Providing evidence for content validity of the most frequently used hip specific recovery outcome measures in hip fracture studies: an International Classification of Functioning approach

Abstract

Purpose

We established the most commonly used clinician and patient-reported hip fracture outcome measures as of 2022, assessed their content validity using an International Classification of Functioning, Disability and Health (ICF) framework, and operationalized these results to contribute to an updated hip fracture core set.

Materials and methods

A literature search was conducted to identify articles utilizing outcome measures related to hip fracture. A total of five outcome measures were identified, linked to the ICF, and assessed for content validity via bandwidth percent, content density, and content diversity.

Results

Outcome measures were linked to 191 ICF codes, most of which were associated with Activities and Participation. Notably, no outcome measure contained concepts linked to Personal Factors and Environmental Factors were underrepresented across all outcome measures. The modified Harris Hip Score had the highest content diversity (0.67), the Hip Disability and Osteoarthritis Outcome Score had the highest bandwidth of ICF content coverage (2.48), and the Oxford Hip Score had the highest content density (2.92).

Conclusions

These results clarify the clinical applicability of outcome measures and guide development of hip fracture outcomes that allow providers to assess the complex role of social, environmental, and personal factors in patient rehabilitation.

IMPLICATIONS FOR REHABILITATION

• Hip fracture is a complex and disabling pathology predominantly affecting older adults and represents a public health problem.

• There are a variety of outcome measures used to assess a patient’s recovery following a hip fracture, each with distinctive objectives and modes of administration.

• Content validity metrics associated with the Harris Hip Score suggest it would be a suitable outcome measure during early-stage recovery, whereas the modified Harris Hip Score may be more suitable for tracking long-term recovery tracking.

• Choosing an outcome measure most appropriate for a hip fracture patient is an individualized decision that must consider aspects such as age, activity level, needs, and environmental factors.

Keywords:

• Hip fracture
• outcome assessment (health care)
• international classification of functioning
• disability and health
• content validity

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

Support for this research was provided by Mitacs and Fulbright Canada as part of the Mitacs Globalink Research Internship conducted at Queen’s University.