DEVELOPMENT OF AN EXTREMITY TRAUMA OUTCOME SCALE

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Musculoskeletal injury is the leading cause of disability and loss of work time in the most productive years of life. Modern orthopaedic surgical and nonsurgical management techniques are widely believed to favorably influence the length and depth of disability following injury. There is, however, little consensus in the specific types of treatment for extremity injuries even where agreement exists for operative management. These variation are regional and are due to the lack of controlled clinical research. Clinical research has not been focussed on functional outcome following injury. Is due to the lack of an available functional outcome instrument for extremity injury. Such an instrument should include an assessment of the psychosocial impact of the injury. This instrument would have broad application in defining the natural history of individual injuries, comparing treatment methods and defining outcomes based on differences in practitioner experience and in treatment delivery settings. An outcome scale will be developed in three phrases. The first phase is concerned with development of the item pool. Item pool development will begin with focus groups designed to elicit information that can be used as cues in a semi-structured interview to be administered to patients recovering from extremity trauma. Respondents will be selected from the Harborview Medical Center Orthopaedic Trauma Database (HMC-OTD) which currently includes over 1500 patients. A stratified sample of approximately 300 patients will be obtained to ensure coverage of all types, location, and stages of recovery from extremity trauma. Additional items will be obtained from the literature and from clinicians representing four professional groups (orthopaedic trauma surgeons, orthopaedic surgeons, psychiatrists, and physical therapists). Criteria will be developed and items will be converted to behavioral statements that describe unique, specific dysfunctions resulting from extremity trauma in several domains of functioning (e.g., physical, mental, role). These statements will be incorporated into an extremity trauma scale (ETS) that will be administered to a second independent sample of 300 patients selected from the HMC-OTD using the same stratification criteria. In addition to the functional status items, objective measures of walking and range of motion will be incorporated into the scale. The purpose of this phase of the study is to provide data for item analysis, scaling, scoring, preliminary reliability and validity. The ETS will be revised based on data obtained in this phase of the study. The third phase is a prospective study in which 305 patients with upper and 305 with lower trauma will be followed for one year post injury. The purpose of this phase of the study is to provide data for assessment of: feasibility, further assessment of reliability; final item selection; discriminant and convergent validity (discrimination between types and locations of fractures that are known to differ with respect to function; trauma versus non-trauma patients; types of respondents, i.e., patients and orthopaedic trauma surgeons; and stage of recovery) and redundancy with other frequently used measures of functional status.