AOT Musculoskeletal Outcomes book sample by AO Foundation

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AO Handbook Musculoskeletal Outcomes Measures and Instruments

Feedback Do you feel that an outcomes instrument is missing from this book? You don’t agree with one of our evaluations? We value your opinions, and will consider including your input in the next edition of this book. Contact us: outcomes@aofoundation.org

Assessment of your instrument If you have developed your own instrument and would like us to have a look at it, send us a your concept. AO Clinical Investigation and Documentation (AOCID) will review your instrument and provide you with feedback. Contact us: outcomes@aofoundation.org

• • • • • •

What outcomes are important to patients and clinicians? What questions make up an outcomes instrument? How is a specific instrument scored? Is it completed by the clinician or the patient? Has the instrument undergone validity or reliability testing? In what population was it validated, and how did it perform?

These questions were the impetus behind the development of this handbook, which provides both educational and quick-reference value. Concepts that are used to evaluate each instrument like validity, reliability, and responsiveness are discussed in a manner that often makes a difficult topic easy to grasp. The purpose of this handbook is to provide the clinician or researcher with a user-friendly display of the most common disease-specific musculoskeletal outcomes instruments, all in one quick-reference location. This book is for orthopedic surgeons, physiatrists, family practice physicians, rheumatologists, musculoskeletal pain specialists, nurses, physical therapists, occupational therapists, and any other health professional that may encounter these outcome instruments.

Suk, Hanson, Norvell, Helfet

Any outcomes instruments that come to our attention, which are not discussed in this edition but fulfill our criteria will be assessed and published on our website.

Outcomes instruments that attempt to assess the function and quality of life in orthopedic patients are multiplying. In this new quick-reference book, more than 150 outcomes instruments for the musculoskeletal extremities are summarized and evaluated!

Musculoskeletal Outcomes Measures and Instruments (Vol 1)

Updates

Michael Suk Beate P Hanson Daniel C Norvell David L Helfet

AO Handbook

Musculoskeletal Outcomes Measures and Instruments Volume 1

Selection and Assessment Upper Extremity

ISBN 978-3-13-141062-7

www.aofoundation.org

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AO Handbook Musculoskeletal Outcomes Measures and Instruments

• • • • • •

Suk, Hanson, Norvell, Helfet

Any outcomes instruments that come to our attention, which are not discussed in this edition but fulfill our criteria will be assessed and published on our website.

Musculoskeletal Outcomes Measures and Instruments (Vol 2)

Updates

Michael Suk Beate P Hanson Daniel C Norvell David L Helfet

AO Handbook

Musculoskeletal Outcomes Measures and Instruments Volume 2

Lower Extremity

ISBN 978-3-13-141062-7

www.aofoundation.org

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Table of contents—Volume 1 Selection and Assessment Upper Extremity I Preface IX II Acknowledgements XIII III Editors XIV 1

Introduction 1 1.1 Current challenges 1 1.2 The handbook 2 1.3 The audience 2

2 Why 2.1 2.2 2.3 2.4 2.5 2.6

appropriate selection is important 3 Introduction 3 Outcomes research 3 Outcomes, outcomes, and more outcomes 4 Selecting important outcomes 5 Conclusion 6 References 6

3 What 3.1 3.2 3.3 3.4 3.5

makes a quality outcomes instrument? 7 Content 7 Methodology 8 Clinical utility 20 Assessing the overall quality of the instrument 23 References 24

4 Clinician-based outcomes measures 27 4.1 Introduction 27 4.2 What are clinician-based outcomes measures? 27 4.3 Are CBO measures more objective than PRO measures? 28 4.4 Do clinician-based outcomes accurately measure patient function? 29 4.5 References 31 5 The purpose of patient-reported outcomes 33 5.1 What are patient-reported outcomes? 33 5.2 The emergence of patient-reported outcomes 33 5.3 Types of instruments 34 5.4 References 36 V

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Musculoskeletal Outcomes Measures and Instruments—Volume 1 Selection and Assessment / Upper Extremity

6 Recommendations 37 6.1 Evaluating outcomes instruments: choosing the right one 37 6.2 Developing outcomes instruments: points to consider 39 6.3 References 43 7 Patient expectations of outcomes 45 7.1 The evolving outcome paradigm 45 7.2 The role of patient expectations 46 7.3 Next challenges 48 7.4 R eferences 50 8 Identifying and evaluating musculoskeletal outcomes instruments 53 8.1 Explanation of search strategy 53 8.2 Summary of outcomes instrument content 54 8.3 S ummary of outcomes instrument methodological evaluation 55 8.4 S ummary of outcomes instrument clinical utility evaluation 56 8.5 Summary of instrument total score 57 8.6 Justification for our scoring system 58 9 Generic and upper extremity outcomes measures and instruments 65 9.1 Generic instruments 71 9.2 Shoulder 81 9.3 Elbow 211 9.4 Wrist/hand 268 A1 List of abbreviations AI A2 Glossary and definitions AV A3 List of assessed instruments AIX

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Table of contents—Volume 2 Lower Extremity 10 Lower extremity outcomes measures and instruments 389 10.1 Pelvis 395 10.2 Hip 402 10.3 Knee 491 10.4 Ankle 628 10.5 Foot 716 10.6 Calcaneus 793 A1 List of abbreviations AI A2 Glossary and definitions AV A3 List of assessed instruments AIX

VII

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9.1 Generic

1. European Quality of Life (EuroQoL) (1990) Source: The EuroQol Group (1990) EuroQol—a new facilit y for the measurement of health-related qualit y of life. Health Policy; 16(3):199–208.

Content Type Patient-reported outcome Scale 6 categories:

Mobility (3 disability levels) Social relationships (2 disability levels) Main activity (2 disability levels) Self-care (3 disability levels) Pain (3 disability levels) Mood (2 disability levels)

Mobility, self-care, and pain categories are ranked from 1 to 3 depending on level of disability. Main activity, social relationships and mood categories are ranked from 1 to 2 depending on level of disability. Interpretation The final score has a unique 6-digit descriptor corresponding to the levels of disability of each category ranging from 111111 to 332232.

The resulting descriptive system defines 216 possible health states. Preferential weights are assigned to each health state level (eg, 21111 = 0.85) to obtain a score of 0 (death) to 1 (optimal health). Maximum health state score: 1 point Minimum health state score: 0 points The lower the score, the greater the disability.

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9.1 Generic

2. European Quality of Life (EuroQoL EQ-5D) (1994) Source: Hurst NP, Jobanputra P, Hunter M, et al (1994) Validit y of Euroqol—a generic health status instrument--in patients with rheumatoid arthritis. Economic and Health Outcomes Research Group. Br J Rheumatol; 33:655–662.

Content Type Patient-reported outcome Scale 5 categories:

Mobility (3 disability levels) Self-care (3 disability levels) Usual activity (3 disability levels) Pain (3 disability levels) Anxiety/depression (3 disability levels)

The “social relationships” category was deleted from the original EuroQoL and “main activity” and “mood” has been renamed “usual activity” and “anxiety/depression” respectively. Categories ranked from 1 to 3 depending on level of disability. An additional category relating to health state today is scored on a 0 to 100 visual analog scale (VAS). This VAS is not part of the fi nal analyses. Interpretation The fi nal score has a unique 5-digit descriptor corresponding to the levels of disability of each category ranging from 11111 to 33333.

