1000 Norms Project: self-reported outcome measures across the lifespan

Abstract

In healthcare, patient-reported outcome measures (PROs) provide valuable information from the individual’s perspective. Normative reference data for PROs are essential to enable comparisons of results with ‘normal’ scores, however data for many PROs are limited. The aim of this thesis was to develop normative reference data for PROs assessing musculoskeletal symptoms, physical function and health-related quality of life, as well as investigate biopsychosocial factors associated with musculoskeletal symptoms and physical function. An observational study collecting PROs and over 50 physical measures was conducted by two PhD students (1000 Norms Project). One thousand males and females aged 3-101 years, self-described as healthy with no major physical disability, were recruited. In this thesis, age and gender-stratified reference data were generated for the Cumberland Ankle Instability Tool, Knee injury and Osteoarthritis Outcome Score, Nordic Musculoskeletal Questionnaire-Extended and Assessment of Quality of Life instrument. Bilateral ankle instability was reported by 23% of healthy children and adults, and knee pain/disability by up to 40% of healthy adults. Twelve-month period prevalence of all musculoskeletal symptoms among adolescents and adults was 69-82% and point prevalence was 23-39%. Biopsychosocial factors associated with musculoskeletal symptoms and self-reported function included female gender, lower self-efficacy and mental health, greater waist circumference and body mass index, decreased joint range of motion and muscle strength, and decreased physical performance. In conclusion, musculoskeletal symptoms are common among healthy individuals and are thus likely an expected human experience. Ultimately, the normative reference data generated provide a powerful resource for clinicians and researchers using PROs to manage musculoskeletal conditions and evaluate new therapies.