ABSTRACT
Many instruments have been designed to measure some aspect of health. They are commonly used to measure changes over time, either as a result of treatment or natural history, such instruments are termed outcome measures. Today, most orthopaedic surgeons are being asked to document the outcome of their practice with very little guidance on how to accomplish this. The methods range from regularly auditing complications (usually short-term perioperative complications) to implementing some form of measuring instrument given to all patients. Often, the surgeon would be happy to implement an outcome measure but is unable to decide or find advice on what this measure should be. These motivated practitioners often end up merely applying a fashionable generic health status measure, for example SF-36 (Tarlov et al. 1989; Ware 1993), that will usually get the blessing of the local health authority. However, although general measures may be suitable for comparisons of health, a measure more specific to a condition will normally be more appropriate. Unfortunately, such a measure may be difficult to find partly because of the wide range of conditions faced by orthopaedic surgeons. For example, in addition to pain and functional problems, much of orthopaedics is concerned with the correction of deformity. Measuring deformity is very difficult,
and few have attempted to define it (Theologis and Fairbank 1997, see also Chapter 11). In trauma, it is difficult to assess the pre-trauma status of the patient. Both in elective surgery and in trauma, the outcome may take many years to be established.