The resulting descriptive system defi nes 243 possible health states. Preferential weights are assigned to each health state level (eg, 21111 = 0.85) to obtain a score of 0 (death) to 1 (optimal health). Maximum health state score: 1 point Minimum health state score: 0 points The lower the score, the greater the disability.

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9.1 Generic

3. Musculoskeletal Function Assessment (MFA) (1996) Source: Martin DP, Engelberg R, Agel J, et al (1996) Development of a musculoskeletal extremit y health status instrument: the Musculoskeletal Function Assessment instrument. J Orthop Res; 14:173–181.

Content Type Patient-reported outcome Scale 10 categories (100 items):

Self-care (18 items) Sleep and rest (6 items) Hand and fine motor skills (7 items) Mobility (20 items) Housework (9 items) Employment and work (4 items) Leisure and recreational activities (4 items) Family relationships (10 items) Cognition and thinking (4 items) Emotional adjustment, coping, and adaptation (18 items)

Items scored with a “yes” (1 point) or “no” (0 points) response to each statement. Interpretation Raw category score = sum of all yes/no items within a category Raw MFA score = sum of all 100 yes/no items or sum of raw category scores

Standardized category score = (raw category score/number of items in category)/ × 100 The MFA score = (raw MFA score/100) × 100 Maximum score: 100 points Minimum score: 0 points The lower the score, the greater the disability.

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9.1 Generic

4. Short Musculoskeletal Function Assessment (SMFA) (1999) Source: Swiontkowski MF, Engelberg R, Martin DP, et al (1999) Short musculoskeletal function assessment questionnaire: validit y, reliabilit y, and responsiveness. J Bone Joint Surg Am; 81:1245–1260.

Content Type Generic patient-reported outcome Scale Two indices (46 items): “Dysfunction index“ (34 items) and “Bother index” (12 items).

Dysfunction index (34 items): • Amount of difﬁ culty one has performing certain functions (25 items) • How often one has difﬁ culty when performing certain functions (9 items)

Functions are divided into the following 4 categories: • Daily activities • Emotional status • Function of the arm and hand • Mobility

Bother index (12 items): Allows patients to assess how much they are bothered by problems in the following broad functional areas: • Recreation and leisure • Sleep and rest • Work • Family Each item scored on 1 to 5-point Likert scale.

Interpretation Item responses are summed then scores are normalized to a range of 0 to 100 points with the following formula:

([actual raw score - lowest possible raw score]/possible range of raw score) × 100 The higher the score, the greater the disability.

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9.1 Generic

5. Nottingham Health Profile (NHP)

(1981)

Source: Hunt SM, McKenna SP, McEwen J, et al (1981) The Nottingham Health Profile: subjective health status and medical consultations. Soc Sci Med [A]; 15:221–229.

Content Type Patient-reported outcome Scale 6 subscales (38 items):

Physical mobility (8 items) Pain (8 items) Sleep (5 items) Emotional reactions (9 items) Social isolation (5 items) Energy level (3 items)

Items scored with a “yes” (1 point) or “no” (0 points) response to each statement. Total score for each subscale is based on the percentage of items affirmed (ie, “yes”) in each subscale. Interpretation Each subscale scored separately.

Overall score is the mean across all subscales. Maximum score: 100 points Minimum score: 0 points The lower the score, the greater the disability.

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9.1 Generic

6. Quality of Well-Being (QWB) (1976) Also known as Index of well-being Source: Kaplan RM, Bush JW, Berry CC (1976) Health status: t ypes of validit y and the index of well-being. Health Serv Res; 11(4):478–507.

Content Type Patient-reported outcome Scale 4 categories:

Mobility (3 disability levels) Physical activities (3 disability levels) Social activities (5 disability levels) Symptoms/problem complexes (21 severity levels)

Mobility and physical activities are ranked from 1 to 3 depending on level of disability. Social activities are ranked from 1 to 5 depending on level of disability. The symptoms/problem complexes are evaluated as being “present” or “absent”, and only the most severe complex is scored. Interpretation The fi nal score has a unique 4 or 5-digit descriptor corresponding to the levels of disability of each category.

The resulting descriptive system defi nes 945 possible health states. Preferential weights are assigned to each health state level (eg, 111(12) = 0.74) to obtain a score of 0 (death) to 1 (optimal health). Maximum health state score: 1 point Minimum health state score: 0 points The lower the score, the greater the disability.

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9.1 Generic

7. Short Form 36 health survey questionnaire (SF‑36)* (1992) Source SF‑36: Ware JE Jr, Sherbourne CD (1992) The MOS 36-item short-form health sur vey (SF-36). I. Conceptual framework and item selection. Med Care; 30(6):473–483. Other versions available: SF-12, SF-8 Both shor ter versions measure the same 8 subscales with fewer items.

Content Type Patient-reported outcome Scale 8 subscales (36 items): Physical functioning (10 items) Physical role limitations (4 items) Bodily pain (2 items) General health (5 items) Vitality (4 items) Social functioning (2 items) Emotional role limitations (3 items) Mental health (5 items)

Reported health transition (1 item) is used to measure changes in health status. It is not included in any of the subscales and is administered as a supplemental question. Interpretation Items are normalized to 100 and subscales scored separately.

Maximum subscale score: 100 points Minimum subscale score: 0 points The lower the score, the greater the disability. Norm-Based Scoring (NBS) can be used to score all 3 SF surveys. Through NBS, scale and summary scores are standardized to a mean of 50 and a standard deviation of 10 in the general US population, allowing scores to be compared within and across the different SF surveys.

* The SF-36 and SF-12 are available in original (SF-36 and SF-12) and updated (SF36v2 and SF-12v2) versions, while the SF-8 is available in one version only. Versions 2.0 are very similar to versions 1.0; however, they offer a number of improvements, including increased range and precision for the role-functioning scales, improved item wording, and an easier-to-use format. The Health Status Questionnaire 2.0 (HSQ 2.0) is an adaptation of the SF-36 and contains all 36 items and 8 subscales of the original SF-36. A ninth subscale of depression with 3 items is added.

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9.1 Generic

8. Short Form 12 health survey questionnaire (SF-12)* (1996) Source: Ware J Jr, Kosinski M, Keller SD (1996) A 12-Item Short-Form Health Sur vey: construction of scales and preliminar y tests of reliabilit y and validit y. Med Care; 34(3):220 –233.

Content Type Patient-reported outcome Scale 2 subscales (12 items):

Physical health • General health (1 item) • Physical functioning (2 items) • Physical role limitations (2 items) • Bodily pain (1 item)

Mental health • Emotional role limitations (2 items) • Social functioning (1 item) • Vitality/mental health (3 items)

Vitality and mental health subscales are combined from the original SF-36. Items scored on a variable 1 to 6 point scale. Interpretation Items summed for each subscale to yield a physical health score and mental health score.

