Scores zur Nachuntersuchung von Behandlungsergebnissen: Welche sind valide?

Zusammenfassung

Ziel Im Fachbereich Orthopädie und Unfallchirurgie finden zahlreiche Scores Anwendung. Ziel der Studie ist die Erstellung einer Übersichtsarbeit zur Prüfung des Ausmaßes der Validität von häufig eingesetzten klinischen Scores in der Orthopädie und Unfallchirurgie.

Methoden Die Auswahl fiel basierend auf der Häufigkeit ihres Einsatzes auf 19 bzw. 22 der am meisten genutzten Scores für die obere bzw. untere Extremität. Für die jeweiligen Scores wurden in den Datenbanken Medline, PubMed und Google Scholar Validierungsstudien identifiziert. Zur Beurteilung der methodologischen Qualität der Validierungsstudien wurde die sog. COSMIN-Checkliste (COSMIN: Consensus-based Standards for the selection of health Measurement Instruments) von Mokkink et al. genutzt.

Ergebnis Die gemeinsame Betrachtung von Validität, Objektivität und Reliabilität scheint kein Standardvorgehen von Validierungsstudien zu sein. Die in der COSMIN-Checkliste aufgeführten Kriterien der Validität wurden von den meisten Validierungsstudien der Scores nicht vollständig erfüllt. Sechs Scores der oberen Extremität und 4 Scores der unteren Extremität sind nach der COSMIN-Checkliste nicht ausreichend validiert. Die Scores mit der umfangreichsten Validität sind für die obere Extremität der Oxford Shoulder Score und für die untere Extremität der Hip Disabilities and Osteoarthritis Outcome Score (HOOS) sowie der Western Ontario and McMaster Universities Score (WOMAC).

Schlussfolgerung Es gibt keinen Goldstandard für den Inhaltsumfang von Validierungsstudien. Die COSMIN-Checkliste gibt eine zuverlässige Übersicht über den Umfang der Validität. Je mehr Kriterien der COSMIN-Checkliste in Validierungsstudien getestet werden, desto umsichtiger sind die Überlegungen des validierenden Studienleiters. In klinischen Studien finden ebenso nicht validierte Scores, z. B. der Score nach Neer und Castaing, regelmäßig ihre Anwendung. Die vorliegende Übersichtsarbeit gibt einen Überblick über den Validitätsumfang der häufig genutzten Scores in der Orthopädie und Unfallchirurgie.

Schlüsselwörter

Score - Validität - Reliabilität - Objektivität - COSMIN-Checkliste

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