title: A prediction rule for shoulder pain related sick leave: a prospective cohort study Shoulder disorders: a state-of-the-art review Measuring Function of the Shoulder. A Cross-Sectional Comparison of Five Questionnaires* Shoulder disability questionnaire design and responsiveness of a functional status measure. The Oxford shoulder score revisited Questionnaire on the perceptions of patients about shoulder surgery. Costs of shoulder pain and resource use in primary health care: a cost-of-illness study in Sweden American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, patient self-report section: reliability, validity, and responsiveness. A Self-Administered Questionnaire for Assessment of Symptoms and Function of the Shoulder* Measurement of shoulder related disability: results of a validation study. Italian version of ASES questionnaire for shoulder assessment: cross-cultural adaptation and validation Development and Psychometric Evaluation of the Flexilevel Scale of Shoulder Function Comparative Evaluation of the Measurement Properties of Various Shoulder Outcome Instruments Development of a shoulder pain and disability index.
abstract: Background Shoulder pain is common in primary care , and has an unfavourable outcome in many patients . Information about predictors of shoulder pain related sick leave in workers is scarce and inconsistent . The objective was to develop a clinical prediction rule for calculating the risk of shoulder pain related sick leave for individual workers , during the 6 months following first consultation in general practice . Methods A prospect i ve cohort study with 6 months follow-up was conducted among 350 workers with a new episode of shoulder pain . Potential predictors included the results of a physical examination , sociodemographic variables , disease characteristics ( duration of symptoms , sick leave in the 2 months prior to consultation , pain intensity , disability , comorbidity ) , physical activity , physical work load , psychological factors , and the psychosocial work environment . The main outcome measure was sick leave during 6 months following first consultation in general practice . Results Response rate to the follow-up question naire at 6 months was 85 % . During the 6 months after first consultation 30 % ( 89/298 ) of the workers reported sick leave . 16 % ( 47 ) reported 10 days sick leave or more . Sick leave during this period was predicted in a multivariable model by a longer duration of sick leave prior to consultation , more shoulder pain , a perceived cause of strain or overuse during regular activities , and co-existing psychological complaints . The discriminative ability of the prediction model was satisfactory with an area under the curve of 0.70 ( 95 % CI 0.64–0.76 ) . Conclusion Although 30 % of all workers with shoulder pain reported sick leave during follow-up , the duration of sick leave was limited to a few days in most workers . We developed a prediction rule and a score chart that can be used by general practitioners and occupational health care providers to calculate the absolute risk of sick leave in individual workers with shoulder pain , which may help to identify workers who need additional attention . The performance and applicability of our model needs to be tested in other working population s with shoulder pain to enable valid and reliable use of the score chart in everyday practice This paper provides an up-to- date overview of the occurrence , diagnosis , risk factors , prognostic indicators and outcome of shoulder disorder ( SD ) , and of the validity and reproducibility of diagnostic classifications and diagnostic imaging techniques for SD . Furthermore , the available evidence on the effectiveness of non-steroidal anti-inflammatory drugs ( NSAIDs ) , corticosteroid injections and physiotherapy for SD is summarized on the basis of r and omized controlled trials with an acceptable quality of their methods . The annual incidence of SD is estimated at about 7 % , its 1-year period prevalence at about 51 % and its lifetime prevalence at about 10 % . While approximately 50 % of all patients with SD seek medical care , about 95 % are treated in primary health care . Of all new episodes of SD presenting to primary care , approximately 50 % seem to resolve within 6 months , while about 40 % seem to persist for up to 12 months . Several prognostic indicators for a favourable or a poor outcome of SD have been identified , but a comprehensive prognostic model is not available . While evidence for the prognostic validity of popular diagnostic classifications of SD is lacking , their reproducibility has been shown to be poor . The accuracy and clinical usefulness of diagnostic imaging techniques appear to be sufficiently verified for SD in secondary care , while their clinical usefulness in primary care and prognostic validity are not . NSAIDs and steroid injections for SD have been