Do patient-reported outcome measures used in assessing outcomes in rehabilitation after hip and knee arthroplasty capture issues relevant to patients? Results of a systematic review and ICF linking process.

Abstract

OBJECTIVE: To compare the contents of patient-reported instruments used in hip and knee arthroplasty rehabilitation with the International Classification of Functioning, Disability and Health (ICF). METHODS: A search of PubMed, CINAHL, Cochrane Central Registry, SCOPUS and PEDro identified patient-reported outcome instruments. The meaningful concepts extracted from the instruments were linked to the ICF based on established linking rules and compared with the osteoarthritis core set. The number of concepts per item, the breadth, and the depth of coverage of instruments in relation to the ICF were determined through calculation of content density, bandwidth per ICF component, and content diversity, respectively. RESULTS: Eight instruments were reviewed and 375 meaningful concepts were linked to the ICF. Activity and participation had the most representation (61%). The Hip Disability and Osteoarthritis Outcome Score and Knee Injury and Osteo-arthritis Outcome Score had the widest coverage (bandwidth) for body functions (1.62%, 1.22%, respectively). The Arthritis Impact Measurement Scales had the broadest bandwidth (8.4%) for activity and participation. All tools addressed general mobility but lacked coverage in "driving", "assisting others", "interpersonal relationships" and "community life". The majority of tools did not address environmental factors. CONCLUSION: Patient-reported outcome measures in arthroplasty rehabilitation do not fully address relevant areas of activity, participation and environment, suggesting limited clinical applicability.