Outcomes Evaluation in Orthopaedics

Abstract
Orthopaedic surgeons are increasingly expected to assess and record the outcome of their practice for reasons of research, audit and clinical governance. Having accepted that assessment is here to stay, how best should we go about it? An outcome measure is essentially an assessment of change which judges how the patient is now, as compared with a previous occasion, such as before surgery. While the health status after treatment may be seen as the outcome of interest, it will usually be the magnitude of change which effectively represents the effect of treatment. Thus in order that the information gathered is of optimal use it needs to be collected at two intervals in time at least. Health status can be assessed by a number of methods which in orthopaedics are classified as either objective or subjective. The former includes the measurement of radio- logical changes, and of strength and range of movement, which involve a clinician making a judgement about the patient. The subjective methods rely on obtaining responses directly from patients about their perceptions of health and illness. Questions relating to patient satisfaction are another consideration and do not necessarily accord with other outcome measures. These findings, when discordant, can often be explained by a failure to achieve the prior expecta- tions of the patient. 1

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