shown to be effective within 6 weeks , but their effect on long-term outcome remains unclear . There is very limited evidence for the effectiveness in SD of physiotherapy , including exercise therapy , ultrasound , electrotherapy , laser , mobilization and manipulation Measures of both generic and disease-specific health status are being developed and used with increasing frequency for the appraisal of musculoskeletal conditions . The purpose of this study was to compare prospect ively the validity of five question naires in the assessment of function of the shoulder . Ninety subjects who had various problems related to the shoulder agreed to enter the study . All of the subjects completed a question naire package that included the  Shoulder Pain and Disability Index , the Simple Shoulder Test , the Subjective Shoulder Rating Scale , the Modified American Shoulder and Elbow Surgeons Shoulder Patient Self-Evaluation Form , and the Shoulder Severity Index as well as a measure of generic health status ( the acute version of the Short Form 36 [ SF-36 ] ) and two questions that asked the patient to rate the severity of the problem and his or her over-all health . Frequency distributions were created and compared among question naires . Spearman rank correlations were calculated to compare the question naires with each other and with other assessment s. One-way analysis of variance was used to determine the ability of the question naires to discriminate between self-rated severity of the problem and over-all health . The frequency distributions were similar among the five shoulder question naires , but those of the five shoulder question naires differed from that of the SF-36 . The correlations were good ( 0.73 ⩽ r ⩽ 0.80 ) among all of the five shoulder question naires except the Subjective Shoulder Rating Scale ; they were lower with the Subjective Shoulder Rating Scale and the physical function dimension of the SF-36 ( 0.12 ⩽ r ⩽ 0.60 ) . The shoulder question naires discriminated between levels of severity ( p < 0.0001 ) but not between levels of over-all health ( 0.10 ⩽ p ⩽ 0.86 ) . In this concurrent comparison of measures of shoulder-specific outcome in the same subjects , the shoulder question naires performed similarly , both in describing function of the shoulder and in discriminating between levels of severity . The shoulder question naires performed differently than the SF-36 , which confirms the need to use both disease-specific and generic health-status measures to evaluate patients who have a problem related to the shoulder The Shoulder Disability Question naire ( SDQ ) is a measure covering 16 items design ed to evaluate functional status limitation in patients with shoulder disorders . The responsiveness of the SDQ was evaluated for 180 patients with soft tissue shoulder disorders , without underlying systemic disorders . These patients participated in a r and omized placebo-controlled trial , in which ultrasound and electrotherapy appeared to be ineffective as adjuvants to st and ardized exercise therapy . At baseline and at 6-week follow-up , patients completed the  SDQ  and rated severity of shoulder pain and their chief complaint , while a research physiotherapist rated severity of symptoms and restriction of mobility . At the 6-week follow-up , patients also rated overall change since baseline . According to the calibrated responsiveness ratio ( CRR ) and the area under the receiver-operator characteristic curve ( AUC ) the SDQ discriminates accurately between self-rated clinical ly stable and improved subjects . The presented results suggest that the SDQ is as responsive as the compared outcome measures , and therefore is ready for use in clinical trials The vali date d ,  patient-reported Oxford shoulder score ( OSS ) was introduced around 10 years ago , primarily for the assessment of outcomes of  shoulder surgery ( excluding shoulder stabilisation )  in r and omised trials . Its uptake has steadily increased in a number of countries and its use has also been extended . Recently a number of issues have been raised in relation to other related patient-reported outcome measures which were devised around the same time as the OSS . This included recommendations to change the scoring system . This paper review s issues concerning patient-reported outcome measures that apply to the OSS and makes some recommendations ( including changes to the scoring system ) as to how it should be used We developed a 12-item question naire for completion by patients having shoulder operations other than stabilisation . A prospect i ve study of 111 patients was undertaken before operation and at follow-up six months later . Each patient completed the new question naire and the SF36 form . Some filled in the Stanford Health Assessment Question naire ( HAQ ) . An orthopaedic surgeon assessed the Constant shoulder score . The single score derived from the question naire