Assessing Elbow Assessment, past, Present and Future

Abstract

The state of elbow assessment is reviewed using a timeline of past, present and future. Empirical evidence is provided supporting the conclusions made in recent years that patient self-assessed evaluation of elbow function is valid, consistent and reliable. This form of assessment is so robust that it does not appear to matter whether the scale is composed of four, five or seven categories or even a visual analogue scale per item. The raw scores are not linear but can be constructed as such using Rasch modelling. Items included in any one scale have been identified as being on a continuum of difficulty, and the continuum itself can be considered as a ‘ruler’ of difficulty. Finally, the health of the elbow cannot be summarized as just one domain. We suggest that health of the elbow be considered by an expert panel (BESS) where the concepts of pain, function and impairment are fitted to the International Classification of Functioning, Disability and Health framework, so that a standardized assessment regime is available on a national basis.