Purpose Patient- and clinician-reported outcome measures (PROMs, CROMs) are used in rehabilitation to evaluate and track the patient’s health status and recovery. However, controversy still exists regarding their relevance and validity when assessing a change in health status. Methods We retrospectively analyzed the changes in a CROM (Fingertip-To-Floor Test – FTF) and PROMs (ODI, HAQ-DI, NPRS, EQ5D) and the associations between these outcomes in 395 patients with lower back pain (57.2 ± 11.8 years, 49.1% female). We introduced a new way to measure and classify outcome performance using a distribution-based approach (t2D). Outcome measures were assessed at baseline and after 21 days of inpatient rehabilitation. Results Overall, the rehabilitation (Cohens d = 0.94) resulted in a large effect size outcome. Medium effect sizes were observed for FTF (d = 0.70) and PROMs (d > 0.50). Best performance rating was observed for pain (NPRS). We found that 13.9% of patients exhibited a deterioration in the PROMs, but only 2.3%, in the FTF. The correlation between the PROMs and FTF were low to moderate, with the highest identified for HAQ-DI (rho = 0.30–0.36); no significant correlations could be shown for changes. High consistency levels were observed among the performance scores (t2D) in 68.9% of the patients. Conclusions Different and complementary assessment modalities of PROMs and CROMs can be used as valuable tools in the clinical setting. Results from both types of measurements and individual performance assessments in patients provide a valid basis for the meaningful interpretation of the patients’ health outcomes. Trial registration. This clinical study was entered retrospectively on August 14, 2020 into the German Clinical Trials Register (DRKS, registration number: DRKS00022854).

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Both clinician-reported outcome measures (CROMs) measures and patient-reported outcome measures (PROMs) are applied to evaluate outcomes in rehabilitation settings. The previous data show only a low to moderate correlation between these measures. Relationships between functional performance measures (Clinician-Reported Outcome Measures, CROMs) and Patient-Reported Outcome Measures (PROMs) were analysed in rehabilitation patients with traumatic injuries of the lower limb. A cohort of 315 patients with 3 subgroups (127 hip, 101 knee and 87 ankle region) was analysed before and after 3 weeks of inpatient rehabilitation. All three groups showed significant improvements in PROMs with low to moderate effect sizes. Moderate to high effect sizes were found for CROMs. Correlation coefficients between CROMs and PROMs were low to moderate. The performance consistency between PROMs and CROMs ranged from 56.7% to 64.1%. In this cohort of rehabilitation patients with traumatic injuries, CROMs showed higher effect sizes than PROMs. When used in combination, patient-reported outcome and performance measures contribute to collecting complementary information, enabling the practitioner to make a more accurate clinical evaluation of the patient’s condition.

Because absolute changes in outcomes are difficult to interpret and the minimal clinically important difference (MCID) is not suitable to address this challenge, a novel method of classifying outcomes by relating changes to baseline values is warranted. We used the “performance score” (T2D), which reflects individual performance, enabling us to consider the functional status at the beginning of rehabilitation without dealing with the problems of mathematical coupling or regression effects, as encountered in ANCOVA. To illustrate the T2D, we retrospectively analyzed changes in the six-minute walking test (6MWT) in COPD patients undergoing outpatient pulmonary rehabilitation and compared the results with absolute differences related to a predetermined MCID. We evaluated a total of 575 COPD patients with a mean age of 61.4 ± 9.2 years. 6MWT improved significantly, with a mean change of 32.3 ± 71.2. A total of 105/311 participants who had reached the MCID were still classified as “below average” by the T2D. Conversely, 76/264 patients who had not reached the MCID were classified as “above average”. This new performance measure accounts for the patient’s current status and for changes over time, potentially representing a simple and user-friendly tool that can be used to quantify a patient’s performance and response to rehabilitation.

