Accurately measuring the quality and effectiveness of cervical spine surgery in registry efforts: determining the most valid and responsive instruments. Patient-Reported and Objectively Measured Function Before and After Reverse Shoulder Arthroplasty Objective outcome evaluation using inertial sensors in subacromial impingement syndrome: a five-year follow-up study. Comparative Evaluation of the Measurement Properties of Various Shoulder Outcome Instruments Measurement of Shoulder Activity Level Responsiveness of six outcome assessment instruments in total shoulder arthroplasty. Objective evaluation of shoulder function using body-fixed sensors: a new way to detect early treatment failures? Acceptability of the method of administration of a patient-reported outcome measure (PROM) with stroke survivors, a randomised controlled trial protocol A Self-Administered Questionnaire for Assessment of Symptoms and Function of the Shoulder* Measuring Function of the Shoulder. A Cross-Sectional Comparison of Five Questionnaires* Testing minimal clinically important difference: consensus or conundrum? Comparison of clinical and patient-based measures to assess medium-term outcomes following shoulder surgery for disorders of the rotator cuff. Prospective analysis of clinical evaluation and self-assessment by patients after decompression surgery for degenerative lumbar canal stenosis. Validation of a consensus-based minimal clinically important difference (MCID) threshold using an objective functional external anchor. American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, patient self-report section: reliability, validity, and responsiveness. The Responsiveness and Minimal Important Change of the Western Ontario Shoulder Instability Index and Oxford Shoulder Instability Score Reliability and validity of shoulder function outcome measures in people with a proximal humeral fracture
BACKGROUND CONTEXT There is a growing dem and to measure the real-world effectiveness and value of care across all specialties and disease states . Prospect i ve registries have emerged as a feasible way to capture real-world care across large patient population s. However , the proven validity of more robust and cumbersome patient-reported outcome instruments ( PROi ) must be balanced with what is feasible to apply in large-scale registry efforts . Hence , commercial registry efforts that measure quality and effectiveness of care in an attempt to guide quality improvement , pay for performance , or value-based purchasing should incorporate measures that most accurately represent patient-centered improvement . PURPOSE We set out to establish the relative validity and responsiveness of common PROi in accurately determining effectiveness of cervical surgery for neck and arm pain in registry efforts . STUDY DESIGN Prospect i ve cohort study . PATIENT SAMPLE Eighty-eight patients undergoing primary anterior cervical discectomy and fusion ( ACDF ) for neck and arm pain . OUTCOME MEASURES Patient-reported outcome measures for pain ( numeric rating scale for neck pain [ NRS-NP ] and arm pain [ NRS-AP ] ) , disability ( neck disability index [ NDI ] ) , general health ( short-form 12-item survey physical component summary [ SF-12 PCS ] and mental component summary [ SF-12 MCS ] ) , and quality of life ( Euro-Qol-5D [ EQ-5D ] ) were assessed . METHODS Eighty-eight patients undergoing primary ACDF for neck and arm pain were entered into a Web-based prospect i ve registry . Baseline and 12-month patient-reported outcomes ( NRS-NP , NRS-AP , NDI , SF-12 PCS , SF-12 MCS , and EQ-5D ) were assessed . Patients were also asked whether they experienced a level of improvement after ACDF that met their expectation ( meaningful improvement ) . To assess the validity of NRS-NP , NRS-AP , and NDI ( measures of pain and disability ) to discriminate between meaningful and nonmeaningful improvement and the validity of SF-12 PCS , SF-12 MCS , and EQ-5D ( measures of general health and quality of life ) to discriminate between meaningful and nonmeaningful improvement , receiver-operating characteristic curves were generated for each outcome instrument . The greater the area under the curve ( AUC ) , the more valid the discriminator . The difference between st and ardized response means ( SRMs ) in patients reporting meaningful improvement versus not was calculated to determine the relative responsiveness of each outcome instrument to changes in  pain and QOL after surgery . RESULTS For pain and disability , both NDI ( AUC=0.75 ) and NRS-AP ( AUC=0.74 ) were valid discriminators of meaningful improvement . Numeric rating scale for neck pain ( AUC=0.69 ) was a poor discriminator . Neck disability index was also most responsive to postoperative improvement ( SRM difference 0.78 ) , followed by NRS-AP ( SRM difference 0.59 ) and NRS-NP ( SRM difference 0.46 ) . For general health and quality of life , SF-12 PCS ( AUC=0.79 ) was the only valid discriminator of meaningful improvement . Euro-Qol-5D ( AUC=0.68 ) and SF-12 MCS ( AUC=0.44 ) were poor discriminators . Short-form 12 physical component summary ( SRM difference 1.08 ) was also most responsive compared with EQ-5D ( SRM difference 0.89 ) and SF-12 MCS ( SRM difference 0.01 ) . CONCLUSIONS For pain and disability , NDI is the most valid and responsive measure of improvement after surgery for neck and arm pain . Numeric rating scale for neck pain and NRS-AP are poor substitutes for NDI when measuring effectiveness of care in registry efforts . For health-related quality of life , only SF-12 PCS could accurately discriminate meaningful improvement after cervical surgery and was found to be most valid and responsive . Large-scale registry efforts aim ed at measuring effectiveness of cervical spine surgery should use NDI and SF-12 to accurately assess improvements in pain , disability , and quality of life Background and Purpose : Documenting functional outcomes after  reverse shoulder arthroplasty ( RSA )  is critical to advancing patient care . The interplay been self-reported and objective ly measured outcome measures has not been widely described . The utilization of wearable devices to document upper extremity limb activity is a new approach for objective ly measuring outcomes . Therefore , the purpose of this study was to evaluate changes in pain , and self-reported function and objective ly measured limb activity after RSA . We also assessed the influence of pain on self-reported function and objective ly measured limb activity to determine the impact of pain on outcomes after RSA . Material s : This study implemented a prospect i ve , repeated- measures design . Fourteen patients undergoing RSA underwent testing before surgery , and 2 and 12 months after surgery . Patient-reported instruments included pain , Disabilities of Arm , Shoulder and h and s ( DASH ) , and physical component summary ( PCS ) of the 36-Item Short Form Health Survey . Objective limb activity ( mean activity value , m/s2/min epoch ; inactive time , % ; low activity , % ; and high activity , % ) was captured with triaxial accelerometers worn on the upper and lower arm . A repeated- measures ANOVA tested for differences across time . The Spearman rank-order correlation was calculated to evaluate the influence of pain on DASH , PCS scores , and mean limb activity . Results : Patient-reported measures improved after surgery ( pain , P < .01 ; DASH , P < .01 ; PCS , P = .01 ) . No change in limb activity was found at 1 year compared with preoperative values for mean ( forearm , P = 1.00 ; arm , P = .36 ) , inactivity ( forearm , P = .33 ; arm , P = .22 ) , low ( forearm , P = .77 ; arm , P = .11 ) or high ( forearm , P = 1.00 ; arm , P = .20 ) activity . There was a relationship between pain and DASH scores 1 year after surgery ( P = .04 ) but not before surgery ( P = .16 ) , or 2 months after surgery ( P = .30 ) . There was no relationship between pain and PCS scores at any time point ( preoperative , P = .97 ; 2 months , P = .21 ; 1 year , P = .08 ) nor pain and limb activity ( forearm : preoperative , P = .36 ; 2 months , P = .67 ; 1 year , P = .16 ; arm : preoperative , P = .97 ; 2 months , P = .59 ; 1 year , P = .51 ) . Conclusions : RSA reduced pain and enhanced patient-perceived function . Objective ly measured upper extremity limb activity is not different 1 year after surgery compared with preoperative levels . Level of Evidence : III Shoulder-related dysfunction is the second most common musculoskeletal disorder and is an increasing burden on health-care systems . Commonly used clinical question naires suffer from subjectivity , pain dominance and a ceiling effect . Objective functional measurement has been identified as a relevant issue in clinical rehabilitation . Inertia based motion analysis ( IMA ) is a new generation of objective outcome assessment tool ; it can produce objective movement parameters while being fast , cheap and easy to operate . In this prospect i ve study , an inertial sensor comprising a three-dimensional accelerometer and gyroscope is attached at the humerus to measure shoulder movements during two motion tasks in patients with subacromial impingement syndrome at baseline and at five-year after treatment . One hundred healthy subjects served as healthy reference data base and 15 patients were measured pre- and post-treatment . IMA was better able to detect improvement in shoulder movements compared to the clinical question naires ( Disability of Arm , Shoulder and H and ( DASH ) and Simple Shoulder Test ( SST ) ; p < 0.05 ) and was hardly correlated with the clinical question naires ( Pearson R = 0.39 ) . It may therefore add an objective functional dimension to outcome assessment . The fast assessment ( t < 5 min ) of a simple motion test makes it suitable for routine clinical follow-up 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 There are many measurement tools for assessing patients ’ shoulder symptoms ( pain ) and function  ( what patients can do ) , but they do