title: Validity and sensitivity to change of patient-reported pain and disability measures for elbow pathologies.
abstract: METHODS
  Prospective cohort study.
  
  
  OBJECTIVE
  To evaluate the internal consistency, concurrent construct validity, longitudinal validity, sensitivity to change, and factor structure of the Patient-Rated Elbow Evaluation form (PREE), the patient-reported form of the American Shoulder and Elbow Surgeons Elbow Questionnaire (pASES-e), and the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH) in a diverse group of patients who had surgery for various elbow pathologies.
  
  
  BACKGROUND
  Measuring functional outcomes after surgical procedures of the elbow requires valid patient-reported pain and disability questionnaires. The PREE, the pASES-e, and the DASH are commonly used questionnaires. There is, however, insufficient evidence available concerning their validity and sensitivity to change.
  
  
  METHODS
  Data were prospectively collected from 128 patients (mean ± SD age, 46.5 ± 12.8 years) post-elbow surgery. Patients completed the PREE, the pASES-e, the DASH, and the Medical Outcomes Study 36-Item Short-Form Health Survey at baseline (first visit after surgery) and 6 months postsurgery. Concurrent construct validity, longitudinal validity, sensitivity to change, and factor structure were analyzed.
  
  
  RESULTS
  Concurrent construct validity was demonstrated by confirmation of expected relationships; the strongest correlations were observed between the PREE pain score, the PREE total score, the pASES-e pain score, and the DASH score (r = 0.73-0.87). The pASES-e function score correlated the least with other constructs. Longitudinal validity demonstrated similar findings: the pASES-e pain change score and PREE change score were most strongly correlated, and the pASES-e function change score and DASH change score were moderately to weakly correlated. All 3 patient-reported questionnaires demonstrated a large effect size and standardized response means greater than 1.0. Structural validity was supported for the PREE (R2 = 77.2%, 4 factors) and the pASES-e (R2 = 74.4%, 4 factors), but not for the DASH (R2 = 71.3%, 5 factors).
  
  
  CONCLUSIONS
  The PREE, the pASES-e, and the DASH have acceptable validity and sensitivity to change. The pASES-e function subscale is the least sensitive to change and is less correlated to other measures.
authors.affiliation: Health and Rehabilitation Sciences, University of Western Ontario, London, Ontario, Canada. jisrael2@uwo.ca
authors.forename: Joshua I
authors.initials: JI
authors.lastname: Vincent
authors.forename: Joy C
authors.initials: JC
authors.lastname: MacDermid
authors.forename: Graham J
authors.initials: GJ
authors.lastname: King
authors.forename: Ruby
authors.initials: R
authors.lastname: Grewal
mesh_terms: D000328:Adult; D000368:Aged; D004550:Elbow / Q000601:surgery*; D004551:Elbow Joint / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D055815:Young Adult