Linking of the Patient Rated Elbow Evaluation (PREE) and the American Shoulder and Elbow Surgeons – Elbow questionnaire (pASES-e) to the International Classification of Functioning Disability and Health (ICF) and Hand Core Sets

STUDY DESIGN: Content analysis-ICF linking. INTRODUCTION: The Patient Rated Elbow Evaluation (PREE) and the self-report section of the American Shoulder and Elbow Surgeons society - Elbow form (ASES-e) are the two commonly used elbow pain and disability self-report measures (PROs). The content of these questions have never been analyzed in light of the International Classification of Functioning Disability and Health (ICF) which is the current standard to describe health and health-related states. PURPOSE: The purposes of this study were to analyze the conceptual basis of the PREE and the ASES-e by linking the meaningful concepts in these PROs to the ICF using standardized linking rules and to determine the extent to which the ICF core set for hand conditions cover the content of elbow questionnaires using summary ICF linkage indicators. METHODS: Two raters linked the two PROs to the ICF using the linking rules proposed by Cieza and colleagues. Percentage agreement was calculated between the raters. Summary linkage indicators proposed by MacDermid were used to estimate the extent to which the ICF core set for hand conditions cover the content of the elbow questionnaires. RESULTS: All the items of the PREE (Measure to ICF linkage - 100%) and all but one item of the pASES-e (Measure to ICF linkage - 95%) were linked to the ICF. The satisfaction item on the ASES-e was not-covered by the ICF. Percentage agreement on linking between the raters was 96% and 95% for the PREE and the pASES-e respectively. The unique linkage of the PREE and the pASES-e to the unique codes on the brief and comprehensive core set were lower than absolute linkage to the core set for hand conditions. The PROs represented less than 20% of the comprehensive core set and more than 70% of the brief core set. While for the unique core set disability representation the 2 PROMs represented 100% brief core set unique disability codes and less than 35% of the comprehensive core set unique disability codes. CONCLUSION: The PREE and the ASES-e are aligned with the ICF framework and the core sets for hand conditions. The ICF Core Set devised for hand conditions may also be useful for elbow conditions. LEVEL OF EVIDENCE: 1b.