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 Table of Contents  
Year : 2017  |  Volume : 3  |  Issue : 1  |  Page : 30

Patient reported outcome measures for lower limb deformities: Let's do it

Department of Orthopedics, Division of Pediatric Orthopedics, Rutgers-New Jersey Medical School, Newark, NJ 07103, USA

Date of Web Publication15-Mar-2017

Correspondence Address:
Sanjeev Sabharwal
Department of Orthopedics, Division of Pediatric Orthopedics, Rutgers-New Jersey Medical School, 90 Bergen Street, DOC 7300, Newark, NJ 07103
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jllr.jllr_2_17

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How to cite this article:
Sabharwal S. Patient reported outcome measures for lower limb deformities: Let's do it. J Limb Lengthen Reconstr 2017;3:30

How to cite this URL:
Sabharwal S. Patient reported outcome measures for lower limb deformities: Let's do it. J Limb Lengthen Reconstr [serial online] 2017 [cited 2020 Sep 19];3:30. Available from: http://www.jlimblengthrecon.org/text.asp?2017/3/1/30/202209

Despite being a relatively young member of the orthopedic community, the field of limb lengthening and deformity correction continues to grow at a rapid pace. Deformity surgeons pride themselves in having a comprehensive approach to limb reconstruction, including management of leg length discrepancy and angular deformities related to various etiologies, affecting both children and adults. Thanks to advances in preoperative deformity analysis, we have come a long way from routinely performing a high tibial osteotomy for genu varum and a distal femoral osteotomy for those with genu valgum. Even with substantial progress in surgical techniques and implants, we remain entrenched in reporting the results of our corrective procedures based on radiographic parameters alone.

It is well-known that functional gains (or losses) do not always correlate with radiographic appearance. We, the international community of deformity surgeons, should come up with a quantifiable, reliable, and valid means of assessing clinical outcomes following limb lengthening and realignment. Our colleagues at the Scoliosis Research Society have successfully established the Scoliosis Research Society (SRS) score,[1] a robust patient reported outcome measure (PROM) pertaining to individuals with spinal deformities. Having been used extensively for nearly two decades, the SRS score is now well-entrenched in the scientific literature.

Four years back, McCarthy introduced the LLRS-AIM classification [2] to help quantify the severity of limb deformity in a patient. Developing a PROM focusing on the effect of limb deformity and its correction on an individual's quality of life is the next logical step as our field matures further. At the 2015 ILLRS Congress in Miami, Florida, we organized a symposium on PROM pertaining to lower limb deformity. I am delighted to see that two of the speakers have published their work in the Journal of Limb Lengthening and Reconstruction. Recently, Fabricant [3] introduced the Limb Deformity-SRS score for adults with lower limb deformities. In the current issue of JLLR, Chhina [4] report their findings based on a systematic review of PROMs related to the assessment of quality of life measures in children with lower limb deformities. In their preliminary report, the authors highlight the lack of consensus and extreme heterogeneity among the existing outcome measures. Hopefully, these investigators and others will continue to evaluate PROMs, perform robust field-testing, and come up with a golden nugget that is clinically relevant, reliable, and universally accepted. Engineering such a PROM will be a highly iterative process that requires an ample dose of time, effort, and teamwork.

What gets measured gets managed. It is my hope that members of our global surgical community will continue to build on this theme. The tools for making a robust PROM include literature review, consensus building, and field-testing.[5] Let us keep advancing the science and clinical care of patients with limb length discrepancy and deformities worldwide. A PROM related to our field is certainly a step in the right direction.

  References Top

Haher TR, Gorup JM, Shin TM, Homel P, Merola AA, Grogan DP, et al. Results of the Scoliosis Research Society instrument for evaluation of surgical outcome in adolescent idiopathic scoliosis. A multicenter study of 244 patients. Spine (Phila Pa 1976) 1999;24:1435-40.  Back to cited text no. 1
McCarthy JJ, Iobst CA, Rozbruch SR, Sabharwal S, Eismann EA. Limb Lengthening and Reconstruction Society AIM index reliably assesses lower limb deformity. Clin Orthop Relat Res 2013;471:621-7.  Back to cited text no. 2
Fabricant PD, Borst EW, Green SA, Marx RG, Fragomen AT, Rozbruch SR. Validation of a modified Scoliosis Research Society instrument for patients with limb deformity: The limb deformity-Scoliosis Research Society (LD-SRS) score. J Limb Lengthen Reconstr 2016;2:86-93.  Back to cited text no. 3
  [Full text]  
Chhina H, Klassen A, Kopec J, Park S, Fortes C, Cooper A. Quality of life of children with lower limb deformities: A systematic review of patient-reported outcomes and development of a preliminary conceptual framework. J Limb Length Recon 2017;3:19-29.  Back to cited text no. 4
Johanson NA, Liang MH, Daltroy L, Rudicel S, Richmond J. American Academy of Orthopaedic Surgeons lower limb outcomes assessment instruments. Reliability, validity, and sensitivity to change. J Bone Joint Surg Am 2004;86-A: 902-9.  Back to cited text no. 5


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