Abstract
Objective In orthopaedics and trauma surgery scores are frequently used to assess treatment
outcomes. The purpose of the review is to create an overview analysing the content
of validity studies of frequently utilized scores for upper and lower extremity.
Methods Commonly used outcome measures to assess clinical outcome of upper (n = 19) and lower
(n = 22) extremity were included. For each of the scores a comprehensive search in
several databases (Medline, PubMed, google scholar) were performed to identify validation
studies. The COSMIN-Checklist (COSMIN: Consensus-based Standards for the selection
of health Measurement Instruments) introduced by Mokkink et al. were used to analyse
systematically the methodological quality of the validation studies.
Results Validity, objectivity and reliability were not routinely considered and addressed
in validation studies. The score related validation studies did not include all defined
criteria of the COSMIN-Checklist. Six scores of the upper extremity and four scores
of the lower extremity are not adequately validated. The best validated scores of
the upper extremity is Oxford Shoulder Score (OSS) and for the lower extremity Hip
Disabilities and Osteoarthritis Outcome Score (HOOS) as well as Western Ontario and
McMaster Universities Score (WOMAC).
Conclusion There is no gold standard for the content-comprehension of validation studies due
to the structure of the original study. The more criteria were tested the more informative
and significant the outcome measure is. However some scores, such as Neer and Castaing
Score, that lack validation are still being successfully used in research and clinical
practice. The present review provides an overview of frequently used score in orthopaedics
and trauma surgery and their grade of validity.
Key words
score - validity - reliability - interpretability - COSMIN-checklist