Maximum physical health score: 20 points Minimum physical health score: 6 points Maximum mental health score: 27 points Minimum mental health score: 6 points Sum the two subscales for a total score. Maximum total score: 47 points Minimum total score: 12 points The lower the score, the greater the disability. * The SF-36 and SF-12 are available in original (SF-36 and SF-12) and updated (SF36v2 and SF-12v2) versions, while the SF-8 is available in one version only. Versions 2.0 are very similar to versions 1.0; however, they offer a number of improvements, including increased range and precision for the role-functioning scales, improved item wording, and an easier-to-use format. The Health Status Questionnaire 2.0 (HSQ 2.0) is an adaptation of the SF-36 and contains all 36 items and 8 subscales of the original SF-36. A ninth subscale of depression with 3 items is added. 79

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9.1 Generic

9. Sickness Impact Profile (SIP) (1976) Sources: Bergner M, Bobbitt R A , Kressel S, et al (1976) The sickness impact profile: conceptual formulation and methodolog y for the development of a health status measure. Int J Health Serv; 6(3):393–415. Bergner M, Bobbitt R A , Carter WB, et al (1981) The Sickness Impact Profile: development and final revision of a health status measure. Med Care; 19(8):787–805.

Content Type Patient-reported outcome Scale 12 categories (136 items):

Social interaction (20 items) Eating (9 items) Work (9 items) Home management (10 items) Sleep and rest (7 items) Mobility (10 items) Alertness (10 items) Emotional behavior (9 items) Recreation (8 items) Ambulation (12 items) Communication (9 items) Self-care (23 items)

The following can be further aggregated into a physical dimension:

• Ambulation • Mobility • Self-care The following can be further aggregated into a psychosocial dimension:

• Social interaction • Alertness • Emotional behavior • Communication The following are independent and each can be scored separately:

• Sleep and rest • Eating • Work • Home management Items scored with a “yes” (1 point) or “no” (0 points) response to each statement.

Interpretation For each category, dimension and overall score, scores are summed and expressed as a percentage of the maximum score possible. Scores can be calculated for each category, physical dimension, psychosocial dimension and overall. Maximum category, dimension and overall score: 100 points Minimum category, dimension and overall score: 0 points The higher the score, the greater the disability. 80

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9.2 Shoulder 84

American Shoulder and Elbow Surgeons (ASES) shoulder assessment Athletic shoulder outcome scoring system

88 90

Constant-Murley functional assessment of the shoulder 94

Darrow score for acromioclavicular separation

Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire 100

Dutch Shoulder Disability Questionnaire (SDQ-NL) 104

Flexilevel scale of Shoulder Function (FLEX-SF) Harryman rotator cuff functional assessment

106

108

Herscovici shoulder scale

110

Hospital for Special Surgery (HSS) shoulder assessment

112

Hospital of the University of Pennsylvania shoulder score

114

Imatani acromioclavicular separation evaluation system

116

Japanese Orthopedic Association (JOA) shoulder score

118

McGinnis and Denton rating scale for scapular fractures Melbourne Instability Shoulder Scale (MISS) Modified Rowe shoulder score Neer shoulder score

120

122

124 126

Oxford instability score Oxford shoulder score

128

Penn Shoulder Score (PSS)

132

Post functional rating for long-head biceps tendinitis QuickDASH

134

136

Rockwood score for sternoclavicular joint arthritis

140

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142

Rotator Cuff Quality of Life measure (RC-QOL) 146 Rowe shoulder score Modified Rowe shoulder score

122

148

Shoulder activity rating scale

150

Shoulder Function Assessment (SFA) scale 152

Shoulder instability questionnaire

154

Shoulder Pain and Disability Index (SPADI) Shoulder pain score

158

Shoulder rating questionnaire

160

Shoulder Severity Index (SSI)

164 166

Simple Shoulder Test (SST)

Single Assessment Numeric Evaluation (SANE) rating

170

172

Subjective Shoulder Rating Scale (SSRS) 176

Swanson shoulder score

Thorling subjective rating for subacromial decompression UCLA end-result score

180 182

UCLA shoulder rating score

United Kingdom Shoulder Disability Questionnaire (SDQ-UK)

188

Upper extremity functional limitation scale 190

Upper Extremity Function Scale (UEFS) Upper Limb Functional Index (ULFI)

184

186

Upper Extremity Functional Index (UEFI)

194

Walch-Duplay shoulder instability score Watson shoulder score

178

196

198

Western Ontario Instability Index (WOSI)

200

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9.2 Shoulder

Western Ontario Osteoarthritis of the Shoulder (WOOS) index Western Ontario Rotator Cuff (WORC) index

202

204

Wolfgang criteria for rating results of rotator cuff surgical repair

208

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9.2 Shoulder

American Shoulder and Elbow Surgeons (ASES) shoulder assessment (1994) Source: Richards RR, An KN, Bigliani LU, et al (1994) A standardized method for the assessment of shoulder function. J Shoulder Elbow Surg; 3:347–352.

Content Type Clinician-based outcome Scale 2 forms, 6 subscales (46 items):

Patient self-evaluation: • Pain (7 items) • Instability (1 item) • Activities of daily living (10 items)

Physician assessment: • Range of motion (5 items) • Strength (4 items) • Tenderness, crepitus, impingement (11 items) • Instability (8 items)

Items that are scored are scored on a 0 to variable maximum 3 or 10 point scale. (10 – pain score) × 5 + (5/3) × ADL Score) = Shoulder Score Index (SSI) Instability item of patient evaluation and all of the physician assessment items do not contribute to the total score. Interpretation Maximum score: 100 points Minimum score: 0 points

The lower the score, the greater the disability. Validation Outcomes validated against [3] • Constant-Murley shoulder score • Visual analog scale for satisfaction

Outcomes validated against [5] • Rowe shoulder score • Modiﬁed Rowe shoulder score

Outcomes validated against [4] • Single assessment numeric evaluation • Rowe shoulder score

Outcomes validated against [7] • SF-36 • DASH • Shoulder pain and disability index • Constant-Murley shoulder score

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American Shoulder and Elbow Surgeons (ASES) shoulder assessment

Validation

9.2 Shoulder

(cont)

Outcomes validated against [8] • Patient satisfaction • Workers’ compensation • Activities of daily living • Work • Sports • Sleep • Instability • Forward elevation • Carrying weight at side • Lifting weight

Outcomes validated against [10] • University of Pennsylvania shoulder score • SF-36 • Therapist’s global rating of function Outcomes validated against [11] • Simple shoulder test • Subjective shoulder rating scale • Shoulder severity index • SF-36 • Shoulder pain and disability index

Outcomes validated against [8] • SF-12 Outcomes validated against [9] • Western Ontario rotator cuff

Patient population tested in

Reliability

Responsiveness

not tested

Patients expected to be stable in their shoulder function (N = 55) (48 years; 45% male) [1]

not tested

Patients with shoulder dysfunction (N = 110) (49 years; 65% male) [2]

not tested

Patients with combined tears of supraspinatus and infraspinatus (N = 23) (55 years; 70% male) [3]

not tested

Patients who underwent shoulder surgery for instability or signiﬁ cant AC separations (N = 163) (20 years; 90% male) [4]

not tested

Patients who underwent shoulder stabilization surgery (N = 52) (28 years; 69% male) [5]

not tested

Patients who underwent rotator cuff surgery or total shoulder arthroplasty (N = 44) (55 years; 59% male) [1]