had a high internal consistency . Reproducibility , examined by test-retest reliability , was found to be satisfactory . The validity of the question naire was established by obtaining significant correlations in the expected direction with the Constant score and the relevant scales of the SF36 and the HAQ . Sensitivity to change was assessed by analysing the differences between the preoperative scores and those at follow-up . Changes in scores were compared with the patients ' responses to postoperative questions about their condition . The st and ardised effect size for the new question naire compared favourably with that for the SF36 and the HAQ . The new question naire was the most efficient in distinguishing patients who said that their shoulder was much better from all other patients . The shoulder question naire provides a measure of outcome for shoulder operations which is short , practical , reliable , valid and sensitive to clinical ly important changes Background Painful shoulders pose a substantial socioeconomic burden . A prospect i ve cost-of-illness study was performed to assess the costs associated with healthcare use and loss of productivity in patients with shoulder pain in primary health care in Sweden . Methods The study was performed in western Sweden , in a region with 24 000 inhabitants . Data were collected during six months from electronic patient records at three primary healthcare centres in two municipalities . All patients between 20 and 64 years of age who presented with shoulder pain to a general practitioner or a physiotherapist were included . Diagnostic codes were used for selection , and the cases were manually controlled . The cost for sick leave was calculated according to the human capital approach . Sensitivity analysis was used to explore uncertainty in various factors used in the model . Results 204 ( 103 women ) patients , mean age 48 ( SD 11 ) years , were registered . Half of the cases were closed within six weeks , whereas 32 patients ( 16 % ) remained in the system for more than six months . A fifth of the patients were responsible for 91 % of the total costs , and for 44 % of the healthcare costs . The mean healthcare cost per patient was € 326 ( SD 389 ) during six months . Physiotherapy treatments accounted for 60 % . The costs for sick leave contributed to 84 % of the total costs . The mean annual total cost was € 4139 per patient . Estimated costs for secondary care increased the total costs by one third . Conclusions The model applied in this study provides valuable information that can be used in cost evaluations . Costs for secondary care and particularly for sick leave have a major influence on total costs and interventions that can reduce long periods of sick leave are warranted The purpose of this study was to examine the psychometric properties of the American Shoulder and Elbow Surgeons St and ardized Shoulder Assessment Form ( ASES ) , patient self-report section . Patients with shoulder dysfunction ( n = 63 ) completed the ASES , The University of Pennsylvania Shoulder Score , and the  Short Form-36  during the initial evaluation , 24 to 72 hours after the initial visit , and after 3 to 4 weeks of physical therapy . The test-retest reliability ( intraclass correlation coefficient[1-way r and om-effects ] , 0.84 ; 95 % CI lower limit , 0.75 ) and internal consistency ( Cronbach alpha , 0.86 ) values were acceptable . The st and ard error of the measure was 6.7 ASES points ( 90 % CI , 11.0 ) . Construct and discriminant validity was demonstrated . Responsiveness was demonstrated with a st and ardized response mean of 1.5 and an effect size of 1.4 . The minimal detectable change was 9.7 ASES points ( 90 % CI , 16 ) , and the minimal clinical ly important difference was 6.4 ASES points . The results indicate that the ASES is a reliable , valid , and responsive outcome tool A self-administered question naire was design ed to assess the severity of symptoms related to and the functional status of the shoulder . It includes domains of global assessment , pain , daily activities , recreational and athletic activities , work , satisfaction , and areas for improvement . Each domain is grade d separately and is weighted to arrive at the total score . The over-all scale and each domain were prospect ively tested for validity , reliability , and responsiveness to clinical change . One hundred patients who were seen for evaluation of the shoulder were enrolled in the study . The validity of the scale was demonstrated by moderate-to-high correlation of the domains and individual questions of the Shoulder Rating Question naire with those of the Arthritis Impact Measurement Scales 2 . Validity was supported further by significant correlation of the scores in each domain with the level of satisfaction in that domain and by significantly lower scores in domains that patients selected as areas important for improvement . The