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

Objective. To assess the content and quality of published wrist outcome instruments using standardized criteria. Design. An analytical study that examined 32 wrist outcome instruments sourced from textbooks, Medline (1951 to present) and Current Contents. Main measures. The content of each instrument was classified into four categories: traditional measures (such as range of movement and strength), measures of the ability to perform daily activities, compensatory mechanisms used, and 'other'. Analysis included the frequency of assessment per category and the method of assessment. In addition, each instrument was graded using 13 quality criteria. Three criteria (scientific justification of the content and scoring system used, demographic utility) were considered to be essential. Results. Eighty-two per cent of instruments reviewed for this paper contained traditional measures, of which most were assessed objectively. The ability to perform specific daily activities was assessed in 31% of the instruments 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 functional terms or in terms that were relevant to each individual. The majority of the reviewed articles had poor quality. Thus use of these instruments may preclude sensitive evaluation of the efficacy of any intervention.