Document Type : Systematic Review
Authors
Trauma Research Center, Clinical Sciences Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
10.30491/tm.2026.598773.1988
Abstract
Introduction: Pelvic ring injuries are associated with substantial morbidity and long-term disability, yet no standardized outcome measurement instruments exist to evaluate clinical and functional results. Studies use the Majeed Pelvic Score, Iowa Pelvic Score, Orlando Pelvic Score, and generic instruments such as the SF-36, SMFA, and PROMIS inconsistently, limiting comparability and hampering evidence synthesis. To systematically identify all outcome measurement instruments used to assess pelvic ring injuries and evaluate their psychometric properties, including validity, reliability, responsiveness, and interpretability, as well as their clinical utility, including feasibility, patient acceptability, and clinical relevance.
Method: A systematic review was conducted in accordance with PRISMA guidelines. We searched PubMed/MEDLINE, Embase, Scopus, Web of Science, and the Cochrane Library from inception to August 2026. Studies evaluating one or more measurement properties of an outcome instrument used in a pelvic ring injury population were included. The COSMIN Risk of Bias checklist was used for quality assessment, and a modified GRADE approach was employed to grade the quality of evidence.
Result: Fifteen primary studies and five systematic reviews were included, evaluating eight outcome instruments. The Majeed Pelvic Score was the most frequently evaluated instrument (53% of studies), demonstrating good construct validity with the SF-36 physical component summary (r=0.65-0.82) and excellent reliability (ICC 0.92-0.96; Cronbach's α 0.91-0.99). However, significant limitations were identified across all pelvic-specific instruments, including ceiling effects, weak correlation with mental health domains (r=0.15-0.28), lack of standardized scoring methods, and absence of established minimal clinically important differences. The Iowa Pelvic Score and Orlando Pelvic Score lacked formal validation evidence. Generic instruments (SF-36, SMFA) demonstrated strong psychometric properties but limited specificity for pelvic-specific issues. PROMIS measures showed strong concurrent validity with the SMFA (r=-0.901) and high clinical utility because of their short administration time and computer-adaptive testing capability.
Conclusion: Despite widespread use of outcome measurement instruments in pelvic ring injury research, significant gaps exist in their psychometric properties and clinical utility. The Majeed Pelvic Score is the most extensively studied but has critical limitations. Content validity studies, standardized scoring methods, establishment of minimal clinically important differences, and development of a core outcome set for pelvic ring injury research are urgently needed.
Keywords
Subjects
