Introduction: The Patient Rated elbow evaluation (PREE) and the self-report section of the American Shoulder and Elbow Surgeons society – Elbow form (ASES-e) are the two commonly used elbow pain and disability self-report measures (PROs).The content of these questions have never been analysed in light of the International Classification of Functioning Disability and Health (ICF) which is the current standard to describe health and health related states.
Purpose: The purposes of this study were to analyse the conceptual basis of the PREE and the ASES-e by linking the meaningful concepts in these PROs to the ICF using standardized linking rules and to determine the extent to which the ICF core set for hand conditions cover the content of elbow questionnaires using summary ICF linkage indicators.
Methods: Two raters linked the two PROs to the ICF using the linking rules proposed by Cieza and colleagues. Percentage agreement was calculated between the raters. Summary linkage indicators proposed by MacDermid were used to estimate the extent to which the ICF core set for hand conditions cover the content of the elbow questionnaires.
Results: All the items of the PREE (Measure to ICF linkage-100%) and all but one item of the pASES-e (Measure to ICF linkage-95%) were linked to the ICF. The satisfaction item on the ASES-e was not-covered by the ICF. Percentage agreement on linking between the raters was 96% and 95% for the PREE and the pASES-e respectively. The unique linkage of the PREE and the pASES-e to the unique codes on the brief and comprehensive core set lower than absolute
A version of this work has been submitted for journal publication: Vincent, JI, MacDermid, JC, King GJW, Grewal, R. Linking of the Patient Rated Elbow Evaluation (PREE) and the American Shoulder and Elbow Surgeons – Elbow questionnaire (pASES-e) to the International Classification of Functioning Disability and Health (ICF) and Hand Core Sets. Journal of Hand Therapy (2014)
linkage to the core set for hand conditions. The PROs represented less than 20% of the
comprehensive core set and more than 70% of the brief core set. While for the unique core set disability representation the 2 measures represented 100% brief core set unique disability codes and less than 35% of the comprehensive core set unique disability codes.
Conclusion: The PREE and the ASES-e are aligned with the ICF framework and the core sets for hand conditions. The ICF Core Set devised for hand conditions may also be useful for elbow conditions..
Level of evidence: 1b
Keywords: ICF, PREE, pASES-e, Content analysis, ICF core set for hand conditions, ICF linking, Linkage indicators
INTRODUCTION
Patient centered outcome research and patient reported outcomes (PRO) have become an integral component in the field of health care. These measures should undergo rigorous validation before they are accepted into clinical practice. The Patient Rated elbow evaluation (PREE)1 and the self-report section of the American Shoulder and Elbow Surgeons society – Elbow form (pASES-e)2 are currently among the most commonly used elbow self-report pain and disability measures used in clinical practice and research. While multiple studies1,3-5 support the
psychometric properties of these toolsthere has been less attention to content validity.
Content analysis is a research technique for making replicable and valid inferences from texts to the contexts of their use.6 Content validity of questionnaires is sometimes assessed by expert review, but is often not structured and sparsely reported. Formal analysis of the content of items of PRO should be a fundamental step in defining the conceptual domain of measures. However content validity is often sparsely addressed in the literature, with informal review by experts being common.7,8
The International Classification of Functioning Disability and Health (ICF) is a framework for classifying health and health-related states.9 The ICF enables the transfer and interpretation of data across borders and disciplines by providing a common language and a hierarchical coding system to describe health and disability. Since PROs are often designed to measure disability, coding the content of items using the ICF can provide a structured evaluation of content. It is recommended that meaningful concepts in the questionnaires should be linked to the ICF codes using established linking guidelines to provide a structured analysis of the content of PRO.10-12
The PREE and the ASES-e were developed using a process where items were generated from pre-existing questionnaires and/or patient interviews. As such, the ICF conceptual framework was not taken into consideration while developing these PROs. Both these PROs have been recommended as key measures for assessing outcomes in elbow disorders.13,14 Cross-cultural validation often evaluates whether questionnaire items can be developed to provide equivalent estimates of disability in a different language or cultural context. For example, the PREE has been translated into German and Japanese, while the pASES-e has been translated into
German. Linking PROs to the ICF can assist with cross-cultural validation or assessment of equivalence across translated measures.
The core set for hand conditions18 was developed by the ICF Research Branch in
collaboration with other organisations to help clinicians who are specialised in conditions of the ‘hand’. In this context, ‘hand’ conditions refer to problems located directly at the hand such as, carpal tunnel syndrome, osteoarthritis of the hand or finger joints, amputation of fingers,
Dupuytren’s, hand injuries etc. As well, ‘hand’ conditions could also refer to conditions which originate at a different part of the body but affect the hand such as stroke, Parkinson’s disease and multiple sclerosis.18 Functionally, the shoulder provides a stable base and the elbow allows placement of the hand in the space for it to function. Hence, clinicians often consider the
function of the upper extremity as a unit. Currently there is no specific ICF core set to help with assessment of upper extremity conditions, although it might be considered that those established for the hand would be relevant to the entire upper extremity.
PURPOSE
The purpose of this study was to analyse the conceptual basis of the PREE and the ASES-e by linking the meaningful concepts in these PRO’s to the ICF following standardized linking rules and also to assess the extent to which the ICF core set for hand conditions cover the content of elbow questionnaires by obtaining the ICF linkage indicators.
METHODS