not measure activity ( how often a patient engages in activity ) . This is relevant because activity level can have an important impact on a patient ’s outcome . Our goal was to develop a short , easy to administer measure of shoulder activity which could be used to predict outcome of shoulder disorders . The activity scale was developed using established principles : item generation , item reduction , pretesting , and reliability and validity testing . The activity rating is a numerical sum of scores for five activities rated on a five-point frequency scale from never performed ( 0 points ) to daily ( 4 points ) . Patients were scored on the following criteria : carrying an object 8 lb or heavier  by h and , h and ling objects overhead ,  weight training with arms , swinging motion ( ie , hitting tennis or golf ball ) , and lifting objects 25 lb or heavier . Two additional multiple choice questions provide a score assessing participation in contact and overhead sports . The activity scale showed excellent reliability and construct validity . It can be completed quickly and used in conjunction with patient-based measures of shoulder outcome to define patient population s for cohort studies , and to assess activity level as a prognostic factor in patients with shoulder disorders . Level of Evidence : Prognostic study , Level I. See the Guidelines for Authors for a complete description of levels of evidence OBJECTIVE To assess the responsiveness ( sensitivity to change ) of 6 shoulder outcome instruments . METHODS In a prospect i ve cohort study of 153 total shoulder arthroplasties , outcome was measured by the Short Form 36 ( SF-36 ) ; Disabilities of the Arm , Shoulder , and H and question naire ( DASH ) ; Shoulder Pain and Disability Index ( SPADI ) ; American Shoulder and Elbow Surgeons question naire for the shoulder ( ASES ) ;  and the Constant ( Murley ) Score ( CS ) .  Responsiveness was mainly quantified by effect sizes before and 6 months after operation . Sensitivity analysis of the effects by receiver operating characteristic ( ROC ) curves was performed to determine the instruments ' ability to classify effects into global health change assessment categories . RESULTS Effect sizes of the self- assessment total scores were 0.71 , 1.19 , 2.10 , and 2.13 for the SF-36 , DASH , SPADI , and ASES , respectively . The clinical ASES and the CS had effect sizes of 1.87 and 2.23 , respectively . The SPADI ( effect size 2.12 ) and the CS ( effect size 2.72 ) were most responsive for pain . For functioning , the patient ASES ( effect size 2.10 ) , the CS ( effect size 1.82 ) , and the clinical ASES ( effect size 1.85 ) were almost equal . The SF-36 bodily pain scale and most scores of the condition-specific instruments showed a significant area under the ROC of up to 0.77 . CONCLUSION The SPADI and /or the CS are the most suitable for short , responsive , shoulder-specific assessment . The more expensive patient ASES can be used for most responsive shoulder-function assessment . For a comprehensive measurement of health and quality of life , the DASH and /or the SF-36 should be added to the set BACKGROUND Variable definitions of outcome ( Constant score , Simple Shoulder Test [ SST ] ) have been used to assess outcome after shoulder treatment , although none has been accepted as the universal st and ard . Physicians lack an objective method to reliably assess the activity of their patients in dynamic conditions . Our purpose was to clinical ly vali date the shoulder kinematic scores given by a portable movement analysis device , using the activities of daily living described in the SST as a reference . The secondary objective was to determine whether this device could be used to document the effectiveness of shoulder treatments ( for glenohumeral osteoarthritis and rotator cuff disease ) and detect early failures . METHODS A clinical trial including 34 patients and a control group of 31 subjects over an observation period of 1 year was set up . Evaluations were made at baseline and 3 , 6 , and 12 months after surgery by 2 independent observers . Miniature sensors ( 3-dimensional gyroscopes and accelerometers ) allowed kinematic scores to be computed . They were compared with the regular outcome scores : SST ; Disabilities of the Arm , Shoulder and H and ; American Shoulder and Elbow Surgeons ; and Constant . RESULTS Good to excellent correlations ( 0.61 - 0.80 ) were found between kinematics and clinical scores . Significant differences were found at each follow-up in comparison with the baseline status for all the kinematic scores ( P < .015 ) . The kinematic scores were able to point out abnormal patient outcomes at the first postoperative follow-up . CONCLUSION Kinematic scores add information to the regular outcome tools . They offer an effective way to measure the functional performance of patients with shoulder pathology and have the potential to detect early treatment failures Background UK-wide national clinical guidelines promote routine 