Percent of Normal: A Pragmatic Patient-Reported Outcome Measure for the Orthopaedic Trauma Clinic

Abstract

Objectives: To compare a single numerical patient-reported outcome measure (PROM) to general health and injury-specific PROMs.

Design: Retrospective cohort.

Setting: Urban Level 1 trauma center.

Patients/participants: The study included 175 patients with 34 humerus, 54 pelvis, 31 acetabular, and 56 ankle fractures.

Main outcome measurements: Patients were administered 3 PROMs: the 12-item short-form (SF-12), an injury-specific PROM (QuickDASH-humerus; Majeed Pelvic Outcome Score (Majeed)-pelvis; modified Merle d'Aubigne score (Merle)-acetabular; Foot and Ankle Disability Index (FADI)-ankle, and the Percent of Normal (PON) PROM, a single numerical PROM, which asked, "How would you rate yourself, if 100% is back to normal?" Floor/ceiling effect, convergent validity, and responsiveness of PROMs were assessed.

Results: None of the PROMs demonstrated a floor effect. The Merle was the only PROM with a ceiling effect (19%). The PON had a strong correlation with the QuickDASH (r = 0.78) and Majeed (r = 0.78); a moderate association with the SF-12 physical component score (r = 0.63), Merle (r = 0.67), and FADI (r = 0.55); and a weak association with the SF-12 mental component score (r = 0.22). The regression coefficient for change in PROM over time, a measure of responsiveness, was greater for the PON compared with the SF-12 physical component score/mental component score, Majeed, Merle, and FADI, but not the QuickDASH.

Conclusions: The PON is a pragmatic PROM that can be easily administered in clinic by the physician to quickly assess and manage a variety of fractures, avoiding the disadvantages of nonrelative general or region-specific PROMs.