Patient-Reported Outcome Measures and Health-Related Quality of Life Instruments in School-Age Children with Upper Limb Fractures: A Scoping Review
Abstract
Objective: Upper limb fractures are common in children, yet the selection of patient-reported outcome measures (PROMs) for research remains inconsistent. This scoping review maps the use of PROMs and health-related quality of life (HRQL) instruments in school-age children with upper limb fractures, evaluates their psychometric properties, and assesses their coverage of pediatric-relevant outcome domains.
Material and Methods: This review followed the Joanna Briggs Institute methodology and is reported in accordance with the PRISMA extension for Scoping Reviews (PRISMA-ScR). Six databases (MEDLINE, EMBASE, Scopus, CENTRAL, CINAHL, and PsycINFO) were searched from 2000 to 2025. Two independent reviewers screened studies, extracted data, and assessed psychometric evidence by using COSMIN guidelines. Instruments were mapped onto the CORE-Kids multidimensional quality-of-life framework.
Results: From 2,847 records, 68 studies were included, identifying 18 distinct PROMs. The QuickDASH was most frequently used (41% of studies), followed by PROMIS Upper Extremity (18%), PODCI (15%), and PedsQL (13%). Psychometric evidence was strongest for PROOF-UE, but critical gaps existed: 90% of instruments lacked content validity studies, and 80% lacked measurement error data. Domain mapping revealed major gaps in emotional well-being (18% coverage) and social functioning (14%), with critical gaps in school/learning (9%) and overall life satisfaction (5%).
Conclusion: Despite the availability of multiple PROMs, significant gaps in psychometric and content validity persist. Commonly used instruments inadequately assess emotional, social, and school-related outcomes. A multi-measure approach that combines physical function, comprehensive quality-of-life, and psychological outcome tools is recommended for clinical and research practice
Keywords
Full Text:
PDF (Early Version)References
Badhe N, Busby C, See A, Deacon C, Altell T, Ollivere BJ, et al. Waterproof casts for the management of upper limb fractures in children: a systematic review and meta-analysis. Bone Joint J 2025;107-B:587-94.
Cordray H, Fiandeiro M, Banala M, Vaile JR, Struble SL, Pehnke M, et al. Gamified assessments of pediatric upper extremity function: a systematic review and appraisal. J Hand Ther 2025;38:715–25.
Higgins MJ, Gomez RW, Storino M, Wang N, Strouse A, Zook Z, et al. 3D-printed casts improve patient-reported function and satisfaction in children with stable fracture patterns. J Pediatr Orthop 2025;45:546–51.
Musters L, Roth KC, Diederix LW, Edomskis PP, Benner JL, Reijman M, et al. Does early conversion to below-elbow casting for pediatric diaphyseal both-bone forearm fractures adversely affect patient-reported outcomes and ROM? Clin Orthop Relat Res 2024;482:1873-81.
Taib MNA, Kamalanathan CK, Sharifudin MA, A.Rahman LM, Abu Bakar MZH, Awang MS. Temporal dynamics of quality of life and functional recovery in pediatric supracondylar humerus fractures: A prospective study. Mal J Med Health Sci 2024;20:157–68.
Alberghina F, Andreacchio A, Pavone V, Mansour M, Dimeglio A, Canavese F. Review of pediatric functional outcomes measures used to evaluate surgical management in pediatric patients with an upper extremity fracture. J Pediatr Orthop B 2022;31:260–9.
Ernat JJ, Wimberly RL, Ho CA, Riccio AI. Vascular examination predicts functional outcomes in supracondylar humerus fractures: a prospective study. J Child Orthop 2020;14:495-501.
Nowak LL, Davis AM, Mamdani M, Beaton D, Kennedy C, Schemitsch EH. A systematic review and standardized comparison of available evidence for outcome measures used to evaluate proximal humerus fracture patients. J Orthop Trauma 2019;33:e256-62.
Fiandeiro M, Cordray H, Vaile JR, Struble SL, Banala M, Pehnke M, et al. Selecting patient-reported outcome measures for pediatric upper extremity function: a systematic review. J Pediatr Orthop 2025;45:508–18.
Fiandeiro M, Cordray H, Vaile JR, Struble SL, Banala M, Pehnke M, et al. Measuring what matters: a guide to selecting the optimal patient-reported outcome measure for pediatric shoulder and elbow function. J Shoulder Elbow Surg 2026;35:e136–46.
Narayanan U, Di Nola L, Ho E, Borkhoff CM, Camp M, Murphy A, et al. Validation of the patient/parent-reported outcome measure of fracture healing (PROOF-UE) questionnaire for upper extremity fractures in children. Orthop Procs 2025;107-B:24.
Morris EJ, Gray K, Gibbons PJ, Grayson J, Sullivan J, Amorim AB, et al. Evaluating the use of PROMs in pediatric orthopaedic registries. Children (Basel) 2023;10:1552.
