The assessment of clinical outcomes is an emerging topic within athletic training and the general health care system. Clinicians, educators, and researchers interested in gaining foundational knowledge related to clinical outcomes assessment will find the AO Handbook: Musculoskeletal Outcomes Measures and Instruments, second expanded edition, to be an easy-to-follow and useful resource.
Expanded from the original 1-volume text, the second edition is a 2-volume set organized much like its predecessor. The text begins with an informative overview of major topics and concepts related to clinical outcomes assessment. This includes selecting the most appropriate outcome instrument for patient care and identifying the differences between clinician-rated and patient-rated outcome instruments.
In addition, the authors describe a systematic approach to evaluating the quality of outcome instruments based on content (ie, name, reference, type), methodology (ie, validity, reliability, responsiveness), and clinical utility (ie, patient friendliness, clinician friendliness). This detailed discussion is the centerpiece of the text, as the authors use the same process and criteria to systematically evaluate the quality of various outcome instruments in later chapters. Although this systematic evaluation appears to be a complex process in plain writing, well-formatted figures and charts help to simplify the process for the reader. The authors offer sufficient information and guidance for the reader to begin evaluating the quality of outcome instruments on his or her own.
The remainder of the text is a series of concise summaries for more than 250 commonly used outcome instruments for musculoskeletal conditions. Generic outcome instruments are grouped together to form one section of the first volume; specific outcome instruments are organized by body region, with upper and lower extremity outcome instruments incorporated into the first and second volume of the text, respectively. Each outcome instrument summary highlights the systematic evaluation of the instrument’s content, methodology, and clinical utility.
A summary score is provided for each outcome instrument based on this evaluation process, but the authors caution that these scores should be used more as guidelines than as the primary deciding factor for choosing an appropriate, high-quality instrument for patient care. The summaries also include pie charts that identify the various health domains or subscales that each outcome instrument assesses. Overall, the reader should find these summaries useful when choosing an outcome instrument for a specific patient or patient population.
Although the text possesses many benefits, it also has several limitations. For instance, single-item outcome instruments, which may be particularly useful in the fast-paced environment of an athletic training clinic, were not included in the text. Also, the text does not include pediatric or adolescent outcome measures that would be important to athletic trainers who work closely with this patient population (eg, high school athletes).
Moreover, it should be noted that the text is formatted as a handbook. Therefore, although it is extremely useful as a clinical resource and reference, it may not be a practical choice as a primary textbook for an educational course. Besides the inclusion of additional outcome instruments, there are few major differences between the first and second editions. As a result, those who currently own the first edition may choose not to update their edition because the content (ie, the first 8 chapters) is relatively the same.
The purposes of the text were to facilitate the incorporation of outcome instruments into daily practice, to offer guidance in terms of critically evaluating outcome instruments, and to highlight the criteria related to developing new outcome instruments. Overall, the authors effectively achieve these goals through a well-organized and detailed text.
Despite minor limitations, I highly recommend the AO Handbook: Musculoskeletal Outcomes Measures and Instruments, second expanded edition, to athletic trainers who are interested in incorporating outcome instruments into clinical practice, education, and research. As the topic of clinical outcomes assessment continues to gain recognition within the athletic training profession and the health care system, athletic trainers and other medical professionals will find this text to be a helpful and informative resource.
Kenneth C. Lam, ScD, ATC
A.T. Still University