Outcome evaluation in patients with elbow pathology: issues in instrument development and evaluation

Measurement of outcome after treatment of elbow pathology has tended to rely on nonstandardized scales and isolated impairment measures, particularly range of motion. This study evaluated the reliability and validity of patient questionnaires with patients with elbow pathology. Patients with a variety of complaints affecting the elbow (n = 70) completed four questionnaires-the American Shoulder and Elbow Surgeons Elbow Form; the Patient-rated Elbow Evaluation; the Disabilities of Arm, Shoulder and Hand questionnaire; and Short Form 36--during clinic attendance and returned repeat questionnaires by mail (n = 50). The test-retest reliability was determined to be acceptable for all four instruments (16 of 19 ICCs for subscales > 0.78; all ICCs for total score s > 0.90). Four constructs on the relationship expected between outcome measures, determined prior to data collection, were observed as anticipated, supporting the validity of outcome questionnaires. This study supports the use of these instruments to evaluate outcome in patients with elbow pathology.