Abbot S, Proudman S, Sim YP, Williams N. Psychometric properties of patient-reported outcomes measures used to assess upper limb pathology: a systematic review. ANZ J Surg 2022;92:3170-5.
Nuttall J, Rolls C. A survey of practice on the use of condition-specific patient reported outcome measures with patients who have distal radius fractures. Hand Ther 2025;30:63-71.
Arguelles GR, Shin M, Lebrun DG, Kocher MS, Baldwin KD, Patel NM. The majority of patient-reported outcome measures in pediatric orthopaedic research are used without validation. J Pediatr Orthop 2021;41:e74-9.
Marson BA, Craxford S, Deshmukh SR, Grindlay DJC, Manning JC, Ollivere BJ. Quality of patient-reported outcomes used for quality of life, physical function, and functional capacity in trials of childhood fractures. Bone Joint J 2020;102-B:1599-607.
Kalle JPR, Saris TFF, Sierevelt IN, Eygendaal D, van Bergen CJA. Quality of patient- and proxy-reported outcomes for children with impairment of the upper extremity: a systematic review using the COSMIN methodology. J Patient Rep Outcomes 2022;6:58.
Korteling DL, Ketelaar M, Limmen S, Terwee CB, Bloemen MAT, Rameckers EAA, et al. Psychometric properties and reference values of the patient-reported outcomes measurement information system (PROMIS®) pediatric item banks mobility, upper extremity, and pain interference in the Dutch population. J Clin Epidemiol 2025;184:111855.
Dorich JM, Cornwall R, Uhl T. ICF linking of patient-reported therapy goals for children with acquired upper extremity impairment. J Hand Ther 2023;36:74-84.
Quax MLJ, Krijnen P, Schipper IB, Termaat MF. Managing patient expectations about recovery after a distal radius fracture based on patient reported outcomes. J Hand Ther 2023;36:903-12.
Morales-Dubois LM, Julian KR, Maruyama M, Kamal RN, Shapiro LM. Have commonly utilised patient-reported outcome measures been validated for the Japanese language and culture amongst patients with distal radius fractures? a systematic review. J Hand Surg Asian Pac 2026;31:137-46.
Cordray H, Fiandeiro M, Struble SL, Vaile JR, Banala M, Pehnke M, et al. Choosing the most appropriate patient-reported outcome measures for hand function: A guide for pediatric hand surgeons. Hand (N Y) 2025:15589447251369035.
Kämppä N, Hulkkonen S, Grahn P, Laaksonen T, Repo J. The construct validity and internal consistency of QuickDASH in pediatric patients with upper extremity fractures. Acta Orthop 2024;95:192–9.
Nguyen HB, Miller PE, Sullivan N, Mahan ST, Spencer SA, Kasser JR, et al. Psychometric evaluation of patient-reported outcome measurement information system (PROMIS) measures in children and adolescents with lower limb orthopaedic conditions: construct validity, reliability, and responsiveness. Bone Joint J 2026;108-B:259–66.
Gates PE, Campbell SR. Effects of age, sex, and comorbidities on the pediatric outcomes data collection instrument (PODCI) in the general population. J Pediatr Orthop 2015;35:203–9.
Yaakobi D, Ron I, Agbaria H, Yelton MJ, Peskin B, Ghrayeb N, et al. Postoperative grip strength and range of motion correlated with better patient-reported outcomes following surgical management of distal radius fractures. J Wrist Surg 2024;15:141-6.
Strydom JP, Pretorius HS, Burge MC. Functional and patient-reported outcomes of terrible triad elbow fracture-dislocations. S Afr Orthop J 2025;24:169-75.
Puckett HD, Borgida JS, Doxey SA, Kleinsmith RM, Bohn DC, Husband JB, Cunningham BP. Anxiety and the attainment of clinically significant outcomes in operatively treated distal radius fracture patients: a retrospective study of 78 patients. Hand (N Y) 2026:15589447261415641. doi: 10.1177/15589447261415641.
Saris TF, Kalle JR, Sierevelt IN, Eygendaal D, van Bergen CJ. Quality of patient- and proxy-reported outcomes for children with impairment of the lower extremity: a systematic review using the consensus-based standards for selection of health measurement instruments methodology. J Child Orthop 2023;18:96-110.
Evans S, Okoroafor UC, Calfee RP. Is social deprivation associated with PROMIS outcomes after upper extremity fractures in children? Clin Orthop Relat Res 2021; 479;826-34.
Uppal H, Garcia D, Abdelmalek G, Attia P, Sahai N, Sinha K, et al. Evaluating the readability of patient-reported outcome measures in pediatric orthopaedic registries: alignment with National Institutes of Health and American Medical Association Standards. J Pediatr Orthop 2025;45:599-606.
Refbacks
- There are currently no refbacks.
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.