over-all scale and each domain were internally consistent ( Cronbach alpha , 0.71 to 0.90 ) . Reproducibility was evaluated by repeated administration of the question naire after a mean of three days to forty patients whose condition was clinical ly stable . Reproducibility of the over-all question naire and individual domains was excellent ( Spearman-Brown index , 0.94 to 0.98 ) . Individual questions were reproducible , with a weighted kappa value of more than 0.7 for each . Responsiveness was evaluated by comparison of the preoperative and postoperative scores of thirty patients who had a satisfactory result one year after an operation on the shoulder . The over-all Shoulder Rating Question naire and each domain were responsive to clinical change as demonstrated by favorable st and ardized response means ( range , 1.1 to 1.9 ) and indices of responsiveness ( range , 1.1 to 2.0 ) . Similar analysis performed for individual diagnostic groups supported the validity , reliability , and responsiveness of the question naire in each group . The self-administered shoulder question naire was found to be valid , reliable , and responsive to clinical change . These qualities should make it a useful instrument for the prospect i ve assessment of the outcome of treatment of disorders related to the shoulder OBJECTIVE --To develop and vali date a question naire to quantify disability associated with shoulder symptoms . METHODS --A set of questions relevant to shoulder symptoms from a general disability interview was developed and the question naire applied to a cross-sectional population survey and a prospect i ve study of general practice attenders . Subjects included adults who reported current shoulder pain in a population survey and patients from three general practice s who attended with shoulder symptoms during a six month period . The main outcome measures were : frequency of problems with daily living related to shoulder symptoms , total score on 22-item disability question naire , and measures of shoulder movement . RESULTS --A higher proportion ( 80 % ) of patients attending their general practitioner with shoulder symptoms had five or more disabilities compared with subjects reporting shoulder pain in a community survey ( 34 % ) . The ranked frequency with which each disability was reported was similar in the two groups , although sleep disturbance was the most common problem in consulters . Self-reported disability is correlated with measures of restricted shoulder movement . CONCLUSION --This disability question naire was simple to complete and should prove useful for both general practice and population -based studies of shoulder pain The patient-oriented measures , represented by self-administered question naire , have become an important aspect of clinical outcome assessment . To be used with different language groups and in different countries , question naires must be translated and adapted to new cultural characteristics and then vali date d by a widely accepted process to evaluate reliability and validity , fundamental characteristic for each measure . The aim of the study is to perform the cross-cultural adaptation and to assess the Italian version instrument reliability and validity . The study design is a cross-cultural adaptation and cross-sectional study of a sample of patients affected by shoulder disorder with a sub sample followed prospect ively for retest reliability . The American Shoulder and Elbow Surgeons St and ardized Shoulder Assessment Form was culturally adapted for Italian-speaking people , following the simplified Guillemin criteria . Reliability and validity were assessed in a cross-sectional study of 50 consecutive patients affected by shoulder disorder . A sub- sample of 20 patients was followed prospect ively for retest reliability . The results were compared with other vali date d patient-oriented measures . The ASES scales showed a high correlation with other patient-oriented measures , as hypothesized , and it also showed good values with regard to reproducibility , consistency and validity , to the original versions published in English . These findings suggest that the evaluation capacities of the Italian version of ASES are equivalent to those of English language version Background . Existing measures of self‐reported shoulder function fail to measure effectively the full range of shoulder functioning . The classic approach for improving the reliability of a scale is adding items , but a scale with a substantial number of items imposes a large response burden on participants . A more efficient approach is to use modern psychometric methods to construct an adaptive scale in which patients respond only to items that are targeted at their level of shoulder function . Objectives . We developed a Flexilevel Scale of Shoulder Function ( FLEX‐SF ) . This scale includes three testlets that target low , medium , and high shoulder