6-month post-stroke follow-up assessment . However , as part of this 6-month assessment little information is gathered from the patient ’s perspective . The means of collecting this patient-centred information might be served best by a patient-reported outcome measure ( PROM ) at the 6-month assessment time point . Currently , four different methods of 6-month follow-up assessment occur ; the most common being face-to-face interview followed by telephone interview , postal question naire and online question naire . Therefore , this study will investigate if the acceptability of telephone , online or postal administration of a PROM at the 6-month post-stoke time point is not inferior to face-to-face administration . Methods / design A UK multicentre , blinded ( analyst and research er ) , pragmatic , non-inferiority study , with 80 % power using a 2.5 % non-inferiority margin was design ed to compare the acceptability of three modes of administration ( telephone interview , postal question naire and online question naire ) compared with face-to-face interview administration of a PROM . We plan to approach and r and omise a minimum of 808 potentially eligible participants , 202 participants per group . Discussion The aim of this ongoing research is to underst and if there is a difference between face-to-face administration and the other three methods of administering a PROM as a patient-centred supplement to the 6-month review for stroke survivors . In utilising a pragmatic design , it is believed that this study will offer UK wide generalisable results , of the acceptability of the methods under investigation , to inform clinicians and commissioners of stroke services . Trials registration Clinical Trials.gov : NCT03177161 . Registered on 6 June 2017 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 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 BACKGROUND CONTEXT Various method ologies have been used in attempting to eluci date a st and ard method for calculating minimal clinical ly important difference ( MCID ) . A consensus-based decision ( Initiative on Methods , Measurement , and Pain Assessment in Clinical Trials [ IMMPACT ] group ) suggested a 30 % reduction from baseline as a means to define the MCID of self-report back pain measures . Additionally , important psychometric issues need to be addressed regarding use of an independent measure of the same construct as an external criterion , instead of simply using another self-report measure , when using an anchor-based approach to MCID . PURPOSE The purpose was to test the validity of recently published guidelines regarding MCID using self-report back pain measures and objective socioeconomic outcomes . STUDY DESIGN / SETTING This is a prospect i ve study assessing change scores on commonly used spinal pain assessment measures in patients with chronic disabling occupational spinal disorders ( CDOSDs ) treated in a regional referral rehabilitation center performing interdisciplinary functional restoration . PATIENT SAMPLE The study consisted of consecutive cohort of patients ( N=1,180 ) with CDOSDs completing a functional restoration program . OUTCOMES MEASURES Self-report measures including the Oswestry Disability Index ( ODI ) and the physical component summary ( PCS ) and mental component summary ( MCS ) of the Short Form-36 ( SF-36 ) obtained before and after treatment , were compared with objective socioeconomically relevant outcomes obtained 1 year after treatment ( ie , work status and additional health-care utilization ) , that were the external criteria for evaluating MCID . METHODS Pre- to posttreatment improvement was calculated separately for each measure , and subjects were divided into two groups based on the change in scores relative to baseline : 30 % or greater versus less than 30 % improvement . One-year posttreatment objective socioeconomic outcomes were used as independent external criteria relevant to the CDOSD population . This population is often studied as the most costly and problematic cohort in spine care . RESULTS The ODI and SF-36 MCS were not associated with any of the objective 1-year outcomes used as external criteria . Reduced post-rehabilitation health-care utilization ( based on the percentage of patients pursuing health care from a new provider ) was weakly associated with 30 % or greater improvement on the SF-36 PCS , relative to patients whose scores changed by less than 30 % relative to baseline ( 17.0 % vs. 21.1 % ) . The same was true for the ODI and return-to-work . CONCLUSIONS When objective and independent criteria are used ( socioeconomic outcomes ) in a CDOSD cohort , the 30 % improvement in the ODI and SF-36 may not be a valid MCID index . This replicates similar conclusions made by an independent research group using a distribution-based approach to MCID . The validity of the MCID concept rests on future research using objective external criteria . Moreover , there remains a question whether the term " important " in MCID can