Arthroscopy: The Journal of Arthroscopic & Related Surgery
Current ConceptsAnalysis of Evidence-Based Medicine for Shoulder Instability
Section snippets
Instrument Development and Testing
A proper quality-of-life tool requires a formal development process and extensive instrument testing. The approach to this methodology is described by Guyatt and colleagues10 and is divided into 2 phases with a total of 9 steps. The first phase, the development process, involves 4 steps. The first step specifies measurement goals. The next step is item generation. This is both expert and patient based. The third step involves item reduction. The fourth step is questionnaire formatting. This
Scoring Systems
When creating a shoulder scoring system, patient input and feedback should be emphasized. The population for whom the tool is being designed should be adequately defined. The purpose of the instrument should be discriminative, evaluative, or predictive. Discriminative systems will differentiate between patients with different levels of a condition, whereas evaluative systems will determine the effectiveness of the treatment. Predictive systems will classify individuals against an external
Discussion
Overall, there were a total of 11 scoring systems that were thoroughly evaluated. Systems were evaluated for proper development, reliability, validity, and responsiveness for a homogeneous subset of patients with known instability (Table 2). Only 3 of the 11 scoring systems, the MISS, the DASH, and the WOSI, appear to have used an adequately described development process. Most of the other systems either did not provide a description of item generation and/or reduction or provided a limited
Conclusions
It is imperative to develop common guidelines and criteria for treatment, which will facilitate identification of effective outcomes for similar conditions. Comparative prospective studies should be encouraged. There is a need for a standardized measuring system that incorporates the following: (1) it must satisfy the needs of those using it, (2) it must satisfy development testing criteria, (3) it must be strongly weighted toward functional outcome, (4) it must be simple and effective, and (5)
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The authors report no conflict of interest.