Subjects without a history of shoulder injury or surgery (N = 343) (43 years; 54% male) [6] Patients who had undergone a shoulder arthroplasty (N = 43) (65 years; 23% male) [7] Patients with shoulder instability, rotator cuff disease or glenohumeral arthritis (N = 91) (50 years; 61% male) [8]

Validity

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9.2 Shoulder

Validation–(cont) Patient population tested in

Reliability

Responsiveness

not tested

Patients receiving treatment following shoulder impingement or surgery (N = 41) (57 years; 44% male) [9]

not tested

Patients with shoulder dysfunction (N = 63) (52 years; 41% male) [10]

Patients with various shoulder problems (N = 90) (48 years; 56% male) [11]

not tested

Patients with shoulder instability (n = 68) (31 years; 60% male); rotator cuff disease (n = 30) (57 years; 73% male); glenohumeral arthritis (n = 8) (62 years; 88% male) [8]

Validity

Validation studies: [1] Beaton D, Richards RR (1998) Assessing the reliability and responsiveness of 5 shoulder questionnaires. J Shoulder Elbow Surg; 7:565–572. [2] Cook KF, Roddey TS, Olson SL, et al (2002) Reliability by surgical status of self-reported outcomes in patients who have shoulder pathologies. J Orthop Sports Phys Ther; 32:336–346. [3] Skutek M, Fremerey RW, Zeichen J, et al (2000) Outcome analysis following open rotator cuff repair. Early effectiveness validated using four different shoulder assessment scales. Arch Orthop Trauma Surg; 120:432–436. [4] Williams GN, Gangel TJ, Arciero RA, et al (1999) Comparison of the Single Assessment Numeric Evaluation method and two shoulder rating scales. Outcomes measures after shoulder surgery. Am J Sports Med; 27:214–221. [5] Romeo AA, Bach BR Jr, O’Halloran KL (1996) Scoring systems for shoulder conditions. Am J Sports Med; 24:472–476. [6] Sallay PI, Reed L (2003) The measurement of normative American Shoulder and Elbow Surgeons scores. J Shoulder Elbow Surg; 12:622–627. [7] Angst F, Pap G, Mannion AF, et al (2004) Comprehensive assessment of clinical outcome and quality of life after total shoulder arthroplasty: usefulness and validity of subjective outcome measures. Arthritis Rheum; 51:819–828. [8] Kocher MS, Horan MP, Briggs KK, et al (2005) Reliability, validity, and responsiveness of the American Shoulder and Elbow Surgeons subjective shoulder scale in patients with shoulder instability, rotator cuff disease, and glenohumeral arthritis. J Bone Joint Surg Am; 87:2006–2011. [9] Razmjou H, Bean A, van Osnabrugge V, et al (2006) Cross-sectional and longitudinal construct validity of two rotator cuff disease-speciﬁc outcome measures. BMC Musculoskelet Disord; 7:26–32. [10] Michener LA, McClure PW, Sennett BJ (2002) American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, patient selfreport section: reliability, validity, and responsiveness. J Shoulder Elbow Surg; 11:587–594. [11] Beaton DE, Richards RR (1996) Measuring function of the shoulder. A cross sectional comparison of ﬁve questionnaires. J Bone Joint Surg Am; 78:882–890. 86

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American Shoulder and Elbow Surgeons (ASES) shoulder assessment

Reliability

Validity

Methodological evaluation

9.2 Shoulder

(5/6)

no score

0 points

1 point

points

Content validity

not tested

not valid

valid

Construct validity

not tested

not valid

valid

Criterion validity

not tested

not valid

valid

Internal consistency

not tested

not consistent

consistent

Reproducibility

not tested

not reproducible

reproducible

Responsiveness

not tested

not responsive

responsive

Subtotal

Clinical utility

(2/4)

0 points

1 point

2 points

points

Patient friendliness

limited

moderate

strong

Clinician friendliness

limited

moderate

strong

Subtotal

Total (out of 10)

7 87

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9.2 Shoulder

2. Athletic shoulder outcome scoring system (1993) Source: Tibone JE, Bradley JP (1993) Evaluation of treatment outcomes for the athlete’s shoulder. Matsen FA, F F, Hawkins RJ (eds), The Shoulder: a balance of mobility and stability. American Academy of Orthopedic Surgeons: Rosemont, IL.

Content Type Clinician-based outcome Scale 6 subscales (6 items):

Pain (10 points) Strength/endurance (10 points) Stability (10 points) Intensity (10 points) Performance (50 points) Range of motion (10 points) Items scored on a 0 to 10 or 50 point scale. Interpretation Excellent: 90–100 points Good: 70–89 points Fair: 50–69 points Poor: < 50 points

Validation No validation studies were identiﬁed.

Patient population tested in

Validity

Reliability

Responsiveness

Not applicable

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2. Athletic shoulder outcome scoring system

9.2 Shoulder

Reliability

Validity

Methodological evaluation

(0/6)

no score

0 points

1 point

points

Content validity

not tested

not valid

valid

Construct validity

not tested

not valid

valid

Criterion validity

not tested

not valid

valid

Internal consistency

not tested

not consistent

consistent

Reproducibility

not tested

not reproducible

reproducible

Responsiveness

not tested

not responsive

responsive

Subtotal

Clinical utility

(2/4)

0 points

1 point

2 points

points

Patient friendliness

limited

moderate

strong

Clinician friendliness

limited

moderate

strong

Subtotal

Total (out of 10)

2 89

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9.2 Shoulder

3. Constant-Murley functional assessment of the shoulder (1987) Also known as Constant-Murley shoulder score Source: Constant CR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res; (214):160 –164.

Content Type Clinician-based outcome Scale 4 subscales (13 items):

Pain (15 points) Activities of daily living (20 points) Range of motion (40 points) Strength (25 points)

Items scored on a 0 to variable maximum 2 to 15 point scale. An abbreviated score that excludes the strength assessment is also available. Interpretation Maximum score: 100 points Minimum score: 0 points

Maximum abbreviated score: 75 points Minimum abbreviated score: 0 points The lower the score, the greater the disability. Validation Outcomes validated against [3] • Oxford shoulder score Outcomes validated against [4] • Oxford shoulder score • Change in day-to-day life • Improvement • Success of operation • SF-36

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Constant-Murley functional assessment of the shoulder

Validation

9.2 Shoulder

(cont)

Outcomes validated against [6] • DASH • ASES shoulder assessment • Simple shoulder test Outcomes validated against [7] • SF-36 • DASH • Shoulder pain and disability index • ASES shoulder assessment Outcomes validated against [8] • Simple shoulder test • UCLA shoulder rating score • Forward elevation • Abduction ratio Patient population tested in

Validity

Reliability

Responsiveness

Patients with “abnormal” shoulders (N = 100) (age NR; sex NR) [1]

not tested

Patients with shoulder dysfunction (N = 110) (49 years; 65% male) [2]

not tested

Patients with frozen shoulders (N = 60) (53 years; 52% male) [3]

not tested

+/-

not tested

Patients who underwent open repair of supraspinatus and infraspinatus (N = 23) (55 years; 70% male) [6]

not tested

Patients who had undergone a shoulder arthroplasty (N = 43) (65 years; 23% male) [7]

not tested

Patients with full thickness rotator cuff tears treated with an open rotator cuff repair (N = 72) (58 years; 61% male) [8]

not tested

Swedish speaking volunteers with no shoulder pathology (N = 20) (26 years; 50% male) [9]

not tested

Patients who underwent rotator cuff surgery (N = 93) (58 years; 66% male) [4] Patients who underwent decompression surgery for chronic impingement syndrome (N = 28) (62 years; 46% male) [5]

