The Short Musculoskeletal Function Assessment: a study of the reliability, construct validity and responsiveness in patients sustaining trauma.
Max W de Graaf, Inge Hf Reininga, Klaus W Wendt and 2 others
PMID 30722686WHAT IT FOUND
In trauma patients, the Dutch Short Musculoskeletal Function Assessment reliably measures four areas of function and tracks recovery, but its upper-extremity subscale misses mild arm problems.
Key findings
01Scores were stable on all four subscales, with the least error for lower-extremity function.
02Of 50 pre-set checks of how scores should relate to other measures, 43 were confirmed; of 43 checks of change over time, 34 were confirmed.
03Twenty percent of patients with an upper-extremity injury scored the best possible function on the upper-extremity subscale.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The study was done at one level-1 trauma centre in the Netherlands, in Dutch, so results may not apply to other hospitals, languages or injury patterns. 248 patients completed the six-week questionnaires, a 64% response rate, and 145 completed the two-week repeat and 160 completed the six-month follow-up, so those who stayed may differ from those who did not. The upper-extremity subscale had a floor effect: 20% of patients with an upper-extremity injury scored the best possible score, limiting its usefulness for mild arm problems. The lower-extremity subscale showed systematic bias between test and retest, although the authors considered it small. The minimal important change for the SMFA-NL is not known, so a score change cannot be labelled meaningful without the smallest detectable change thresholds. The two-week repeat interval could allow recall bias, and the questions used to confirm no clinical change may not capture subtle recovery.
Declared interests
The authors declared no conflicts of interest and reported no financial support.
The easy way to misread this
Do not read any score change as meaningful recovery. The paper says it is not known what score change matters to patients, and individual-level measurement error may make early change hard to detect for upper-extremity and mental/emotional subscales.