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Measuring what matters: a guide to selecting the optimal patient-reported outcome measure for pediatric shoulder and
Miguel Fiandeiro1, Holly Cordray1, John R Vaile2
1Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
Insights
The Pediatric/Adolescent Shoulder Survey (PASS) is the most suitable tool for assessing pediatric shoulder function. More research is needed for patient-reported elbow function measures.
Area of Science:
- Orthopedic surgery
- Pediatric healthcare
- Rehabilitation medicine
Background:
- Patient-reported outcome measures (PROMs) are frequently utilized beyond their validated scope in pediatric orthopedic care.
- This systematic review addresses the need for guidance on selecting appropriate PROMs for evaluating pediatric shoulder and elbow function.
Purpose of the Study:
- To systematically review and analyze the content, readability, and psychometric properties of existing PROMs for pediatric shoulder and elbow function.
- To provide evidence-based recommendations for clinicians and researchers.
Main Methods:
- A systematic literature search was conducted across PubMed, Embase, CINAHL, and Scopus.
- Studies evaluating psychometric properties of PROMs for pediatric shoulder/elbow function were included, following PRISMA guidelines.
- Data extraction, risk of bias assessment, and psychometric rating (COSMIN) were performed independently by two reviewers. Content analysis included the Occupational Therapy Practice Framework and readability indices.
Main Results:
- Ten reports on six PROMs were included after screening 2513 studies.
- The Pediatric/Adolescent Shoulder Survey (PASS) demonstrated strong validity, reliability, and responsiveness with comprehensive content and acceptable readability.
- The Functional Arm Scale for Throwers (FAST) and Kerlan-Jobe Orthopaedic Clinic (KJOC) Shoulder and Elbow Score are suitable for adolescent overhead athletes. Limited evidence exists for pediatric elbow function PROMs. PROMIS-UE and Pedi-ASES require further validation, and QuickDASH showed poor responsiveness and validity.
Conclusions:
- The PASS is the most appropriate clinical choice for pediatric shoulder function assessment.
- The FAST and KJOC offer advantages in adolescent sports medicine.
- Further development and validation are essential for pediatric elbow function PROMs, including the PROMIS-UE and Pedi-ASES.
Background:
Patient-reported outcome measures (PROMs) are often used beyond their scope of validation in orthopedic care of the pediatric shoulder and elbow. This systematic review analyzed content, readability, and psychometrics of existing PROMs to guide clinicians and researchers seeking to evaluate pediatric shoulder or elbow function.
Methods:
Databases included PubMed, Embase, CINAHL, and Scopus. Eligible studies evaluated psychometrics of PROMs validated for pediatric shoulder/elbow function. Following Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, 2 reviewers independently screened studies, extracted data, assessed risk of bias, and rated psychometrics using the COnsensus-based Standards for selection of health Measurement INstruments. Content was analyzed using the Occupational Therapy Practice Framework and well-established readability indices.
Results:
Reviewers screened 2,513 studies; 10 reports on 6 PROMs were included. The Pediatric/Adolescent Shoulder Survey (PASS) has strong evidence of validity, reliability, and responsiveness; comprehensive coverage of functional categories and occupational domains; and acceptable readability. The Functional Arm Scale for Throwers and Kerlan-Jobe Orthopaedic Clinic shoulder and elbow score have content tailored to assess joint function in sports and are valid options for evaluating shoulder function among adolescent overhead athletes. Limited evidence is available for PROMs validated for pediatric elbow function. The Patient-Reported Outcomes Measurement Information System Upper Extremity (PROMIS-UE) module has evidence of structural and construct validity in this population, but its content lacks nuanced assessment of the elbow joint and has a large ceiling effect. The Pediatric and Adolescent Shoulder and Elbow Survey (Pedi-ASES) has strong evidence of content validity but needs evidence of construct validity. Both lack strong evidence of reliability and responsiveness. Despite evidence of construct validity, the short version of the Disabilities of the Arm, Shoulder, and Hand Questionnaire showed poor responsiveness, structural validity, and measurement invariance. The PROMIS-UE, Pedi-ASES, and the PASS were the most readable measures, optimizing accessibility to children of younger ages.
Conclusion:
The PASS is overall the most appropriate clinical option for pediatric shoulder function, although the Functional Arm Scale for Throwers and Kerlan-Jobe Orthopaedic Clinic have some advantages in adolescent sports medicine. Further validation and development are warranted for patient-reported elbow function questionnaires, particularly the PROMIS-UE and Pedi-ASES.
