From outcome measurement to improving health outcomes following lower limb amputation - A narrative review exploring outcome measurement from a clinical practice perspective

Background: Outcome measurement is essential to understand the impact of clinical interventions and the performance of services. Despite national and professional body encouragement, and successful examples of system level outcome measurement within some health care settings, many barriers still exist preventing outcome measurement from becoming embedded in clinical practice. Objectives: To explore the status of outcome measurement in prosthetic rehabilitation, as applied in clinical practice, with a view to identifying areas of future work aimed at making outcome measurement in prosthetic rehabilitation a meaningful and useful reality. Study Design: Narrative review Methods: A literature search of four databases was undertaken, following the PRISMA principals appropriate to narrative reviews, and using the search terms outcome, measure*, tool, scale, instrument, prosthe*, amput* and limb loss. A total of 1116 papers were identified. Following screening 35 papers, focusing on four main themes, were included in the review. Results: The four themes were 1) What outcomes should be measured? 2) How can these outcomes be measured? 3) What are the barriers to outcome measurement? and 4) What examples of routine outcome measurement currently exist in prosthetic practice? Conclusions: Successful outcome measurement in clinical practice is multifaceted. Understanding and embedding value at every step is key to success. Addressing the questions of `why’, `what’ and `how’ we measure outcome may move us closer to a consensus. Routine outcome measurement at the clinical level should ensure data collection is valuable to clinical practice, makes use of IT solutions and has all important organisational buy in