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Ann Rheum Dis. Apr 2004; 63(4): 335–341.
PMCID: PMC1754942

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

Abstract

Methods: Systematic literature searches were performed to identify self administered shoulder disability questionnaires. A checklist was developed to evaluate and compare the clinimetric quality of the instruments.

Results: Two reviewers identified and evaluated 16 questionnaires by our checklist. Most studies were found for the Disability of the Arm, Shoulder, and Hand scale (DASH), the Shoulder Pain and Disability Index (SPADI), and the American Shoulder and Elbow Surgeons Standardised Shoulder Assessment Form (ASES). None of the questionnaires demonstrated satisfactory results for all properties. Most questionnaires claim to measure several domains (for example, pain, physical, emotional, and social functioning), yet dimensionality was studied in only three instruments. The internal consistency was calculated for seven questionnaires and only one received an adequate rating. Twelve questionnaires received positive ratings for construct validity, although depending on the population studied, four of these questionnaires received poor ratings too. Seven questionnaires were shown to have adequate test-retest reliability (ICC >0.70), but five questionnaires were tested inadequately. In most clinimetric studies only small sample sizes (n<43) were used. Nearly all publications lacked information on the interpretation of scores.

Conclusion: The DASH, SPADI, and ASES have been studied most extensively, and yet even published validation studies of these instruments have limitations in study design, sample sizes, or evidence for dimensionality. Overall, the DASH received the best ratings for its clinimetric properties.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Higginson IJ, Carr AJ. Measuring quality of life: Using quality of life measures in the clinical setting. BMJ. 2001 May 26;322(7297):1297–1300. [PMC free article] [PubMed]
  • Croft P, Pope D, Zonca M, O'Neill T, Silman A. Measurement of shoulder related disability: results of a validation study. Ann Rheum Dis. 1994 Aug;53(8):525–528. [PMC free article] [PubMed]
  • Dawson J, Fitzpatrick R, Carr A. The assessment of shoulder instability. The development and validation of a questionnaire. J Bone Joint Surg Br. 1999 May;81(3):420–426. [PubMed]
  • Dawson J, Fitzpatrick R, Carr A. Questionnaire on the perceptions of patients about shoulder surgery. J Bone Joint Surg Br. 1996 Jul;78(4):593–600. [PubMed]
  • van der Heijden GJ, Leffers P, Bouter LM. Shoulder disability questionnaire design and responsiveness of a functional status measure. J Clin Epidemiol. 2000 Jan;53(1):29–38. [PubMed]
  • Hollinshead RM, Mohtadi NG, Vande Guchte RA, Wadey VM. Two 6-year follow-up studies of large and massive rotator cuff tears: comparison of outcome measures. J Shoulder Elbow Surg. 2000 Sep-Oct;9(5):373–381. [PubMed]
  • Hudak PL, Amadio PC, Bombardier C. 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. 1996 Jun;29(6):602–608. [PubMed]
  • Kirkley A, Griffin S, McLintock H, Ng L. The development and evaluation of a disease-specific quality of life measurement tool for shoulder instability. The Western Ontario Shoulder Instability Index (WOSI). Am J Sports Med. 1998 Nov-Dec;26(6):764–772. [PubMed]
  • Kohn D, Geyer M. The subjective shoulder rating system. Arch Orthop Trauma Surg. 1997;116(6-7):324–328. [PubMed]
  • L'Insalata JC, Warren RF, Cohen SB, Altchek DW, Peterson MG. A self-administered questionnaire for assessment of symptoms and function of the shoulder. J Bone Joint Surg Am. 1997 May;79(5):738–748. [PubMed]
  • Lo IK, Griffin S, Kirkley A. The development of a disease-specific quality of life measurement tool for osteoarthritis of the shoulder: The Western Ontario Osteoarthritis of the Shoulder (WOOS) index. Osteoarthritis Cartilage. 2001 Nov;9(8):771–778. [PubMed]
  • Pransky G, Feuerstein M, Himmelstein J, Katz JN, Vickers-Lahti M. Measuring functional outcomes in work-related upper extremity disorders. Development and validation of the Upper Extremity Function Scale. J Occup Environ Med. 1997 Dec;39(12):1195–1202. [PubMed]
  • Roach KE, Budiman-Mak E, Songsiridej N, Lertratanakul Y. Development of a shoulder pain and disability index. Arthritis Care Res. 1991 Dec;4(4):143–149. [PubMed]