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9.2 Shoulder

Validation

(cont)

Validation studies: [1] Constant CR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res; (214):160–164. [2] Cook KF, Roddey TS, Olson SL, et al (2002) Reliability by surgical status of self-reported outcomes in patients who have shoulder pathologies. J Orthop Sports Phys Ther; 32:336–346. [3] Othman A, Taylor G (2004) Is the constant score reliable in assessing patients with frozen shoulder? 60 shoulders scored 3 years after manipulation under anaesthesia. Acta Orthop Scand; 75:114–116. [4] Dawson J, Hill G, Fitzpatrick R, et al (2001) The beneﬁts of using patient-based methods of assessment. Medium-term results of an observational study of shoulder surgery. J Bone Joint Surg Br; 83:877–882. [5] O’Connor DA, Chipchase LS, Tomlinson J, et al (1999) Arthroscopic subacromial decompression: responsiveness of disease-speciﬁc and health-related quality of life outcome measures. Arthroscopy; 15:836–840. [6] Skutek M, Fremerey RW, Zeichen J, et al (2000) Outcome analysis following open rotator cuff repair. Early effectiveness validated using four different shoulder assessment scales. Arch Orthop Trauma Surg; 120:432–436. [7] Angst F, Pap G, Mannion AF, et al (2004) Comprehensive assessment of clinical outcome and quality of life after total shoulder arthroplasty: usefulness and validity of subjective outcome measures. Arthritis Rheum; 51:819–828. [8] Romeo AA, Mazzocca A, Hang DW, et al (2004) Shoulder scoring scales for the evaluation of rotator cuff repair. Clin Orthop; 107–114. [9] Johansson KM, Adolfsson LE (2005) Intraobserver and interobserver reliability for the strength test in the Constant-Murley shoulder assessment. J Shoulder Elbow Surg; 14:273–278.

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Constant-Murley functional assessment of the shoulder

9.2 Shoulder

Reliability

Validity

Methodological evaluation

(5/6)

no score

0 points

1 point

points

Content validity

not tested

not valid

valid

Construct validity

not tested

not valid

valid

Criterion validity

not tested

not valid

valid

Internal consistency

not tested

not consistent

consistent

Reproducibility

not tested

not reproducible

reproducible

Responsiveness

not tested

not responsive

responsive

Subtotal

Clinical utility

(2/4)

0 points

1 point

2 points

points

Patient friendliness

limited

moderate

strong

Clinician friendliness

limited

moderate

strong

Subtotal

Total (out of 10)

7 93

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9.2 Shoulder

4. Darrow score for acromioclavicular separation (1980) Source: Darrow JC Jr, Smith JA , Lockwood RC (1980) A new conser vative method for treatment of Type III acromioclavicular separations. Orthop Clin North Am; 11:727–733.

Content Type Patient-reported outcome Scale 4 subscales (4 items):

Pain (4 points) Function (4 points) Cosmesis (2 points) Satisfaction (2 points)

Items scored on a 0 to variable maximum 2 or 4 point scale. Interpretation Excellent: 11–12 points Good: 9–10 points Fair: 7–8 points Poor: 0–6 points

Validation No validation studies were identiﬁed.

Patient population tested in Not applicable

Validity -

Reliability -

Responsiveness -

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Darrow score for acromioclavicular separation

Reliability

Validity

Methodological evaluation

9.2 Shoulder

(0/6) (1/6)

no score

0 points

1 point

points

Content validity

not tested

not valid

valid

Construct validity

not tested

not valid

valid

Criterion validity

not tested

not valid

valid

Internal consistency

not tested

not consistent

consistent

Reproducibility

not tested

not reproducible

reproducible

Responsiveness

not tested

not responsive

responsive

Subtotal

Clinical utility

(0/4) (4/4)

0 points

1 point

2 points

points

Patient friendliness

limited

moderate

strong

Clinician friendliness

limited

moderate

strong

Subtotal

Total (out of 10)

4 95

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9.2 Shoulder

5. Disabilities of the Arm, Shoulder and Hand (DASH) (1996) Source: Hudak PL, Amadio PC , Bombardier C (1996) Development of an upper extremit y outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremit y Collaborative Group (UECG). Am J Ind Med; 29:602–608. Other versions available: Chinese, Dutch, French, German, Hebrew, Italian, Nor wegian, Spanish, Swedish, Taiwan Chinese, Turkish http://w w w.dash.iwh.on.ca

Content Type Patient-reported outcome Scale 3 modules (one required, two optional) Module 1: Function/symptoms (required)

7 subscales (30 items): Activities of daily living (85 points) Social/work activities (10 points) Recreational activities (15 points) Sexual activities (5 points) Severity of symptoms (25 points) Sleeping (5 points) Conﬁdence (5 points) Module 2: Sports/performing arts (optional) Sports/performing arts (20 points) Module 3: Work (optional) Work (20 points)

Items scored on a 1 to 5 point scale. Interpretation Scores normalized to 100 and each module scored separately. Maximum score: 100 points Minimum score: 0 points The higher the score, the greater the disability.

Validation Outcomes validated against [1] • SF-36

Outcomes validated against [2] • Shoulder pain and disability index • Brigham (carpal tunnel) questionnaire • Visual analog scales of pain, function and ability to work

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Disabilities of the Arm, Shoulder and Hand (DASH) 9.2 Shoulder

Validation Outcomes validated against [3] • Patient perception of change

Outcomes validated against [9] • Canadian occupational performance measure

Outcomes validated against [4] • Number of actively inﬂ amed joints • Grip strength

Outcomes validated against [10] • SF-36 • ASES shoulder assessment • Shoulder pain and disability index • Constant-Murley shoulder score

Outcomes validated against [5] • Constant-Murley shoulder score

Outcomes validated against [12] • Western Ontario rotator cuff index • Simple shoulder test • Internal and external range of motion • Isometric strength

Outcomes validated against [6] • SF-12 Outcomes validated against [7] • SF-36 • Health assessment questionnaire • Numeric pain rating scale • Range of motion

Outcomes validated against [13] • SF-36 • Pain intensity • Grip strength

Outcomes validated against [8] • SF-36 Patient population tested in

Validity

Reliability

Responsiveness

Patients with shoulder, elbow, wrist or hand complaints (N = 90) (40 years; 44% male) [1]

not tested

Patients with wrist/hand or shoulder disorders (N = 200) (54 years; 43% male) [2]

Patients with upper-extremity conditions planned for surgery (N = 109) (52 years; 42% male) [3]

