The authors of this handbook identify in the preface their primary intent
to "identify the most commonly used musculoskeletal outcomes instruments
reported in the literature." They have successfully achieved this goal.
In the introduction, they further state that their purpose is to
"facilitate the use of outcomes instruments in daily clinical
practice." This handbook, which serves as an easily usable resource
within the office setting, does help to fulfill this purpose. The authors also
state that they would like to "ease critical assessment of academic
journal articles." This particular function is more related to issues
surrounding clinical research design. This handbook will not facilitate this
function. The authors also state that they would like to "foster the
development of new and improved outcomes instruments via standardized
criteria." This book is a good tool, but it is not comprehensive enough
to serve as a definitive resource for those individuals who wish to develop
and validate new outcomes instruments.
The handbook is intended for a broad audience, including orthopaedic
surgeons, rheumatologists, physical therapists, occupational therapists,
family physicians, and nurses. In my opinion, it is best used by
residents-in-training and individuals who are beginning their careers as
clinical researchers.
The introductory chapters are very well done and provide an excellent
tutorial for the audience described. Chapter 3, on identifying a quality
outcomes instrument, is particularly useful. Chapter 6 describes the
instruments themselves and is the meat of the text. The instruments are
categorized regionally by anatomic grouping. The authors provide, in an easily
readable format, a content summary; a summary of the validity, reliability,
and responsiveness testing for individual instruments; a score for clinical
utility (which the authors assign); and an overall score. Interestingly, the
authors did not subject their own scoring for clinical utility to
reproducibility or reliability testing!
The list of generic instruments is somewhat lacking. It includes the Short
Form-36 health survey questionnaire (SF-36), the Nottingham Health Profile
(NHP), and the Musculoskeletal Function Assessment (MFA) as well as the Short
Musculoskeletal Function Assessment (SMFA). The authors left out the Quality
of Well-Being (QWB) scale, the EuroQual (subjective health-rating scale), and
the Sickness Impact Profile (SIP), all of which have been widely used in
assessing musculoskeletal outcomes, particularly those related to injury. This
reviewer questions the value of listing "old-style" expert-derived
patient outcomes questionnaires that have not been subjected to any
reliability or reproducibility testing. Although the intent was to identify
the most commonly used instruments for musculoskeletal outcomes, some of the
instruments in wide use have not been developed with modern techniques or
validated. It would have been wise to mention these instruments in passing but
then to direct budding clinical researchers toward the use of appropriately
developed and validated instruments.
Following Chapter 6, which lists the instruments, the authors include a
chapter on recommendations, then some appendices, followed by abbreviations
and a glossary. The abbreviation list is somewhat incomplete. The glossary is
very useful for the audiences described.
It seems to this reviewer that clinical researchers in orthopaedic surgery
should endeavor to stimulate the use of currently available instruments of the
highest quality and design rather than encourage the development of more
instruments, as these authors do. We have plenty of high-quality instruments,
and our universe of musculoskeletal researchers needs to be encouraged to use
these tools in appropriate clinical research designs, generally of a
multicenter nature.
This handbook is a useful tool for all academic departments and large
orthopaedic practices. It belongs in the libraries of these entities as well
as on the shelves of any individual involved in musculoskeletal clinical
research. The increasing emphasis on the part of patients and payers toward
identifying the outcomes of our care will facilitate the expansion of this
important group of researchers.