicators, is focused on the audience in the United Kingdom,
with appropriate terminology from the National Health Service; it has little
application for the North American clinical research community. Both chapter
two, on health-outcome measurement, and chapter three, in the section on
validation, overlapped considerably with the information on outcome measures
as provided in chapter one. Mr. Fairbank's chapter on randomized controlled
trials is a very clear and distinct presentation of the topic. The chapter on
registries does not mention the inherent problems with these data sources,
such as selection bias, which occurs wherever voluntary reporting of data is
the main process involved.
Overall, the chapters based on anatomical regions do meet the stated
objectives of the text in providing references to sources of instruments;
however, no information on scoring or on the sources for normative data is
provided. Several as yet unvalidated instruments are presented, but they are
not clearly identified as such. A single appendix that offered more validation
data along with information on the scoring process and normative data would
have been more useful to the broader clinical-research audience.
Ultimately, the chapters are well written, easy to read, and provide useful
information. This text belongs in the libraries of all orthopaedic departments
and academic centers and will be useful to trainees and clinicians who are
involved in the clinical research of musculoskeletal disease and injury.