  • Simonsick EM, Kasper JD, Guralnik JM, Bandeen-Roche K, Ferrucci L, Hirsch R, Leveille S, Rantanen T, Fried LP. Severity of upper and lower extremity functional limitation: scale development and validation with self-report and performance-based measures of physical function. WHAS Research Group. Women's Health and Aging Study. J Gerontol B Psychol Sci Soc Sci. 2001 Jan;56(1):S10–S19. [PubMed]
  • Croft P. Measuring up to shoulder pain. Ann Rheum Dis. 1998 Feb;57(2):65–66. [PMC free article] [PubMed]
  • Garratt Andrew, Schmidt Louise, Mackintosh Anne, Fitzpatrick Ray. Quality of life measurement: bibliographic study of patient assessed health outcome measures. BMJ. 2002 Jun 15;324(7351):1417–1417. [PMC free article] [PubMed]
  • Lohr KN, Aaronson NK, Alonso J, Burnam MA, Patrick DL, Perrin EB, Roberts JS. Evaluating quality-of-life and health status instruments: development of scientific review criteria. Clin Ther. 1996 Sep-Oct;18(5):979–992. [PubMed]
  • Bombardier C, Tugwell P. Methodological considerations in functional assessment. J Rheumatol Suppl. 1987 Aug;14 (Suppl 15):6–10. [PubMed]
  • Guyatt GH, Feeny DH, Patrick DL. Measuring health-related quality of life. Ann Intern Med. 1993 Apr 15;118(8):622–629. [PubMed]
  • Kirshner B, Guyatt G. A methodological framework for assessing health indices. J Chronic Dis. 1985;38(1):27–36. [PubMed]
  • McHorney CA, Tarlov AR. Individual-patient monitoring in clinical practice: are available health status surveys adequate? Qual Life Res. 1995 Aug;4(4):293–307. [PubMed]
  • Bland JM, Altman DG. Measurement error and correlation coefficients. BMJ. 1996 Jul 6;313(7048):41–42. [PMC free article] [PubMed]
  • Fitzpatrick R, Davey C, Buxton MJ, Jones DR. Evaluating patient-based outcome measures for use in clinical trials. Health Technol Assess. 1998;2(14):i–74. [PubMed]
  • Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986 Feb 8;1(8476):307–310. [PubMed]
  • de Bruin AF, Diederiks JP, de Witte LP, Stevens FC, Philipsen H. Assessing the responsiveness of a functional status measure: the Sickness Impact Profile versus the SIP68. J Clin Epidemiol. 1997 May;50(5):529–540. [PubMed]
  • Terwee CB, Dekker FW, Wiersinga WM, Prummel MF, Bossuyt PMM. On assessing responsiveness of health-related quality of life instruments: guidelines for instrument evaluation. Qual Life Res. 2003 Jun;12(4):349–362. [PubMed]
  • Testa MA, Simonson DC. Assesment of quality-of-life outcomes. N Engl J Med. 1996 Mar 28;334(13):835–840. [PubMed]
  • Heald SL, Riddle DL, Lamb RL. The shoulder pain and disability index: the construct validity and responsiveness of a region-specific disability measure. Phys Ther. 1997 Oct;77(10):1079–1089. [PubMed]
  • Romeo AA, Bach BR, Jr, O'Halloran KL. Scoring systems for shoulder conditions. Am J Sports Med. 1996 Jul-Aug;24(4):472–476. [PubMed]
  • Cook KF, Gartsman GM, Roddey TS, Olson SL. The measurement level and trait-specific reliability of 4 scales of shoulder functioning: an empiric investigation. Arch Phys Med Rehabil. 2001 Nov;82(11):1558–1565. [PubMed]
  • Curtis KA, Roach KE, Applegate EB, Amar T, Benbow CS, Genecco TD, Gualano J. Development of the Wheelchair User's Shoulder Pain Index (WUSPI). Paraplegia. 1995 May;33(5):290–293. [PubMed]
  • Davis AM, Wright JG, Williams JI, Bombardier C, Griffin A, Bell RS. Development of a measure of physical function for patients with bone and soft tissue sarcoma. Qual Life Res. 1996 Oct;5(5):508–516. [PubMed]
  • Marino RJ, Shea JA, Stineman MG. The Capabilities of Upper Extremity instrument: reliability and validity of a measure of functional limitation in tetraplegia. Arch Phys Med Rehabil. 1998 Dec;79(12):1512–1521. [PubMed]
  • Soldatis JJ, Moseley JB, Etminan M. Shoulder symptoms in healthy athletes: a comparison of outcome scoring systems. J Shoulder Elbow Surg. 1997 May-Jun;6(3):265–271. [PubMed]
  • Salerno DF, Franzblau A, Armstrong TJ, Werner RA, Becker MP. Test-retest reliability of the Upper Extremity Questionnaire among keyboard operators. Am J Ind Med. 2001 Dec;40(6):655–666. [PubMed]
  • Winters JC, Sobel JS, Groenier KH, Arendzen JH, Meyboom-De Jong B. A shoulder pain score: a comprehensive questionnaire for assessing pain in patients with shoulder complaints. Scand J Rehabil Med. 1996 Sep;28(3):163–167. [PubMed]
  • Roddey TS, Olson SL, Cook KF, Gartsman GM, Hanten W. Comparison of the University of California-Los Angeles Shoulder Scale and the Simple Shoulder Test with the shoulder pain and disability index: single-administration reliability and validity. Phys Ther. 2000 Aug;80(8):759–768. [PubMed]
  • Reise SP, Widaman KF, Pugh RH. Confirmatory factor analysis and item response theory: two approaches for exploring measurement invariance. Psychol Bull. 1993 Nov;114(3):552–566. [PubMed]
