Arthroscopy: The Journal of Arthroscopic & Related Surgery
ISAKOS scientific committee reportScoring systems for the functional assessment of the shoulder
Section snippets
The rating sheet for Bankart repair
In 1978, Carter Rowe published a classic article evaluating the long-term results of the Bankart repair.1 It was in this article that he introduced a new rating system for the postoperative assessment of patients undergoing anterior stabilization. This system scores patients based on 3 separate areas—stability, motion, and function—with 1 item for each of these areas. The weighting is such that stability accounts for 50 points, motion for 20 points and function for 30 points, giving a total
The UCLA shoulder score
The University of California at Los Angeles Shoulder Rating scale was first published in 1981 in a paper by H. C. Amstutz et al.2 The instrument was intended to be used in studies of patients undergoing total shoulder arthroplasty for arthritis of the shoulder. Since then, however, it has been used for patients with other shoulder conditions including rotator cuff disease3 and shoulder instability.4
This instrument assigns a score to patients based on 5 separate domains: pain, function, active
The shoulder pain and disability index (SPADI)
In 1991, Roach et al. published the development and evaluation of the SPADI.5 The authors state that “the SPADI was developed to provide a self-administered instrument that would reflect the disability and pain associated with the clinical syndrome of painful shoulder.” It was designed as both a discriminative and evaluative instrument. The majority of the item generation and reduction was carried out by a panel of 3 rheumatologists and a physical therapist without direct patient input. Further
The American shoulder and elbow surgeons evaluation form (ASES)
In 1993, the Society of the American Shoulder and Elbow Surgeons developed a standardized form for the assessment of shoulder function.6 The purpose was to facilitate communication between investigators and to permit and encourage multicenter trials. The members felt that the required attributes of any new tool were ease of use, a method of assessing activities of daily living and inclusion of a patient self-evaluation section. The research committee of the ASES reviewed all published forms
The constant score
The Constant Score7 has become the most widely used shoulder evaluation instrument in Europe. This scoring system combines physical examination tests with subjective evaluations by the patients. The subjective assessment consists of 35 points and the remaining 65 points are assigned for the physical examination assessment.
The subjective assessment includes a single item for pain (15 points) and 4 items for activities of daily living (work 4, sport 4, sleep 2, and positioning the hand in space
The disabilities of the arm, shoulder and hand (DASH)
Recently, the American Academy of Orthopaedics Surgeons (AAOS) along with the Institute for Work & Health (Toronto, Ontario, Canada) developed an outcome tool to be used for patients with any condition of any joint of the upper extremity. This instrument called the Disabilities of the Arm, Shoulder and Hand Measurement tool or DASH is made available by the AAOS. A brief description of the methodology for the item generation and the initial item reduction phases has been published.9 In 1999, the
The shoulder rating questionnaire
In 1997, L’Insalata et al. published the Shoulder Rating Questionnaire “a self-administered questionnaire for the assessment of symptoms and function of the shoulder.”18 It is unknown how the items on the instrument were generated or selected. It is simply stated that “A preliminary questionnaire was developed.” The preliminary questionnaire was administered to 30 patients and a subset of those patients were interviewed to identify clinical relevance, relative importance, and ease of completion
The simple shoulder test (SST)
In 1992 Lippitt, Harryman, and Matsen reported on the development and testing of the Simple Shoulder Test (SST).19 The purpose of the instrument is stated to be a means of documenting the functional improvement resulting from a specified procedure performed by a specific surgeon in response to a given diagnosis and to characterize the severity of the condition.
The SST consists of 12 questions with “yes or no” response options. The instrument combines subjective items and items that actually
The western Ontario shoulder tools
In 1998, Kirkley et al. published the first in a series of disease-specific quality of life measure tools for the shoulder, The Western Ontario Shoulder Instability Index (WOSI).14 This instrument was developed and evaluated using the methodology as described by Kirschner and Guyatt.22 The stated purpose of the instrument was for use as the primary outcome measure in clinical trials evaluating treatments for patients with shoulder instability.
