Are Clinical Practice Guidelines Representative of Patients with Distal Radius Fractures? A Review of Patient Demographics and Patient-Reported Outcome Measures Used to Inform Guidelines

Ashley Mulakaluri; Kaitlyn R Julian; Alicia Fernandez; Robin N Kamal; Lauren M Shapiro

doi:10.1016/j.jhsa.2024.03.015

Are Clinical Practice Guidelines Representative of Patients with Distal Radius Fractures? A Review of Patient Demographics and Patient-Reported Outcome Measures Used to Inform Guidelines

J Hand Surg Am. 2024 May 10:S0363-5023(24)00148-5. doi: 10.1016/j.jhsa.2024.03.015. Online ahead of print.

Authors

Ashley Mulakaluri¹, Kaitlyn R Julian¹, Alicia Fernandez², Robin N Kamal³, Lauren M Shapiro⁴

Affiliations

¹ Department of Orthopaedic Surgery, University of California, San Francisco, CA.
² Department of Medicine, University of California, San Francisco, CA.
³ VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, CA.
⁴ Department of Orthopaedic Surgery, University of California, San Francisco, CA. Electronic address: Lauren.shapiro@ucsf.edu.

PMID: 38739072
DOI: 10.1016/j.jhsa.2024.03.015

Abstract

Purpose: Clinical practice guidelines (CPGs) are recommendations developed for broad application to optimize high-quality care and decision-making. The composition of patients and outcome measures used in studies informing CPGs; however, has not been rigorously evaluated. With growing evidence that outcomes in musculoskeletal surgery vary by sociocultural factors, we aimed to: (1) review the linguistic, racial, and ethnic representation of the patients in the studies informing CPGs for distal radius fractures and (2) assess their use of linguistically and culturally adapted patient-reported outcome measures (PROMs).

Methods: The American Academy of Orthopaedic Surgeons website was used to identify relevant studies. Key variables were extracted, including inclusion and exclusion criteria, language of study, patient language and proficiency, patient race and ethnicity, and use of translated or culturally adapted PROMs. If provided, the clinical trial registration page for the study was evaluated. Descriptive statistics were used to describe the frequency of each variable.

Results: Fifty-four published texts were evaluated. Participant language was reported in four (7%) of the published texts and six (11%) when including the clinical trial registration information. Of the published texts, one (2%) reported ethnic group/race data and 40 (74%) used PROMs. Of those using PROMs, eight (20%) of 40 reported the use of translated PROMs, and three (8%) of 40 reported the use of culturally adapted PROMs.

Conclusions: There is a lack of reporting of linguistic, racial, and ethnic data and inconsistent use of PROMs, particularly those that are translated and culturally adapted, in studies included in the American Academy of Orthopaedic Surgeons CPG for distal radius fractures. As sociocultural characteristics and PROMs are associated with outcomes, ensuring they are broadly represented in studies, may improve equity and shared decision-making.

Clinical relevance: Greater inclusion and reporting of demographic data and PROMs are required in musculoskeletal studies to ensure broad applicability and advance health equity.

Keywords: Clinical practice guidelines; distal radius fractures; patient-reported outcome measures; randomized controlled trials; upper extremity.