title: Comparing the responsiveness of functional outcome assessment measures for trauma registries.
abstract: BACKGROUND
  Measuring long-term disability and functional outcomes after major trauma is not standardized across trauma registries. An ideal measure would be responsive to change but not have significant ceiling effects. The aim of this study was to compare the responsiveness of the Glasgow Outcome Scale (GOS), GOS-Extended (GOSE), Functional Independence Measure (FIM), and modified FIM in major trauma patients, with and without significant head injuries.
  
  
  METHODS
  Patients admitted to two adult Level I trauma centers in Victoria, Australia, who survived to discharge from hospital, were aged 15 years to 80 years with a blunt mechanism of injury, and had an estimated Injury Severity Score >15 on admission, were recruited for this prospective study. The instruments were administered at baseline (hospital discharge) and by telephone interview 6 months after injury. Measures of responsiveness, including effect sizes, were calculated. Bootstrapping techniques, and floor and ceiling effects, were used to compare the measures.
  
  
  RESULTS
  Two hundred forty-three patients participated, of which 234 patients (96%) completed the study. The GOSE and GOS were the most responsive instruments in this major trauma population with effect sizes of 5.3 and 4.4, respectively. The GOSE had the lowest ceiling effect (17%).
  
  
  CONCLUSIONS
  The GOSE was the instrument with greatest responsiveness and the lowest ceiling effect in a major trauma population with and without significant head injuries and is recommended for use by trauma registries for monitoring functional outcomes and benchmarking care. The results of this study do not support the use of the modified FIM for this purpose.
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
authors.forename: Owen D
authors.initials: OD
authors.lastname: Williamson
authors.forename: Belinda J
authors.initials: BJ
authors.lastname: Gabbe
authors.forename: Ann M
authors.initials: AM
authors.lastname: Sutherland
authors.forename: Rory
authors.initials: R
authors.lastname: Wolfe
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Forbes
authors.forename: Peter A
authors.initials: PA
authors.lastname: Cameron
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods*; D010351:Patient Discharge; D011446:Prospective Studies; D020127:Recovery of Function / Q000502:physiology*; D012042:Registries; D014193:Trauma Centers / Q000706:statistics & numerical data*; D015599:Trauma Severity Indices; D014739:Victoria / Q000453:epidemiology; D014949:Wounds, Nonpenetrating / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy; D055815:Young Adult