Patients with psoriatic arthritis (N = 50) (49 years; 56% male) [4]

not tested

Patients who underwent open repair of supraspinatus and infraspinatus (N = 23) (55 years; 70% male) [5]

not tested

Swedish speaking patients with upper extremity conditions (N = 176) (52 years; 43% male) [6]

not tested

German speaking patients with shoulder pain (N = 49) (59 years; 27% male) [7]

not tested

Italian speaking patients with overuse syndromes of the shoulder, elbow and wrist (N = 108) (54 years; 55% male) [8]

not tested

Dutch speaking patients with unilateral disorder of the upper limb (N = 50) (41 years; 48% male) [9]

not tested 97

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9.2 Shoulder

Validation

(cont)

Patient population tested in

Validity

Reliability

Responsiveness

Patients who had undergone a shoulder arthroplasty (N = 43) (65 years; 23% male) [10]

not tested

Canadian French speaking patients with multiple upper extremity pathologies (N = 40) (43 years; 50% male) [11]

not tested

Patients two years post-rotator-cuff repair (N = 62) (60 years; 68% male) [12]

not tested

Chinese speaking patients with a variety of upper extremity disorders (N = 334) (46 years; 43% male) [13]

not tested

Chinese speaking patients with upper extremity disorders (N = 88) (43 years; 42% male) [14]

not tested

Validation studies:

[1] SooHoo NF, McDonald AP, Seiler JG, 3rd, et al (2002) Evaluation of the construct validity of the DASH questionnaire by correlation to the SF-36. J Hand Surg [Am]; 27:537–541. [2] Beaton DE, Katz JN, Fossel AH, et al (2001) 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; 14:128–146. [3] Gummesson C, Atroshi I, Ekdahl C (2003) The disabilities of the arm, shoulder and hand (DASH) outcome questionnaire: longitudinal construct validity and measuring self-rated health change after surgery. BMC Musculoskelet Disord; 4:11–16. [4] Navsarikar A, Gladman DD, Husted JA, et al (1999) Validity assessment of the disabilities of arm, shoulder, and hand questionnaire (DASH) for patients with psoriatic arthritis. J Rheumatol; 26:2191–2194. [5] Skutek M, Fremerey RW, Zeichen J, et al (2000) Outcome analysis following open rotator cuff repair. Early effectiveness validated using four different shoulder assessment scales. Arch Orthop Trauma Surg; 120:432–436. [6] Atroshi I, Gummesson C, Andersson B, et al (2000) The disabilities of the arm, shoulder and hand (DASH) outcome questionnaire: reliability and validity of the Swedish version evaluated in 176 patients. Acta Orthop Scand; 71:613–618. [7] Offenbacher M, Ewert T, Sangha O, et al (2003) Validation of a German version of the ‘Disabilities of Arm, Shoulder and Hand’ questionnaire (DASH-G). Z Rheumatol; 62:168–177. [8] Padua R, Padua L, Ceccarelli E, et al (2003) Italian version of the Disability of the Arm, Shoulder and Hand (DASH) questionnaire. Cross-cultural adaptation and validation. J Hand Surg [Br]; 28:179–186. [9] Veehof M M, Sleegers EJ, van Veldhoven NH, et al (2002) Psychometric qualities of the Dutch language version of the Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH DLV). J Hand Ther; 15:347–354. [10]Angst F, Pap G, Mannion AF, et al (2004) Comprehensive assessment of clinical outcome and quality of life after total shoulder arthroplasty: usefulness and validity of subjective outcome measures. Arthritis Rheum; 51:819–828. [11]Durand MJ, Vachon B, Hong QN, et al (2005) The cross-cultural adaptation of the DASH questionnaire in Canadian French. J Hand Ther; 18:34–39. [12]Getahun TY, MacDermid JC, Patterson SD (2000) Concurrent validity of patient rating scales in assessment of outcome after rotator cuff repair. J Musculoskelet Res; 4:119–127. [13]Lee EW, Chung M M, Li AP, et al (2005) Construct validity of the Chinese version of the disabilities of the arm, shoulder and hand questionnaire (DASH-HKPWH). J Hand Surg [Br]; 30:29–34. [14] Lee EW, Lau JS, Chung MM, et al (2004) Evaluation of the Chinese version of the Disability of the Arm, Shoulder and Hand (DASH-HKPWH): cross-cultural adaptation process, internal consistency and reliability study. J Hand Ther; 17:417–423. 98

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Disabilities of the Arm, Shoulder and Hand (DASH) 9.2 Shoulder

Reliability

Validity

Methodological evaluation

(5/6)

no score

0 points

1 point

points

Content validity

not tested

not valid

valid

Construct validity

not tested

not valid

valid

Criterion validity

not tested

not valid

valid

Internal consistency

not tested

not consistent

consistent

Reproducibility

not tested

not reproducible

reproducible

Responsiveness

not tested

not responsive

responsive

Subtotal

Clinical utility

(2/4)

0 points

1 point

2 points

points

Patient friendliness

limited

moderate

strong

Clinician friendliness

limited

moderate

strong

Subtotal

Total (out of 10)

7 99

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9.2 Shoulder

6. Dutch Shoulder Disability Questionnaire (SDQ-NL) (2000) Also known as van der Heijden shoulder disability questionnaire Source: van der Heijden GJ, Leffers P, Bouter LM (2000) Shoulder disabilit y questionnaire design and responsiveness of a functional status measure. J Clin Epidemiol; 53:29–38.

Content Type Patient-reported outcome Scale 4 subscales (16 pain related disability items):

Activities of daily living (5 items) Functional activities (6 items) Psychosocial issues (2 items) Positioning (3 items)

Items scored by ticking a “yes”, “no”, or “not applicable” box if item does or does not describe patient. Interpretation Items ticked “yes” are summed and normalized to 100.

Maximum score: 100 points Minimum score: 0 points The higher the score, the greater the disability.

Validation Outcomes validated against [3] • Shoulder rating questionnaire • Shoulder pain and disability index • United Kingdom shoulder disability questionnaire

Outcomes validated against [4] • Dutch shoulder disability questionnaire

100

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6. Dutch Shoulder Disability Questionnaire (SDQ-NL) 9.2 Shoulder

Validation

(cont)

Patient population tested in

Reliability

Responsiveness

not tested

Spanish speaking patients with subacromial impingement syndrome (N = 35) (55 years; 23% male) [4]

not tested

Bilingual (English/Spanish) speaking patients (N = 35) (35 years; 71% male) [4]

not tested

Patients with soft tissue shoulder disorders (N = 180) (51 years; 49% male) [1] Patients with shoulder disorders presenting to primary care (N = 349) (50 years; 44% male) [2] Patients with new episodes of shoulder pain (N = 180) (54 years; 50% male) [3]

Validity

Validation studies: [1] van der Heijden GJ, Leffers P, Bouter LM (2000) Shoulder disability questionnaire design and responsiveness of a functional status measure. J Clin Epidemiol; 53:29–38. [2] van der Windt DA, van der Heijden GJ, de Winter AF, et al (1998) The responsiveness of the Shoulder Disability Questionnaire. Ann Rheum Dis; 57:82–87. [3] Paul A, Lewis M, Shadforth MF, et al (2004) A comparison of four shoulder-speciﬁc questionnaires in primary care. Ann Rheum Dis; 63:1293–1299. [4] Alvarez-Nemegyei J, Puerto-Ceballos I, Guzman-Hau W, et al (2005) Development of a Spanish-language version of the Shoulder Disability Questionnaire. J Clin Rheumatol; 11:185–187.

