Kevin C. Chung, MD, MS, Editor

Andrea L. Pusic, MD, MHS, FRCSC, Editor

The Michigan Hand Outcome Questionnaire (MHQ) was developed when the use of PRO instruments was still in its infancy; however, after many years of clinical application, the MHQ has become a standard by which outcomes in hand surgery are judged. As we move forward, important advancements are being made in the ways that PRO instruments are developed. Specifically, there is strong emphasis on developing scales that can provide clinically meaningful data and effectively measure change. Condition-specific outcome instruments, such as the Breast-Q and Face-Q, have recently been developed using in-depth qualitative research and new psychometric methods such as Rasch. These “next generation” PRO instruments offer the potential to rigorously quantify outcomes from our patients’ perspective to inform technical advancement and clinical care. In fact, new PRO instruments are so responsive to clinical change that government agencies such as the National Institutes of Health and the Food and Drug Administration are investing substantial resources to apply their use to measure the effectiveness of current and new treatments. Internationally, many countries are now starting to require that new devices and medications present PRO data before new medical products are approved.

Because Plastic Surgery is a specialty that addresses quality of life issues for patients with a variety of diseases and conditions, the application of PRO instruments is particularly pertinent to measure functional as well as psychosocial changes after treatment. In this volume, we have invited some of the top scientists in outcomes research to share with you the current status of outcomes instrument design and selection in all disciplines of Plastic Surgery. These articles were written not in a dry, pedantic academic fashion, but in a relevant manner so that the readers can apply these principles in their daily practices to assess outcomes in their patients. For researchers interested in outcomes research, these articles are necessary reading when embarking on a critical assessment of outcomes of a particular device or treatment.

We trust that as the outcomes movement continues to evolve, there will be ever more innovative studies using new PRO instruments to better delineate and understand patients’ perceptions of the treatments they receive. This will be accomplished in part by leveraging electronic and web-based data capture. In addition, we now seek to measure not only quality of life, but also our patients’ expectations and satisfaction. As Plastic Surgery continues to embrace outcomes research and evidence-based medicine, we hope that our field will take a leading role in designing and applying PRO instruments. After all, Plastic Surgery is a quality-of-life specialty, and its mission is to enhance patients’ well-being through a careful consideration of the functional, aesthetic, and psychosocial welfare of the patients we treat.