In 2001, the second in the series of
The western Ontario shoulder instability index (WOSI)
The reliability of the WOSI has been evaluated in 51 stable patients at 2 weeks and 3 months in conjunction with a global rating of change score. The patient population tested was only briefly described as patients with shoulder instability who were stable and it is not clear how diverse a population this was. The ICCs at 2 weeks and 3 months for the total score (.95 and .91) and individual domain scores (range .72 to .94) are reported.
The instrument was administered to 47 patients undergoing
The western Ontario osteoarthritis of the shoulder index (WOOS)
The reliability of the WOOS instrument has been evaluated in 58 stable patients at 3 months in conjunction with a global rating of change score. The patient population tested was described as meeting the inclusion criteria of primary osteoarthritis of the shoulder. The ICC was calculated based on the 22 subjects who remained stable over the 3 months. The ICC for the total score was .96 and for each of the domains ranged from .87 to .95. This number may be falsely decreased by the long
The western Ontario rotator cuff index (WORC)
The reliability and validity of the WORC was assessed in patients who were being treated for rotator cuff tendinosis with no or a small full-thickness cuff tear. Patients completed the WORC and other measures of health as well as a global rating of change score. Those that indicated they had not changed at 2 weeks were used for the analysis of reliability. The ICC was calculated based on the 50 subjects who remained stable over the 2 weeks. The ICC for the total score was .96 and for each of
The rotator cuff quality-of-life measure (RC-QOL)
In October 2000, Hollinshead et al. published a paper reporting on the 6-year follow-up of large and massive rotator cuff tears.27 In the article, they introduced a new disease-specific quality of life instrument for patients with rotator cuff disease. The instrument was developed and tested using similar methodology to that described by Guyatt et al.28 This instrument is indicated for use as an outcome tool in patients with the “full spectrum of rotator cuff disease.”
Item generation was
Oxford shoulder scores (OSS)
Similar to Kirkley et al., Dawson, Fitzpatrick and Carr29 have published 2 questionnaires that deal with the perceptions of patients about shoulder surgery. The first, the Oxford Shoulder Score (OSS) was published in 1996 and is for patients having shoulder operations other than stabilization. The second questionnaire was published in 1999 and is meant for the group of patients who had been excluded from the original questionnaire, those presenting with shoulder instability.30 Both are 12-item
Conclusion
In summary, older instruments designed for evaluating shoulder conditions were developed at a time when little information was available or little attention was paid to the appropriate methodology for such endeavors. However, there now exist a number of instruments that are excellent for specific conditions of the shoulder. Much work remains to be done to evaluate these instruments in specific patient populations, to determine values for the minimally clinically important difference for each of
References (29)
- et al.
A standardized method for the assessment of shoulder function
J Shoulder Elbow Surg
(1994) - et al.
The disablement process
Soc Sci Med
(1994) - et al.
The development and evaluation of a disease-specific quality of life measurement tool for osteoarthritis of the shoulderThe Western Ontario Osteoarthritis of the Shoulder Index (WOOS)
Arthritis Cartilage
(2001) - et al.
A comparison of Likert and visual analogue scales for measuring change in function
J Chronic Dis
(1987) - et al.
The Bankart procedure—A study of late results
J Bone Joint Surg Am
(1977) - et al.
UCLA anatomic total shoulder arthroplasty
Clin Orthop
(1981) - et al.
Repair of rotator cuff. Factors influencing reconstruction
J Bone Joint Surg Am
(1986) - et al.
Scoring systems for shoulder conditions
Am J Sports Med
(1996) - et al.
Development of a shoulder pain and disability index
Arthritis Care Res
(1991) - et al.
A clinical method of functional assessment of the shoulder
Clin Orthop
(1987)
An evaluation of the Constant-Murley Shoulder Assessment
J Bone Joint Surg Br
Development of an upper extremity outcome measure: The DASH (disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG)
Am J Ind Med
Expectations and outcome of total hip replacement
Rheumatol Rehabil
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Deceased.