Validated Outcomes Measures

Many "Instruments" or Questionnaires, have been developed and utilized
over the last 30 years. One of the first Outcomes Measures which has had
widespread use as a General Health Measure to date, is the SF36. This
was created by the Rand Corporation many years ago, in order to follow the
General Health Status of populations. It is not highly specific nor
highly selective in demonstrating particular disease conditions, because it
was developed to evaluate general health status. It has, however, been
widely utilized because of its reproducibility and statistically scrutinized
method of development.
Many specific
tools have been developed since then, in an effort to demonstrate the
effectiveness of interventions for more specific disease conditions. In
Orthopaedics, these include the IKDC, the Tegner, and the Lysholm knee
scales as examples. Some of these have been found to be very helpful
in measuring specific functional improvements. This is important in determining the effect of
disease specific treatment.
Unfortunately, several measures have also been used extensively over the
years which have actually been found later to correlate poorly with functional
improvement. These measures were often developed more by intuition
than by valid statistical means, but have been incorporated in the body of
medical literature through use.
The collection of Validated Outcomes Measures is one necessary
prerequisite to improving medical care. This along with Patient
Demographics, and Physician treatment data create a complete Outcomes
Database.
In addition, it should be stressed that because of the many "instruments"
available, it is common for physicians to connect several "instruments" into
one, by sharing similar questions, and report on multiple scores.
Unfortunately, this is not a valid means to collect data. Each
Questionnaire must be completed individually from start to finish.
Combined Questionnaires could
be proven valid if statistic validation were performed utilizing the
combined measure on a large test population. Hopefully, with improved
data collection efforts, the specificity and sensitivity of the instruments
themselves will be improved. In addition, utilizing "criteria" based
questionnaires, the same or more information may be garnered utilizing fewer questions. |