Analysis of clinical grading scales for the foot and ankle

To evaluate grading methods used to report clinical results, we reviewed 1,607 articles related to the foot and ankle published in six orthopaedic journals from 1980 through July 1993. Many clinical studies use criteria such as patient satisfaction to grade results. A numeric score or grade was used in 346 articles: 238 used a grade only, 90 used a numeric score and grade, and 18 used a numeric score only. The numeric score or grade was usually, but not always, reported with details of the individual clinical factors that composed the score or grade. Twenty-three articles used a score before and after treatment. Statistics were used in 62 articles, and in 6 of those the statistics were used to compare clinical condition before and after treatment. This study demonstrated the array of grading methods used in selected orthopaedic journals and indicated the need for standardized grading techniques to allow for more meaningful interpretation of the orthopaedic literature.