A systematic review of the content and quality of wrist outcome instruments

Objective. To assess the content and quality of published wrist outcome ins truments using standardized criteria. Design. An analytical study that examined 32 wrist outcome instruments sour ced from textbooks, Medline (1951 to present) and Current Contents. Main measures. The content of each instrument was classified into four cate gories: traditional measures (such as range of movement and strength), meas ures of the ability to perform daily activities, compensatory mechanisms us ed, and 'other'. Analysis included the frequency of assessment per category and the method of assessment. In addition, each instrument was graded usin g 13 quality criteria. Three criteria (scientific justification of the cont ent and scoring system used, demographic utility) were considered to be ess ential. Results. Eighty-two per cent of instruments reviewed for this paper contain ed traditional measures, of which most were assessed objectively. The abili ty to perform specific daily activities was assessed in 31% of the instrume nts whereas compensatory mechanisms were evaluated in only one instrument. These variables were not assessed in a consistent manner. Using the quality scoring system derived for this study, the quality of the instruments was generally poor. Only one instrument fulfilled all of the essential criteria . Only four instruments completely satisfied more than 50% of the criteria. Conclusions. Most wrist outcome instruments neglected to assess the impact of the disorder on the individual. Outcome was generally not expressed in f unctional terms or in terms that were relevant to each individual. The majo rity of the reviewed articles had poor quality. Thus use of these instrumen ts may preclude sensitive evaluation of the efficacy of any intervention.