JOA - 2026-08-14 - Journal Article; Review
A Review of Patient-Reported Outcome Measures and Patient Demographics in Randomized Controlled Trials Used to Synthesize Clinical Practice Guidelines for Hip Fractures in Older Adults.
Valdivia LM, Farid CJ, Nguyen AX, Swaminathan S, Moucha CS, Hayden BL
Topics
Key Takeaway
Of 160 RCTs informing the 2021 AAOS hip fracture CPG, 90.6% reported no language, race, or ethnicity data, and only 3.2% used culturally adapted PROMs.
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Summary
This study audited the 160 RCTs underlying the 2021 AAOS CPG for hip fractures in older adults for demographic reporting and PROM cultural adaptation. Only 7 studies (4.4%) reported patient language and all used it as an inclusion/exclusion criterion rather than a demographic variable; 9 studies (5.6%) reported race/ethnicity. PROMs were used in 78.9% of studies, but translated versions appeared in only 6.4% and culturally adapted versions in 3.2%.
Key Limitation
The study identifies underreporting but cannot determine whether unreported patients were actually excluded or simply not characterized, making the true magnitude of selection bias unquantifiable.
Original Abstract
BACKGROUND
Clinical practice guidelines (CPGs) are vital to uphold quality orthopaedic care in various populations. The outcome measures and patient demographics in studies used to synthesize the CPGs may not be fully representative of the general population, even though many studies have demonstrated the impact of sociocultural elements with musculoskeletal outcomes. Assessing the linguistic, racial, and ethnic representation of participants as well as the linguistic and cultural adaptation of patient-reported outcome measures (PROMs) used in trials informing CPGs for hip fractures in older adults is essential.
METHODS
The 2021 American Academy of Orthopaedic Surgeons CPG for the management of hip fractures in older adults and related clinical trial registrations were screened for full-text randomized controlled trials. Included studies were reviewed, and the location of the trial, inclusion/exclusion criteria, patient language proficiency, ethnic and racial demographics, PROM usage, and the use of translated and culturally adapted PROMs were extracted. Descriptive statistics were used to summarize findings. Of the 160 included studies from 31 different countries, seven studies (4.4%) reported the patient population's preferred language.
RESULTS
All seven studies utilized language proficiency to select study participants. There were nine studies (5.6%) that reported race and ethnicity of the participants. In total, 145 studies (90.6%) did not report any language, race, or ethnicity data. The PROMs were reported in 125 studies (78.9%), eight (6.4%) of which utilized a translated version and four (3.2%) employed culturally adapted PROMs.
CONCLUSIONS
Trials that inform CPGs for hip fracture adults demonstrate low reporting of patient language, race, and ethnicity. When language was recorded, it functioned exclusively as an inclusion or exclusion criterion rather than as a demographic characteristic, raising further concerns for selection bias and underrepresentation of patients who have limited English proficiency. Although PROMs were widely used, translated and culturally adapted versions were rarely reported.