The Stanmore Limb Reconstruction Score : validation of a novel patient-reported outcome measure

The Stanmore Limb Reconstruction Score (SLRS) has been developed to capture the unique perspective of patients undergoing deformity correction. In this multiphase mixed method approach, face validity has previously been established. This study presents the next stage of validation and illustrates the evolution of this novel patient-reported outcome measure (PROM).

All patients aged ≥ 18 years, undergoing deformity correction, who met the inclusion criteria were recruited, between March 2021 and January 2025. Data were collected at significant timepoints over the patients' treatment journey. In accordance with the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidance, construct validity, reliability, and responsiveness of the SLRS was investigated.

A total of 62 patients were included in the analysis. Diverse demographic background, with heterogenous pathologies and varied surgical interventions, made this a representative population of limb reconstruction patients. Convergent validity was established with statistically significant correlations between American Academy of Orthopaedic Surgeons (AAOS)-lower-limb (r = 0.77, p < 0.001) and 36-Item Short-Form Health Survey (SF-36) questionnaire scales (pain and function, p < 0.001). Notably there was sufficient variability, ensuring this new tool is not entirely identical in scope. Divergent validity was confirmed, with no correlations between SLRS and sex, anatomical location, laterality, deformity, and implant. The scale was demonstrated to be reliable (intraclass correlation coefficient (ICC) > 0.9 for pain, and combined ICC 0.78), indicated high internal consistency (Cronbach α score 0.89) and negligible floor-ceiling effects were noted. Responsiveness was established, confirming the instrument's sensitivity to accurately reflect clinically meaningful change in all domains, consistent with expected outcomes following deformity correction surgery (p < 0.001).

This study provides evidence of construct validity, reliability, and responsiveness for the SLRS. Field-test, through collaborative work, is necessary for further validation. This has the potential to deliver a unified outcome assessment tool in adult limb reconstruction surgery, to inform evidence-based clinical care.