Orthopaedic assessment in haemophilia

Outcomes may be measured in terms of both objective and subjective variables and also on the basis of cost-efficiency. Most tools currently used to quantify outcomes, especially in orthopaedics, involve measurements of general health and of specific body part or organ system function. Patients' expectations of medical care are linked to their requests for treatment and to their assessments of outcome and satisfaction. Rating results are fundamental to evaluation and comparison of different methods of treatment. The discrepancies existing among rating scales have been an impediment in the evaluation of haemophilic patients from the orthopaedic point of view. Progress depends on international cooperation to improve communication and on the evaluation of new surgical techniques. The World Federation of Haemophilia (WFH) physical joint examination instrument and the Colorado physical examination (PE) instruments made important contributions by developing forms that will serve as a foundation for future evaluation systems. Some authors have suggested that the Colorado PE instruments are more indicative of early joint dysfunction than the WFH instrument. Future goals of the Colorado PE instruments are to refine the standard forms, identify additional important reproducible criteria and develop a comprehensive method of evaluation. It is paramount to develop valid and reliable surveys that can be used preoperatively to direct patient education and shared decision making and to provide a framework for setting reasonable goals. Re-examining patients' responses postoperatively could provide a way to assess fulfilment of expectations, which is a crucial patient-derived measure of outcome and satisfaction.