Electronic Thesis and Dissertation Repository


Doctor of Philosophy


Health and Rehabilitation Sciences


Joy C. MacDermid


Elbow disorders are one of the commonest musculoskeletal problems with a prevalence of 9% in men and 8.1% in women. Patient centered care is the goal of current healthcare delivery models; but optimizing treatment outcome and clinical research is hampered by a lack of outcome measures. Since pain and disability resulting from elbow disorders are experienced differently across individuals, they are best captured by patient reported outcome measures (PROM).

PROMs like the Patient-rated Elbow Evaluation (PREE); American Shoulder and Elbow surgeons – Elbow form (pASES-e) have been developed for use in elbow disorders, but important questions remain about their measurement properties. The key questions are: 1) what is the structural, construct validity and responsiveness of existing PROMs? 2) Does the PREE fit a continuous metric? 3) Do PROMs reflect the concerns that are important to patients and the World Health Organisation’s International Classification of Functioning Disability and Health (ICF) and its core sets? And finally, 4) what is known after synthesizing this new information with all prior knowledge on measurement elbow-related disability?

The overall objective of this thesis is to evaluate the psychometric properties of the PREE and the pASES-e. We used a mix of modern and traditional psychometric methods to assess the psychometric properties of the two elbow PROMs. We analysed the construct validity, sensitivity to change, factor structure and internal consistency of these two measures using classical test methods. Then we synthesized the literature on psychometric properties of these two measures by conducting a systematic review. International Classification of Functioning Disability and Health (ICF) was used to analyse the content of these PROMs and compare them to the concerns self-nominated by patients with regards to functional activities. Finally Rasch analysis of the PREE was completed.

The results of the thesis indicate that the PREE and the pASES-e are valid reliable and sensitive to change. Both measures exhibited acceptable levels of content validity and have conformed to the framework of ICF. They also had enough depth and breadth to cover the important concerns related to function self-endorsed by patients with elbow disorders. The PREE satisfied Rasch model requirements with minimal data handling with a potential for obtaining an unbiased interval level estimate. Appropriate recommendations have been made for future research based on the outcomes of this work.

This work has enabled us to establish a core set of measures that are valid, reliable and sensitive to change to measure activity limitation and participation restrictions in people with elbow disorders that are critical to advancing clinical research and practice.