101

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10.1 Pelvis

Iowa pelvic score

(1996)

Source: Templeman D, Goulet J, Duwelius PJ, et al (1996) Internal fixation of displaced fractures of the sacrum. Clin Orthop; (329):180 –185.

Content Type Patient-reported outcome Scale 6 subscales (25 items):

Activities of daily living (20 points) Work history (20 points) Pain (25 points) Limp (20 points) Visual pain line (10 points) Cosmesis (5 points) Items scored on a 0 to variable maximum 1 to 25 point scale. Interpretation Original not designed with qualitative grades: Excellent: 85–100 points Good: 70–84 points Fair: 55–69 points Poor: < 55 points

Validation Outcomes validated against • SF-36 Patient population tested in Patients with vertical shear fracture of pelvic ring (N = 33) (37 years; 61% male ) [1]

Validity +

Reliability not tested

Responsiveness not tested

Validation study: [1] Nepola JV, Trenhaile SW, Miranda MA, et al (1999) Vertical shear injuries: is there a relationship between residual displacement and functional outcome? J Trauma; 46:1024–1029.

396

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Iowa pelvic score

10.1 Pelvis

Reliability

Validity

Methodological evaluation

(2/6)

no score

0 points

1 point

points

Content validity

not tested

not valid

valid

Construct validity

not tested

not valid

valid

Criterion validity

not tested

not valid

valid

Internal consistency

not tested

not consistent

consistent

Reproducibility

not tested

not reproducible

reproducible

Responsiveness

not tested

not responsive

responsive

Subtotal

Clinical utility

(2/4)

0 points

1 point

2 points

points

Patient friendliness

limited

moderate

strong

Clinician friendliness

limited

moderate

strong

Subtotal

Total (out of 10)

4 397

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10.1 Pelvis

2. Majeed pelvic score

(1989)

Source: Majeed SA (1989) Grading the outcome of pelvic fractures. J Bone Joint Surg Br; 71:304–306.

Other versions available: Dutch.

Content Type Patient-reported outcome Scale 5 subscales (7 items):

Pain (30 points) Work (20 points) Sitting (10 points) Sexual intercourse (4 points) Standing (36 points)

Items scored on a 0 to variable maximum 4 to 30 point scale. Interpretation Working: Excellent: > 85 points Good: 70–84 points Fair: 55–69 points Poor: < 55 points

Not working: Excellent: > 70 points Good: 55–69 points Fair: 45–54 points Poor: < 45 points

Validation Outcomes validated against [1] • SF-36 Patient population tested in

Validity

Patients with unstable pelvic fracture (N = 37) (35 years; 70% male ) [1]

Reliability not tested

Responsiveness not tested

Validation study: [1] Van den Bosch EW, Van der Kleyn R, Hogervorst M, et al (1999) Functional outcome of internal fi xation for pelvic ring fractures. J Trauma; 47:365–371.

398

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2. Majeed pelvic score

10.1 Pelvis

Reliability

Validity

Methodological evaluation

(2/6)

no score

0 points

1 point

points

Content validity

not tested

not valid

valid

Construct validity

not tested

not valid

valid

Criterion validity

not tested

not valid

valid

Internal consistency

not tested

not consistent

consistent

Reproducibility

not tested

not reproducible

reproducible

Responsiveness

not tested

not responsive

responsive

Subtotal

Clinical utility

(4/4)

0 points

1 point

2 points

points

Patient friendliness

limited

moderate

strong

Clinician friendliness

limited

moderate

strong

Subtotal

Total (out of 10)

6 399

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10.1 Pelvis

3. Orlando pelvic outcome score

(1996)

Source: Cole JD, Blum DA , Ansel LJ (1996) Outcome after fixation of unstable posterior pelvic ring injuries. Clin Orthop; (329):160–179.

Content Type Clinician-based outcome Scale 6 subscales (12 items):

Functional pain (5 points) Subjective pain (4 points) Narcotic use (1 points) Activities status (10 points) Physical exam (10 points) Radiographic (10 points)

Items scored on a 0 to variable maximum 1 to 10 point scale. Interpretation: Maximum score: 40 points Minimum score: 0 points

The lower the score, the greater the disability. Validation Outcomes validated against [1] • SF-36 Patient population tested in Patients with unstable pelvic ring injuries (N = 64) (32 years; 56% male) [1]

Validity +

Reliability not tested

Responsiveness not tested

Validation study: [1] Cole JD, Blum DA, Ansel LJ (1996) Outcome after fi xation of unstable posterior pelvic ring injuries. Clin Orthop; (329):160–179.

400

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Orlando pelvic outcome score

10.1 Pelvis

Reliability

Validity

Methodological evaluation

(2/6)

no score

0 points

1 point

points

Content validity

not tested

not valid

valid

Construct validity

not tested

not valid

valid

Criterion validity

not tested

not valid

valid

Internal consistency

not tested

not consistent

consistent

Reproducibility

not tested

not reproducible

reproducible

Responsiveness

not tested

not responsive

responsive

Subtotal

Clinical utility

(3/4)

0 points

1 point

2 points

points

Patient friendliness

limited

moderate

strong

Clinician friendliness

limited

moderate

strong

Subtotal

Total (out of 10)

5 401

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10.2 Hip 404

Algofunctional Index (AFI)

American Academy of Orthopaedic Surgeons (AAOS) lower limb and hip score 408 412

Charnley hip score

414

Children’s Hospital Oakland Hip Evaluation Scale (CHOHES) Functional Recovery Score (FRS) Harris hip score

416

418 422

Hip disability and Osteoarthritis Outcome Score (HOOS) Hip evaluation chart 2 of Larson

426 428

Hip fracture functional rating scale 430

Hip-rating questionnaire

Hospital for Special Surgery (HSS) hip rating system Iowa hip score

434

Judet and Judet score

436 438

Lower Extremity Activity Scale (LEAS) Lower Extremity Gain Scale (LEGS) Lower Extremity Measure (LEM)

440 442

444

Mayo clinical hip score

McMaster-Toronto Arthritis questionnaire (MACTAR)

Modified Merle d’Aubigne hip score New Zealand priority score Nonarthritic hip score

446

448

Merle D’Aubigne hip score

Oxford hip score

432

452

456

458

460

402

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10.2 Hip

Oxford heup score

464 466

Parkland and Palmer mobility score

Patient Specific Index (PASI) hip rating scale

468

Rheumatoid and Arthritis Outcome Score (RAOS) for the lower extremity Thompson and Epstein score

472

474 476

Total hip arthroplasty outcome evaluation

Western Ontario and McMaster Universities (WOMAC) osteoarthritis Index 480 WOMAC function subscale short form Reduced WOMAC function scale

484

486

403

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10.2 Hip

Algofunctional Index (AFI)

(1987)

Source: Lequesne MG, Mery C , Samson M, et al (1987) Indexes of severit y for osteoarthritis of the hip and knee. Validation--value in comparison with other assessment tests. Scand J Rheumatol Suppl; 65:85–89.

Other versions available: German.