be unequivocally and operationally defined as a reliable construct OBJECTIVE To compare different assessment s following  shoulder surgery for impingement syndrome with or without rotator cuff tear or repair . METHODS A prospect i ve study of 93 patients was conducted . St and ard assessment s were performed before , at 6 months , and at 4 years following shoulder surgery using the patient-based Oxford Shoulder Score ( OSS ) , the Medical Outcomes Study Short Form-36 ( SF-36 ) question naire , and a surgeon-assessed Constant Shoulder Score . Patients were categorized according to the surgery received in relation to the presence of cuff tears : full repair , partial repair , cuff tear/no repair , no tear/no repair . RESULTS Most patients ( 57 % ) received subacromial decompression for impingement with no cuff tear . This group had the fewest pre- and postoperative symptoms . The category of patients who received only partial repair of a cuff tear had worse scores on all outcome assessment s compared with other groups . Patient-based measures were more stable over time than the Constant . CONCLUSION The shoulder-specific measures had greater sensitivity than the SF-36 in registering significant differences in outcomes between comparison groups at 6 months and 4 years BACKGROUND CONTEXT Objective measures including neurological findings , radiographic evaluation , and the Japanese Orthopaedic Association ( JOA ) score are commonly used for the evaluation of surgical outcomes . Because many surgeries are performed primarily to improve quality of life , a patient 's subjective evaluations are also important for accurately assessing surgical outcomes . Currently available instruments for assessing quality of life include the Short-Form 36 ( F-36 ) , the Oswestry disability index ( ODI ) , and the visual analog scale ( VAS ) clinical pain scale . PURPOSE The aims of this study were to measure surgical outcomes by using both objective measures and subjective measures including patient self- assessment s and psychological changes ; to assess the adequacy of the JOA alone for measuring outcome ; and to determine which measures , the SF-36v2 , ODI , VAS , or JOA correlate with the VAS pain scale score in lumbar canal stenosis . STUDY DESIGN We performed a prospect i ve study to measure surgical outcomes for lumbar canal stenosis using traditional objective measures such as neurological findings and subjective measures such as performance of ADLs , patient self- assessment s , and psychological changes . PATIENT SAMPLE Forty-two surgical patients with a mean age of 66.8+/-10.9 years at the time of surgery were included in the study . All cases were followed for more than 2 years . Surgical indications included no response to conservative treatment and neurological deterioration . Neurological symptoms were classified as nerve root type , cauda equine type , or combined type . We performed surgical decompression at the location of the dural or root indentation by myelography . The concomitant diagnosis causing the spinal stenosis was degenerative spondylolisthesis in 20 cases undergoing posterolateral fusion with pedicle screws . OUTCOME MEASURES Surgical outcomes were assessed by comparing preoperative and 24-month postoperative JOA scores for low back pain , SF-36v2 , ODI-v2 , and VAS scores . Statistical analysis was performed by using the analysis of variance . A p value<0.05 was considered statistically significant . METHODS Objective clinical measures , patient self- assessment s , and psychological changes were measured before and at 24 months postoperatively . We also examined which measurements correlated with the VAS scale for pain evaluation , thereby relating patient satisfaction to surgery outcome . RESULTS All JOA , SF-36v2 , ODI-v2 , and VAS scores significantly improved postoperatively . The physical component summary ( PCS ) of the SF-36 v2 showed significant improvement , although all scores remained less than the Japanese norm-based scores ( NBSs ) . The mental component summary ( MCS ) exhibited such a significant improvement that all postoperative subscales were higher than the Japanese NBS . JOA scores significantly correlated only with postoperative lower-extremity VAS score . All PCS and two MCS scores significantly correlated with the VAS score for low back pain . Parts of the PCS and MCS significantly correlated with the lower-extremity VAS . The ODI significantly correlated with both the preoperative and postoperative VAS scores for low back pain as well as with the postoperative lower-extremity VAS score . CONCLUSIONS The JOA , SF-36 , ODI , and VAS question naires are all useful instruments for measuring surgical outcomes . The VAS score is a better assessment of physical rather than mental health . The ODI is more reflective of patients ' subjective symptoms . Finally , the SF-36 is particularly informative because it includes questions addressing both psychological and physical status . Therefore , when combined , the