Measures of health-related quality of life and physical function

Outcome measures may be seen as windows, each of which provides a different perspective on a single view, the impact of a disease or disorder on the patient concerned. A comparison of the orthopaedic literature in 1991 with that in 2001 suggests that the intervening decade saw an increasing interest in the use of patient-based measures in clinical outcome studies, particularly randomized controlled trials. The tool most commonly used to determine the patient's point of view was the generic Short Form-36 (SF-36). Other measures included regional assessments such as the Musculoskeletal Functional Assessment, or the Disability of the Arm, Shoulder and Hand. The Western Ontario McMaster Osteoarthritis Index (WOMAC) (hip and knee), the Simple Shoulder Test (shoulder) and the Roland-Morris Questionnaire or Oswestry Disability Index (low back) were the most common joint-specific measures. Each of the questionnaires reported was supported by evidence of reliability and validity, and in most cases one or more studies had shown responsiveness in at least musculoskeletal disorders. We provide a brief description of the most common tools, and review the evidence that orthopaedic research is making increased use of measures of health status and function.