function . Scores on the testlets were equated to a common mathematical metric . Design and Subjects . We developed an initial pool of 68 items . This pool was administered to 400 patients , and responses were calibrated using a rating scale model . Subsets of items were identified for an easy , medium difficulty , and hard testlet . Properties of the scale were evaluated in a 3‐month longitudinal study of 200 shoulder patients . Results . The FLEX‐SF exhibited high reliability at both the scale level ( intraclass correlation coefficient [ 3,1 ] = 0.90 ) and specific trait levels . The validity of the FLEX‐SF was supported by its internal and external responsiveness ( Guyatt responsiveness index = 1.12 ) and the pattern of its associations with other health status measures . Conclusions . The FLEX‐SF can be used as a primary endpoint in clinical trials even when there are relatively few people in each treatment group . The scale also has excellent properties for use in clinical setting s tracking individual changes over time Background Various shoulder outcome instruments have been used despite lack of information on their measurement properties ; reliability , responsiveness , and validity ; and correlation with health-related quality of life . Hypothesis Most shoulder outcome instruments have poor correlation with Short Form−36 , a general measure of health-related quality of life , and with each other . Study Design Cohort study ( diagnosis ) ; Level of evidence , 2 . Methods A consecutive group of 285 patients who had undergone shoulder surgery completed several shoulder outcome instruments — Short Form−36 ; University of California , Los Angeles shoulder score ; American Shoulder and Elbow Surgeons shoulder evaluation form ; Constant score ; Simple Shoulder Test ; Western Ontario Shoulder Instability Index ; and the rating sheet for Bankart repair ( Rowe score)—preoperatively and at 3 , 6 , 9 , and 12 months postoperatively . Internal consistency , st and ardized response mean , effect size , and Pearson correlation were used to evaluate reliability , responsiveness , and validity . Results The American Shoulder and Elbow Surgeons form , Simple Shoulder Test , and Western Ontario Shoulder Instability Index displayed good internal consistency . The University of California , Los Angeles shoulder score and American Shoulder and Elbow Surgeons form exhibited good responsiveness , whereas Short Form−36 showed the least responsiveness . Pearson correlation coefficients between the shoulder outcome instruments and Short Form−36 were less than excellent ( r < .60 ) . Pearson correlation coefficients between the outcome instruments were generally low except for the Constant score and University of California , Los Angeles shoulder score ( r = .673 , P < .01 ) . Conclusion There was no single shoulder outcome instrument that was superior to the others in terms of the measurement properties . Most of the tested shoulder outcome instruments did not reflect health-related quality of life well and poorly correlated with each other . This meant that the comparison of a given surgical result with different outcome instruments might be of little practical utility . Further prospect i ve and serial studies should be conducted to develop better shoulder outcome instruments that have significant reliability , responsiveness , validity , and correlation with health-related quality of life . A careful combination of outcome instruments might be necessary to compensate the current evaluation systems A  shoulder pain and disability index ( SPADI ) was developed to measure the pain and disability associated with shoulder pathology . The SPADI is a self-administered index consisting of 13 items divided into two subscales : pain and disability . Thirty-seven male patients with shoulder pain were used in a study to examine the measurement characteristics of the SPADI . Test-retest reliability of the SPADI total and subscale scores ranged from 0.6377 to 0.6552 . Internal consistency ranged from 0.8604 to 0.9507 . SPADI total and subscale scores were highly negatively correlated with shoulder range of motion ( ROM ) supporting the criterion validity of the index . Principal components factor analysis with and without varimax rotation supported the construct validity of the total SPADI and its subscales . High negative correlations between changes in SPADI scores and changes in shoulder ROM indicated the SPADI detected changes in clinical status over short time intervals . The SPADI should prove useful for both clinical and research purpose
target: They have been shown to be valid , reliable , and responsive , with a low administration burden .
background: BACKGROUND The aim of this study was to perform a st and ardized and systematic evaluation of the available evidence on multi-item shoulder-specific patient-reported outcome measures that are applicable to a wide spectrum of disorders .