  • Hays RD, Morales LS, Reise SP. Item response theory and health outcomes measurement in the 21st century. Med Care. 2000 Sep;38(9 Suppl):II28–II42. [PMC free article] [PubMed]
  • McHorney CA, Cohen AS. Equating health status measures with item response theory: illustrations with functional status items. Med Care. 2000 Sep;38(9 Suppl):II43–II59. [PubMed]
  • Guyatt GH. Making sense of quality-of-life data. Med Care. 2000 Sep;38(9 Suppl):II175–II179. [PubMed]
  • Lydick E, Epstein RS. Interpretation of quality of life changes. Qual Life Res. 1993 Jun;2(3):221–226. [PubMed]
  • Greenhalgh J, Meadows K. The effectiveness of the use of patient-based measures of health in routine practice in improving the process and outcomes of patient care: a literature review. J Eval Clin Pract. 1999 Nov;5(4):401–416. [PubMed]
  • Hays RD, Anderson R, Revicki D. Psychometric considerations in evaluating health-related quality of life measures. Qual Life Res. 1993 Dec;2(6):441–449. [PubMed]
  • McHorney CA, Ware JE, Jr, Lu JF, Sherbourne CD. The MOS 36-item Short-Form Health Survey (SF-36): III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups. Med Care. 1994 Jan;32(1):40–66. [PubMed]
  • Cook Karon F, Roddey Toni S, Olson Sharon L, Gartsman Gary M, Valenzuela Franz Felix T, Hanten William P. Reliability by surgical status of self-reported outcomes in patients who have shoulder pathologies. J Orthop Sports Phys Ther. 2002 Jul;32(7):336–346. [PubMed]
  • Hyland Michael E. Recommendations from quality of life scales are not simple. BMJ. 2002 Sep 14;325(7364):599–599. [PMC free article] [PubMed]
  • van der Windt DA, van der Heijden GJ, de Winter AF, Koes BW, Devillé W, Bouter LM. The responsiveness of the Shoulder Disability Questionnaire. Ann Rheum Dis. 1998 Feb;57(2):82–87. [PMC free article] [PubMed]
  • Beaton DE, Katz JN, Fossel AH, Wright JG, Tarasuk V, Bombardier C. Measuring the whole or the parts? Validity, reliability, and responsiveness of the Disabilities of the Arm, Shoulder and Hand outcome measure in different regions of the upper extremity. J Hand Ther. 2001 Apr-Jun;14(2):128–146. [PubMed]
  • Skutek M, Fremerey RW, Zeichen J, Bosch U. Outcome analysis following open rotator cuff repair. Early effectiveness validated using four different shoulder assessment scales. Arch Orthop Trauma Surg. 2000;120(7-8):432–436. [PubMed]
  • SooHoo Nelson Fong, McDonald Allen P, Seiler John Gray, 3rd, McGillivary Gary R. Evaluation of the construct validity of the DASH questionnaire by correlation to the SF-36. J Hand Surg Am. 2002 May;27(3):537–541. [PubMed]
  • Beaton D, Richards RR. Assessing the reliability and responsiveness of 5 shoulder questionnaires. J Shoulder Elbow Surg. 1998 Nov-Dec;7(6):565–572. [PubMed]
  • Beaton DE, Richards RR. Measuring function of the shoulder. A cross-sectional comparison of five questionnaires. J Bone Joint Surg Am. 1996 Jun;78(6):882–890. [PubMed]
  • Williams JW, Jr, Holleman DR, Jr, Simel DL. Measuring shoulder function with the Shoulder Pain and Disability Index. J Rheumatol. 1995 Apr;22(4):727–732. [PubMed]
  • Meenan RF, Mason JH, Anderson JJ, Guccione AA, Kazis LE. AIMS2. The content and properties of a revised and expanded Arthritis Impact Measurement Scales Health Status Questionnaire. Arthritis Rheum. 1992 Jan;35(1):1–10. [PubMed]
  • Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res. 1987 Jan;(214):160–164. [PubMed]
  • Rowe CR, Patel D, Southmayd WW. The Bankart procedure: a long-term end-result study. J Bone Joint Surg Am. 1978 Jan;60(1):1–16. [PubMed]
  • Ware JE, Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992 Jun;30(6):473–483. [PubMed]
  • Fries JF, Spitz P, Kraines RG, Holman HR. Measurement of patient outcome in arthritis. Arthritis Rheum. 1980 Feb;23(2):137–145. [PubMed]
  • Bergner M, Bobbitt RA, Carter WB, Gilson BS. The Sickness Impact Profile: development and final revision of a health status measure. Med Care. 1981 Aug;19(8):787–805. [PubMed]
  • Amstutz HC, Sew Hoy AL, Clarke IC. UCLA anatomic total shoulder arthroplasty. Clin Orthop Relat Res. 1981 Mar-Apr;(155):7–20. [PubMed]
  • Ellman H, Hanker G, Bayer M. Repair of the rotator cuff. End-result study of factors influencing reconstruction. J Bone Joint Surg Am. 1986 Oct;68(8):1136–1144. [PubMed]
  • Guyatt G, Walter S, Norman G. Measuring change over time: assessing the usefulness of evaluative instruments. J Chronic Dis. 1987;40(2):171–178. [PubMed]

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