A systematic review of the psychometric properties of the Constant-Murley score

doi:10.1016/j.jse.2009.04.008

Journal of Shoulder and Elbow Surgery

Volume 19, Issue 1, January 2010, Pages 157-164

https://doi.org/10.1016/j.jse.2009.04.008 Get rights and content

Hypothesis

The purpose of this study was to conduct a systematic review of the psychometric evidence relating to Constant-Murley score.

Materials and methods

A search of 3 databases (Medline, CINAHL, and EMBASE) and a manual search yielded 35 relevant publications. Pairs of raters used structured tools to analyze these articles, through critical appraisal and data extraction. A descriptive synthesis of the psychometric evidence was then performed.

Results

Quality ratings of 23% of the studies reviewed reached a level of 75% or higher. Studies evaluating the content validity of the Constant-Murley score suggest that the description in the original publication is insufficient to accomplish standardization between centers and evaluators. Despite this limitation, the Constant-Murley score correlates strongly (≥ 0.70) with shoulder-specific questionnaires, reaches acceptable benchmarks (ρ > 0.80) for its reliability coefficients, and is responsive (effect sizes and standardized response mean > 0.80) for detecting improvement after intervention in a variety of shoulder pathologies.

Discussion

This systematic review provides evidence to support the use of the Constant-Murley score for specific clinical and research applications but underscores the need for greater standardization and precaution when interpreting scores. Methods to improve standardization and measurement precision are needed. Responsiveness has been shown to be excellent, but some properties still need be evaluated, particularly those related to the absolute errors of measurement and minimal clinically important difference.

Conclusion

Given the widespread acceptance for usage of the Constant-Murley score in clinical studies and early indications that the measure is responsive, studies defining more rigid standardization of the tools/procedures are needed.

Level of evidence

Level 1

Section snippets

Materials and methods

Investigational Review Board approval was not required for this systematic review.

Discussion

This systematic review provides evidence to support the use of the CMS for specific clinical and research applications, but underscores the need for greater standardization for performing the CMS and precaution when interpreting scores. Despite identifying 34 studies that address at least one psychometric property of the CMS, a number of issues remain unresolved. For example, methods to improve standardization and precision of the strength and ROM subscales are needed. There is concern that

Disclaimer

The authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.

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Citation Excerpt :
However, its use is (up to now) only advised for patients with subacromial shoulder disorders96 and it is only validated in English.97 If patients are unable to achieve 90° abduction (which is the case in many patients with FS), they should receive the score 0, and this might not reflect the actual strength of this patient but rather the restriction of ROM.97,98 In addition, pain is measured in 2 elements, during self-report and as a factor in pain-free ROM.97
To determine (1) the effect of exercise therapy alone or in combination with other interventions compared with solely exercises and programs with or without exercises and (2) what kind of exercise therapy or combination with other interventions is most effective.
PubMed, Web of Science and Cochrane Central Register of Controlled Trials.
Studies were screened in a 2-phase approach by 2 independent reviewers (M.M. and L.M.). Reference lists of included studies and interesting systematic reviews were hand searched.
Two independent reviewers (M.M. and L.M.) extracted information about origin, characteristics of study participants, eligibility criteria, characteristics of interventions, outcome measures and main results in a pre-defined template.
Thirty-three studies were included in the qualitative and 19 in the meta-analysis. Preliminary evidence was found for supervised exercises to be more beneficial than home exercises for ROM and function. Multimodal programs comprising exercises may result in little to no difference in ROM compared to solely exercises. Programs comprising muscle energy techniques show little to no difference in ROM when compared with programs with other exercises. Adding stretches to a multimodal program with exercises may increase ROM. There is uncertain evidence that there is a difference between those programs regarding function and pain. Preliminary evidence was found for several treatment programs including exercises to be beneficial for improvement in both passive and active ROM, function, pain, and muscle strength. No studies used patient satisfaction as an outcome measure.
ROM, function, and pain improve with both solely exercises and programs with exercises, but for ROM and pain there was little to no difference between programs and for function the evidence was uncertain. Adding exercises improve active ROM compared with a program without exercises, whereas adding physical modalities has no beneficial effect. Muscle energy techniques are a beneficial type of exercise therapy for improving function compared with other types of exercise. Unfortunately, no conclusion can be drawn about the results in the long-term and most effective dose of exercise therapy.

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Review ArticleA systematic review of the psychometric properties of the Constant-Murley score

Hypothesis

Materials and methods

Results

Discussion

Conclusion

Level of evidence

Section snippets

Materials and methods

Discussion

Disclaimer

J Shoulder Elbow Surg

J Shoulder Elbow Surg

J Shoulder Elbow Surg

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Arthritis Rheum

Comprehensive assessment of clinical outcome and quality of life after total shoulder arthroplasty: usefulness and validity of subjective outcome measures

Arthritis Rheum

Dynamic ultrasonography of rotator cuff muscles

J Clin Ultrasound

Clinimetric evaluation of shoulder disability questionnaires: a systematic review of the literature

Ann Rheum Dis

An evaluation of the Constant-Murley shoulder assessment

J Bone Joint Surg Br

Review Article
A systematic review of the psychometric properties of the Constant-Murley score