Background: Gait analysis constitutes an essential part of orthopedic rehabilitation assessment. Previous studies indicate that observational-based gait analysis lacks reliability and requires extensive clinical training. Therefore, gait analysis in the clinical practice heavily relies on technical aids. The aim of the present study is to develop a reliable gait analysis assessment tool that can accurately assess clinically relevant gait cycle parameters in daily clinical practice. Methods: In this pilot study, a new gait analysis and motion score (GAMS), comprising 10 observational and 5 technically measured (e.g. pressure plate) gait parameters, was developed. The parameters were dichotomously operationalized, reflecting pathological versus physiological manifestations of the parameters. The rating algorithm was administered by 12 raters using videotaped treadmill sessions of 10 orthopedic subjects ( n = 120 ratings). Inter-rater reliability was calculated using the intraclass correlation coefficient (ICC) and the percentage of rating agreement. Results: The mean (standard deviation (SD)) GAMS ratings ranged from 10.0 (1.1) to 21.5 (1.3) points. The overall GAMS ICC was 0.98 (95% confidence interval (CI) 0.96–1.00), whereas the ICC of observational parameters alone was 0.97 (95% CI 0.93–0.99). The mean (SD) percentage of rating agreement was 86.1% (3.3%). For the observational parameters, the mean (SD) rating agreement was 82.5% (4.5%). Conclusion: This new GAMS shows excellent overall inter-rater reliability for a continuum of functional gait statuses. The new score may be an appropriate clinical tool to objectively evaluate patients’ gait patterns. Furthermore, the GAMS may find application as a clinician-reported outcome measure in orthopedic rehabilitation. Further studies are required to verify the validity and accuracy of the new GAMS and its functionality in assessing clinical changes in gait patterns.

Shoulder pain is regularly associated with limited mobility and limitations in activities of daily living. In occupational therapy, various interventions, including active isokinetic training with a Baltimore Therapeutic Equipment (BTE) Work Simulator, help the patient improve shoulder mobility and alleviate pain. This randomized controlled cohort study aims to evaluate the impact of different isokinetic movement patterns on the DASH score, pain, and objective performance measures, such as range of motion (ROM) and hand grip strength. Patients that participated in a specific 3-week inpatient orthopedic rehabilitation were divided into two groups. The first group (UNI-group, n = 9) carried out uniplanar exercises for shoulder flexion, abduction, and external rotation. The patients in the second group (ADL-group, n = 10) imitated multiplanar everyday movements, such as climbing on a ladder, loading a shopping cart, and raising a glass to their mouth. Compared to the UNI-group, the ADL-group improved significantly in DASH scores (mean −10.92 ± 12.59 vs. −22.83 ± 11.31), pain (NPRS −1.11 ± 2.37 vs. 3.70 ± 2.00), and shoulder abduction (+2.77 ± 15.22 vs. +25.50 ± 21.66 degrees). In conclusion, the specific BTE exercise program with multiplanar movement patterns contributed considerably to the therapeutic improvement.

Background. Gait analysis systems serve as important tools for assessing disturbed gait patterns. Amongst other factors, functional limitations of the shoulder joint may relate to such disturbances. Patient-reported outcome measures, assessment of pain, and active range of motion are commonly used to describe shoulder impairment. Purpose. The aim of this cohort study was to evaluate the impact of unilateral limitations of shoulder mobility and pain on gait patterns and to detect correlations between pain, shoulder mobility, and particular phases of human gait using a Zebris gait analysis system. Methods. 20 subjects with unilaterally restricted mobility and pain of the affected shoulder and a control group of 10 healthy subjects underwent a gait analysis. Various gait parameters, the DASH score, pain at rest and movement of the affected shoulder, and the active range of motion (aROM) for shoulder flexion and abduction were recorded. Results. We determined significant differences of the duration of the loading response ( p  = 0.021), midstance ( p  = 0.033), and the terminal stance phase ( p  = 0.019) between the shoulder group and the control group, with a shorter loading response phase and a longer terminal stance phase of the affected side in the shoulder group. In the shoulder group, we found significant correlations between the DASH and the duration of the midstance phase ( p  = 0.023) and the terminal stance phase ( p  = 0.038). In addition, there was a significant correlation between shoulder flexion and the duration of the midstance phase ( p  = 0.047).