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C.Y. Le1,2, L.K. Truong3,4, C.J. Holt1,5, S.R. Filbay6,7, L. Dennett8, J.A. Johnson9, C.A. Emery10,11, J.L. Whittaker1,12,4,13
1University of Alberta, Faculty of Rehabilitation Medicine, Edmonton, Canada, 2University of Alberta, Glen Sather Sports Medicine Clinic, Edmonton, Canada, 3University of British Columbia, Department of Physical Therapy, Faculty of Medicine, Vancouver, Canada, 4Arthritis Research Centre of Canada, Richmond, Canada, 5Summerside Children’s and Sport Physiotherapy, Edmonton, Canada, 6University of Melbourne, Centre for Health Exercise and Sports Medicine, Department of Physiotherapy, Melbourne, Australia, 7University of Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, Oxford, United Kingdom, 8University of Alberta, John W. Scott Health Sciences Library, Edmonton, Canada, 9University of Alberta, School of Public Health, Edmonton, Canada, 10University of Calgary, Sport Injury Prevention Research Centre, Faculty of Kinesiology, Calgary, Canada, 11University of Calgary, Departments of Pediatrics and Community Health Sciences, Cumming School of Medicine, Calgary, Canada, 12University of British Columbia, Faculty of Medicine, Vancouver, Canada, 13University of Calgary, Sport Injury Prevention Research Centre, Calgary, Canada
Background: Health-related quality of life (HRQoL) represents an individual’s perception of their physical, psychological, and social well-being. Youth who suffer a sport-related injury can experience poor long-term HRQoL. The HRQoL of active youth is unique, with young athletes reporting higher HRQoL compared to non-athletes. Previous research has relied on a wide range of patient-reported outcome measures (PROMs) to assess the HRQoL of active youth but it is unclear if these PROMs possess robust measurement properties.
Purpose: This systematic review aims to identify the most suitable PROM(s) for measuring generic and condition-specific HRQoL of active youth, based on measurement properties, interpretability, and feasibility.
Methods: We followed the COnsensus‐based Standards for the selection of health Measurement INstruments (COSMIN) Manual for Systematic Reviews of PROMs (2018) and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Six electronic databases were searched. Records with original data that described the development and/or psychometric evaluation of a generic or condition-specific HRQoL PROM or PROM subscale in active youth (15-24 years old), with or without a musculoskeletal injury, were included. Two authors independently screened title/abstracts and full-texts. Adhering to the COSMIN Manual, we evaluated the methodological quality and results of individual studies that assessed a measurement property of an identified PROM. Measurement properties were then summarized by PROM and the quality of evidence for each property was graded. After describing interpretability and feasibility, all PROMs were categorized as ‘A’ (evidence of sufficient content validity and at least low quality evidence of sufficient internal consistency), ‘B’ (not ‘A’ or ‘C’), or ‘C’ (high quality evidence of any insufficient measurement property). Instruments categorized as ‘A’ were considered the most suitable.
Results: From 6931 potential records, 21 studies were included. Four generic and 14 condition-specific HRQoL PROMs were identified. The quality of evidence for measurement properties was highly variable and information regarding interpretability and feasibility was scarce. No PROMs demonstrated sufficient content validity and, subsequently, no PROMs were categorized as ‘A’ for final recommendation. However, the Quality of Life (QoL) survey, Disablement in the Physically Active scale-Mental Summary Component short-forms (DPA-MSC SF-10 and DPA-MSC SF-8), and Functional Arm Scale for Throwers (FAST) were identified as the most suitable existing PROMs due to high quality evidence of sufficient structural validity and internal consistency.
Conclusion(s): No definitively robust PROM to assess HRQoL in active youth was identified. Until an acceptable instrument is available, we recommend selecting the QoL survey, DPA SF-10, DPA SF-8, or FAST; using multiple PROMs; and/or applying qualitative methods to best triangulate HRQoL in this population. More research is needed to examine the measurement properties, interpretability, and feasibility of existing PROMs or develop a new, psychometrically sound PROM for active youth.
Implications: Monitoring HRQoL can provide insight into how a patient perceives their injury recovery. Establishing robust measurement properties, interpretability, and feasibility of an existing or new HRQoL PROM would help physiotherapists understand how sport-related injuries affect youth HRQoL by identifying domains of health that deteriorate following injury and should be addressed during rehabilitation.
Funding, acknowledgements: CYL holds an Arthritis Society Training Graduate PhD Salary Award. JLW holds a Michael Smith Foundation of Health Scholar Award.
Keywords: Patient-reported outcome measure, Validity, Reliability
Topic: Musculoskeletal
Did this work require ethics approval? No
Institution: University of Alberta
Committee: Health Research Ethics Board, Health Panel
Reason: This project is a systematic review
All authors, affiliations and abstracts have been published as submitted.