Content Type Patient-reported outcome Scale 3 subscales (11 items):

Pain (8 points) Maximum distance walked (8 points) Activities of daily living (8 points) Items scored on a 0 to variable maximum 1 to 8 point scale. Interpretation Maximum score: 24 points Minimum score: 0 points

The higher the score, the greater the disability. Handicap: None: 0 points Mild: 1–4 points Moderate: 5–7 points Severe: 8–10 points Very severe: 11–13 points Extremely severe: > 14 points Validation Outcomes validated against [1] • Degree of severity • Patient and physician overall assessment • Walking time • Range of motion Outcomes validated against [2] • Radiological osteoarthritis severity • Range of motion • WOMAC

404

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Algofunctional Index (AFI)

10.2 Hip

Outcomes validated against [3] • SF-36 • Self-rated pain severity Outcomes validated against [5] • WOMAC

Patient population tested in Patients with hip osteoarthritis (N = 38) (age NR; sex NR) [1]

Validity

Reliability

Responsiveness

not tested

Patients with hip or knee osteoarthritis (N = 51) (70 years; 33% male) [2]

+/-

not tested

Patients with unilateral hip pain (N = 471) (73 years; 40% male) [3]

+/-

not tested

Patients undergoing hip or knee replacement (N = 40) (69 years; 39% male) [4] German speaking patients with hip or knee osteoarthritis (N = 195) (51 years; 33% male) [5]

Validation studies: [1] Lequesne MG, Mery C, Samson M, et al (1987) Indexes of severity for osteoarthritis of the hip and knee. Validation--value in comparison with other assessment tests. Scand J Rheumatol Suppl; 65:85–89. [1] Lequesne MG, Samson M (1991) Indices of severity in osteoarthritis for weight bearing joints. J Rheumatol Suppl; 27:16–18. [2] Stucki G, Sangha O, Stucki S, et al (1998) Comparison of the WOMAC (Western Ontario and McMaster Universities) osteoarthritis index and a self-report format of the self administered Lequesne-Algofunctional index in patients with knee and hip osteoarthritis. Osteoarthritis Cartilage; 6:79–86. [3] Dawson J, Linsell L, Doll H, et al (2005) Assessment of the Lequesne index of severity for osteoarthritis of the hip in an elderly population. Osteoarthritis Cartilage; 13:854–860. [4] Theiler R, Sangha O, Schaeren S, et al (1999) Superior responsiveness of the pain and function sections of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) as compared to the Lequesne-Algofunctional Index in patients with osteoarthritis of the lower extremities. Osteoarthritis Cartilage; 7:515–519. [5] Ludwig FJ, Melzer C, Grimmig H, et al (2002) [Cross cultural adaptation of the lequesne algofunctional indices for german speaking patients with osteoarthritis of the hip and the knee]. Rehabilitation; 41:249–257. German. 405

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10.2 Hip

Algofunctional Index (AFI) Details see previous pages.

406

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Algofunctional Index (AFI)

10.2 Hip

Reliability

Validity

Methodological evaluation

(3/6)

no score

0 points

1 point

points

Content validity

not tested

not valid

valid

Construct validity

not tested

not valid

valid

Criterion validity

not tested

not valid

valid

Internal consistency

not tested

not consistent

consistent

Reproducibility

not tested

not reproducible

reproducible

Responsiveness

not tested

not responsive

responsive

Subtotal

Clinical utility

(3/4)

0 points

1 point

2 points

Patient friendliness

limited

moderate

strong

Clinician friendliness

limited

moderate

strong

points

Subtotal

Total (out of 10)

6 407

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10.2 Hip

2. American Academy of Orthopaedic Surgeons (AAOS) hip and knee score

(2004)

Source: Johanson NA , Liang MH, Daltroy L, et al (2004) American Academy of Orthopaedic Surgeons lower limb outcomes assessment instruments. Reliabilit y, validit y, and sensitivit y to change. J Bone Joint Surg Am; 86-A:902–909.

Content Type Patient-reported outcome Scale Hip and knee core scale • General pain • General disability

4 localized subscales: • Left hip • Left knee • Right hip • Right knee Interpretation Raw scores: mean score of all items within each category scale

Individualized standardized score = 100 - [(Summed value scale items – minimum score)/maximum score)] × 100 Individual normative score = [(Individual score – General population mean score)/General population standard deviation] × (10 + 50) The higher the score, the greater the disability. Validation Outcomes validated against[1] • WOMAC • AAOS lower limb core scale • SF-36

Patient population tested in Patients with hip and/or knee complaints (N = 290) (54% male; 48 years) [1]

Validity

Reliability

Responsiveness

not tested

Validation study: [1] Johanson NA, Liang MH, Daltroy L, et al (2004) American Academy of Orthopaedic Surgeons lower limb outcomes assessment instruments. Reliability, validity, and sensitivity to change. J Bone Joint Surg Am; 86-A:902–909. 408

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2. American Academy of Orthopaedic Surgeons (AAOS) hip and knee score

Reliability

Validity

Methodological evaluation

10.2 Hip

(5/6)

no score

0 points

1 point

points

Content validity

not tested

not valid

valid

Construct validity

not tested

not valid

valid

Criterion validity

not tested

not valid

valid

Internal consistency

not tested

not consistent

consistent

Reproducibility

not tested

not reproducible

reproducible

Responsiveness

not tested

not responsive

responsive

Subtotal

Clinical utility

(4/4)

0 points

1 point

2 points

Patient friendliness

limited

moderate

strong

Clinician friendliness

limited

moderate

strong

points

Subtotal

Total (out of 10)

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10.2 Hip

3. American Academy of Orthopaedic Surgeons (AAOS) lower limb and hip score (2004) Source: Johanson NA , Liang MH, Daltroy L, et al (2004) American Academy of Orthopaedic Surgeons lower limb outcomes assessment instruments. Reliabilit y, validit y, and sensitivit y to change. J Bone Joint Surg Am; 86-A:902–909. http://www.aaos.org/research/outcomes/outcomes_documentation.asp

Content Type Patient-reported outcome Scale 7 subscales (7 items):

Stiffness (5 points) Swelling (5 points) Walking (5 points) Going up and down stairs (5 points) Lying in bed (5 points) Mobility (5 points) Putting on socks (5 points) Items scored on a 1 to variable maximum 5 to 7 point scale and then rescored on a 0 to 5 point scale. Interpretation Scores summed and normalized to 100. Total score then subtracted from 100.

Maximum score: 100 points Minimum score: 0 points The lower the score, the greater the disability. Validation Outcomes validated against [1] • Physician ratings of pain and function • WOMAC • SF-36

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American Academy of Orthopaedic Surgeons (AAOS) lower limb and hip score

Patient population tested in Patients with hip or knee pain (N = 43) (54% male; 48 years) [1] Patients with coxarthrosis and candidates for total hip arthroplasty (N = 35) (59 years; 49% male) [2]

Validity

Reliability

10.2 Hip

Responsiveness

not tested

Validation studies: [1] Johanson NA, Liang MH, Daltroy L, et al (2004) American Academy of Orthopaedic Surgeons lower limb outcomes assessment instruments. Reliability, validity, and sensitivity to change. J Bone Joint Surg Am; 86-A:902–909. [2] Kirmit L, Karatosun V, Unver B, et al (2005) The reliability of hip scoring systems for total hip arthroplasty candidates: assessment by physical therapists. Clin Rehabil; 19:659–661.

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