Measurement of Upper Extremity–Specific Comfort and Capability

Abstract

Patient-reported outcome measures (PROMs) quantify symptom intensity and magnitude of capability. Upper extremity PROMs were developed shortly after the advent of general health PROMs. PROMs are still primarily research tools, and their use with individual patients is still evolving. When PROMs were developed, the initial and intuitive expectation was a strong correlation of comfort and capability with pathophysiology severity. In other words, people with greater radiographic arthritis or larger degenerative tendon defects were expected to feel worse and do less. After more than 20 years of research using PROMs, it is clear that mindset and circumstances account for more of the variation in PROMs than pathophysiology severity. Mounting research establishes upper extremity PROMs and PROMs in general as useful tools for anchoring and developing comprehensive, biopsychosocial approaches to care.T he results of musculoskeletal treatment were often reported as radiographic features (union, alignment, arthritis), physical examination (motion, stability), and physician rating of patient ability to complete tasks. Since the 1990's, the emphasis is now on measuring health from the perspective of the patient rather than the specialist, particularly for qualityof-life conditions, for which tests and treatments are discretionary. Instruments were developed to measure and quantify comfort and capability. These were initially referred to as health status or quality-of-life measures. 1 We now refer to them as patient-reported outcome measures (PROMs). Upper extremity-specific PROMs were developed shortly after the advent of general health PROMs. Measures of mental and social health may also be referred to as PROMs, but we prefer to think of them as mental and social health measures. Measures of the comfort and experience of health care are increasingly referred to as patient-reported experience measures.The ability to quantify illness (the state of being unwell) has allowed us to measure the degree to which illness corresponds with pathophysiology (for instance, diminished motion or sensibility, loss of motor strength, arthritis, or malalignment) in the upper extremity. PROMs also allow us to compare the Chizitam F. Ibezim, MD