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A systematic review and standardized comparison of available evidence for outcome measures used to evaluate proximal humerus fracture patients

Nowak, Lauren, MSc1,2; Davis, Aileen M., PhD1,2,3,4; Mamdani, Muhammad, MPH, PharmD5; Beaton, Dorcas, PhD3,4,6; Kennedy, Carol, MSc7; Schemitsch, Emil, MD, FRCS(C)1,8

doi: 10.1097/BOT.0000000000001462
Review Article: PDF Only

Objectives: To summarize and appraise any patient-reported or clinician-measured outcome measures based on their measurement properties in proximal humerus fracture patients.

Data Sources and Study Selection: MEDLINE, EMBASE, and CINAHL were searched from January 2000 to August 2018 to identify all studies of proximal humerus fracture patients that reported a measurement property evaluation of an outcome measure.

Data Extraction and Synthesis : Quality appraisal of each measure was completed using the Evaluating the Measurement of Patient-Reported Outcomes (EMPRO) tool. The EMPRO takes into account all studies of each measure, and the overall score is transformed linearly to a range of 0 (lowest) to 100 (best).

Results: Eleven instruments were identified. Intended concepts of the instruments included clinician-measured shoulder function, patient-reported function or disability, and patient-reported general health state. Only the Disabilities of the Arm, Shoulder and Hand (DASH), Oxford Shoulder Score (OSS), Constant Score (CS), University of California, Los Angeles Shoulder Score (UCLA) and Euro-Qol 5 Dimension (EQ5D) were evaluated in more than one study. The Shoulder Function Index (SFINX), DASH, and EQ5D had the highest EMPRO scores (80, 66, and 58 respectively). The SFINX and DASH consistently scored among the top three instruments for each attribute.

Conclusions: Evidence on the measurement properties of outcome measures for proximal humerus fracture patients is limited. With the available evidence, the SFINX is recommended as a clinician-measured functional outcome measure, the DASH as a patient-reported functional outcome measure, and the EQ5D as a general health status measure.

1Institute of Medical Science, University of Toronto, Toronto, Ontario;

2Health Care and Outcomes Research, Krembil Research Institute, University Health Network, Toronto, Ontario;

3Institute of Health Policy, Management and Evaluation, University of Toronto

4Dalla Lana School of Public Health, University of Toronto

5Li Ka Shing Centre for Healthcare Analytics Research and Training, St. Michael’s Hospital, Toronto, Ontario;

6Musculoskeletal Health & Outcomes Research, Institute for Work Health, Toronto, Ontario

7Quality Standards, Health Quality Ontario;

8Division of Orthopaedic Surgery, London Health Sciences Centre, London, Ontario

Correspondence: Lauren Nowak, MSc 55 Queen Street East, Suite 800 Toronto, Ontario M5C 1R6 Tel: 416-779-5007 Fax: 416-359-1601 Email:

The authors report no conflicts of interest related to this work.

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