Assessing outcome measures used after rib fracture: A COSMIN systematic review. Issue 11 (November 2019)

• Record Type: Journal Article
• Authors: Craxford, Simon; Deacon, Christopher; Myint, Yulanda; Ollivere, Benjamin
• Is Part Of: Injury. Volume 50:Issue 11(2019)
• Page Start: 1816
• Page End: 1825
• Publication Date: 2019-11
• Subjects: Rib fracture -- Chest injury -- Outcome measures -- COSMIN -- Patient reported outcome measures -- PROM; Wounds and injuries -- Surgery -- Periodicals; Accidents -- Periodicals; Wounds and Injuries -- surgery -- Periodicals; Lésions et blessures -- Chirurgie -- Périodiques; Electronic journals; Electronic journals; 617.1
• DOI: 10.1016/j.injury.2019.07.002
• Languages: English
• ISSNs: 0020-1383

Abstract

Highlights: This is the first systematic review of outcome measures in rib fracture research and the first to apply the COSMIN checklist. The SF-36 is the most widely used patient reported outcome measure however only very poor quality evidence to support its use exists. There is poor quality evidence that the EQ-5D-5L, the MRC, BPI and the MPQ have adequate content validity. In the absence of high quality evidence, we recommend that the EQ-5D-5 L is used in combination with the MRC and BPI Abstract: Purpose: The incidence of invasive treatment of rib fracture has increased significantly over the last decade however the evidence of improved patient outcomes to support this is lacking. A systematic review was performed to identify patient reported outcome measures (PROMs) used in the assessment of outcomes following chest wall injury. The quality of evidence for the psychometric properties of the identified PROMs was graded using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology. Methods: Rib fracture studies measuring patient reported outcomes were identified using PubMed/Medline, EMBASE, AMED and PsycINFO. Methodological quality of measurement properties was evaluated with the COnsensus-based Standards for selection of health status Measurement INstruments (COSMIN) checklist. Results: A total of 64 studies were identified including 19 different PROM instruments. Domains included in the reported PROMs included pain, breathlessness, general health quality of life, physical function and physiological health. No rib fracture specific PROM was identified. The most frequently reported instrument was the SF-36 reporting overall quality of life (HRQoL) although there was very low quality evidence for its content validity. There was low quality evidence to support good content validity for the Medical Research Council (MRC) dyspnoea scale, Brief Pain Index (BPI) and McGill Pain Questionnaire (MPQ). No PROM had undergone validation in a rib fracture population. The overall quality of the PROM development studies was poor. While we were unable to identify a clear "gold standard", based on the limited current evidence, we recommend that the EQ-5D-5L is used in combination with the MRC and BPI or MPQ for future rib fracture studies. Conclusion: The lack of validated outcome measures for rib fracture patients is a significant limitation of the current literature. Further studies are needed to provide validated outcome measures to ensure accuracy of the reported results and conclusions. As interventions for rib fractures have become more common in both research and clinical practice this has become an urgent priority.