Recommendations for Evaluating and Selecting Appropriately Valued Outcome Measures.

The changing healthcare environment has essentially mandated that outcome scores play an increasing role in orthopaedic research and clinical care. Value is defined as the best outcome at the lowest cost. The reasoning behind the collection of outcome scores can be examined from several perspectives. The process of selecting an appropriate outcome measure involves analyzing its psychometrics in addition to other aspects, such as responsiveness, reliability, validity, and the ability to detect change in a reasonable manner. A minimal clinically important difference measures clinical change, and a minimal detectable change measures statistical change. Orthopaedic surgeons are most interested in minimal clinically important differences because they indicate meaningful clinical changes. Guidelines for selecting appropriately valued outcome measures include the consideration of patient-reported outcomes, proper psychometrics, validated scores, and cost effectiveness.