Abstract
Background: Patient reported outcomes (PROs) are important for the assessment of the effectiveness of surgical interventions. If patient reported outcome measures (PROMs) are used to prioritise resources then it is important to ensure that the instruments are scientifically valid. This review aims to assess whether the currently available PROMs in hand surgery adhere to international development guidelines and whether they incorporate the use of item response theory (IRT) or Rasch Analysis (RA).
 Methods: A systematic review was performed to identify all PROMs that are relevant to the field of hand surgery. An a priori protocol with strict inclusion and exclusion criteria was followed. Only instruments developed in the English language were included. A comprehensive search of nine databases was undertaken. The development methodology of the identified instruments was then analysed, followed by examination of the domain content and initial psychometric validation of each instrument.
 Results: A total of 3,039 article citations were retrieved, 139 citations went on to a full text review. A total of 24 patient reported outcome instruments were identified. This consisted of 10 regional upper limb, six hand and/or wrist specific and a further eight condition specific instruments. Documentation of the details of PROM development was lacking for many instruments.
 Conclusion: The field of hand surgery has many instruments available but few fulfil international development guidelines or use IRT or RA psychometric techniques. There are limitations in either the breadth of the domains explored or the developmental methodology used in all currently available instruments.
Highlights
Patient reported outcomes (PROs) are important for the assessment of the effectiveness of surgical interventions
Papers that had been published in peer-reviewed literature and that discussed the development or psychometric analysis of patient reported outcome measures (PROMs) used in hand conditions were included
This review has systematically examined seminal papers on all identified PROMs with a focus on instrument development
Summary
Patient reported outcomes (PROs) are important for the assessment of the effectiveness of surgical interventions. In the current health landscape it is important to collect meaningful information on the outcome of interventions performed in order to justify their value.[1,2] Increasingly, outcome measurement is broadening to include patient reported metrics that gauge satisfaction and health-related quality of life.[3] In hand surgery, traditional indicators such as mortality or rate of postoperative complications are not sensitive enough to distinguish variations.[4] Clinical measurements such as range of motion or grip strength do not take into account the patient’s perspective Constructs such as pain, or a patient’s perception of their ability, cannot be directly measured and this is where self-reported outcomes are useful.[5] Patient reported outcomes (PROs) have become an important contributor to the overall picture of appraising outcomes at both the individual and health service level. It is important that scientifically rigorous PROMs are used when evaluating the impact of an injury or disease and the associated treatment.[6]
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