Clinical Rating Systems in Elbow Research - A Systematic Review Exploring Trends and Distributions of Use

Abstract

Background: Clinical rating systems are used as outcome measures in clinical trials and attempt to gauge the patient's views of their own health. The choice of clinical rating system should be supported by its performance against established quality standards. Methods: A search strategy was developed to identify all studies reporting the use of clinical rating systems in the tennis elbow literature. The strategy was run from inception in Medline Embase and CINHAL. Data extraction identified the date of publication, country of data collection, pathology assessed and outcome measure used. Results: 980 studies were identified that reported clinical rating system use. 72 separate rating systems were identified. 41% of studies used two or more separate measures. Overall 54% of studies used the Mayo Elbow Performance Score (MEPS). For Arthroplasty 82% used MEPS, 17% used Disabilities of Arm, Shoulder and Hand (DASH), 7% used quickDASH. For Trauma 66.7% used MEPS, 32% used DASH, 23% used the Morrey Score. For Tendinopathy, 31% used DASH, 23% used Patient-Rated Tennis Elbow Evaluation, 13% used MEPS. Over time there is increased proportional use of the MEPS, DASH, qDASH, Patient Rated Tennis Elbow Evaluation (PRTEE) and Oxford Elbow Score (OES). Conclusions: This study has identified the wide choice and usage of clinical rating systems in the elbow literature. Numerous studies report measures without a history of either pathology specific or cross-cultural validation. Interpretability and comparison of outcomes is dependent on the unification of outcome measure choice. This is not currently demonstrated.