Choosing an outcome measure.

Most orthopaedic surgeons are being asked to evaluate the outcome of their practice with very little guidance as to how to accomplish this. Their approach may be simply to conduct short-term audit of perioperative complications regularly, or to implement some form of measuring instrument which can be given to all patients. They may wish to implement an outcome measure but are unable to obtain advice on which one to use. They may then apply a fashionable generic health-status measure such as the SF36. Such types of assessment may be suitable for comparisons between disciplines, but a measure specific to a condition will normally be more appropriate for audit. Such measures are hard to find because of the wide range of conditions faced by orthopaedic surgeons. For example, in addition to pain and function, much of orthopaedics is concerned with the correction of deformity, but there have been few attempts to define outcomes for such procedures. In trauma, it is difficult to assess the state of the patient before injury. In both elective surgery and trauma the outcome may take many years to be established. Most outcome instruments do not stand alone since a disorder must be classified in order to ensure that comparative results are for the same condition and severity. Thus, an instrument designed to measure disability due to low back pain in primary care may be more sensitive to a low level of disability than one used in a hospital setting.