SF-36v2 , VAS , and ODI scores are a valuable complement to the JOA scores in evaluating outcomes of surgery for lumbar canal stenosis BACKGROUND CONTEXT The minimal clinical ly important difference ( MCID ) is defined as the smallest change in an outcome that a patient would perceive as meaningful . The Initiative on Methods , Measurement and Assessment in Clinical Trials ( IMMPACT ) group proposed defining the MCID as a 30 % improvement in self-reported pain or function . However , this MCID threshold has not been vali date d against an objective physical measure . PURPOSE To test the validity of the IMMPACT-based MCID threshold , using an objective physical measure as an external anchor . STUDY DESIGN / SETTING Prospect i ve study of chronic disabling occupational lumbar disorder ( CDOLD ) patients completing a functional restoration program . PATIENT SAMPLE A consecutive cohort of 743 CDOLD patients . OUTCOME MEASURES Self-report measures of pain-related function were compared with an objective lifting measure , the progressive isoinertial lifting evaluation ( PILE ) , obtained after treatment . METHODS The association between reporting 30 % or greater improvement ( the IMMPACT 's MCID key criterion ) and the PILE score after treatment was assessed . RESULTS A 30 % or greater improvement on the self-report measures was significantly associated with improvement in physical function on the PILE task . CONCLUSIONS Despite extensive use of the MCID to evaluate effects of treatment in spinal disorders , this is the first empirical documentation of the validity of the IMMPACT 's 30 % change criterion compared with an objective physical anchor 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 • STUDY DESIGN : Prospect i ve cohort study . • BACKGROUND : Patient‐reported outcome measurements ( PROMs ) are widely used to evaluate functional limitations . Considering PROMs for shoulder instability , information is lacking with regard to what constitutes a relevant change from baseline scores . • OBJECTIVES : To evaluate the responsiveness of the Western Ontario Shoulder Instability Index ( WOSI ) and the  Oxford Shoulder Instability Score ( OSIS ) and estimate their minimal important change ( MIC ) . • METHODS : One hundred five consecutive patients with shoulder instability completed 5 PROMs at baseline and at 6‐month follow‐up . The PROMs included the  WOSI and OSIS , the Simple Shoulder Test , the Oxford Shoulder Score , and the Disabilities of the Arm , Shoulder and H and assessment .  Patients also rated their functional change on an anchor question at follow‐up . Responsiveness was evaluated by testing 9 hypotheses regarding predefined correlations between the changes in PROM scores , by calculating the area under the receiver operating characteristic curve and by calculating the st and ardized response mean and effect size statistics . The MIC was determined by identifying the optimal cutoff on the receiver operating characteristic curve . • RESULTS : Seven out of 9 hypotheses ( 78 % ) were confirmed ; as expected , a high correlation ( 0.77 ) was found between change scores of the WOSI and OSIS , whereas the correlations of the change scores of the WOSI and OSIS with those of general shoulder PROMs were slightly lower ( 0.61‐0.75 ) . The area under the curve was 0.83 ( 95 % confidence interval : 0.75 , 0.91 ) for the OSIS and 0.82 ( 95 % confidence interval : 0.74 , 0.90 ) for the WOSI . The MIC was about 6 points for the OSIS and about 14 points for the WOSI . • CONCLUSION : Both the WOSI and OSIS are able to measure change in shoulder function in patients with shoulder instability . The estimated MIC is 6 points for the OSIS ( on a scale from 0 to 48 ) and 14 points for the WOSI ( on a scale from 0 to 100 ) . •KEY WORDS : clinimetrics , functional outcome measures , outcome assessment , Abstract Purpose : Investigate test -- retest reliability and validity of five shoulder outcome measures in people during their active rehabilitation after a shoulder fracture . Method : This prospect i ve longitudinal study assessed shoulder function in 20 people ( 16 women , mean age 68.1 years ) with surgical or conservative management at 6 , 12 and 13 weeks post proximal humeral fracture using three patient-reported ( Disabilities of Arm , Shoulder and H and ; Oxford Shoulder Score ; Subjective Shoulder Value ) and two clinician-administered ( Constant Score ; UCLA Shoulder score ) outcome measures . Results : Content analysis categorised items into multiple domains of functioning for each outcome measure . Construct validity testing between measures found moderate to strong correlations ( r = 0.43–0.92 ) . Longitudinal validity ( responsiveness ) , represented by correlations between change scores , was moderate to strong ( r = 0.44–0.83 ) . Although ICCs2,1 for test – retest reliability ranged from 0.75 to 0.93 , Limits of Agreement between measurements were relatively wide ( 10–23 % of available range of scores ) . Minimal clinical ly important difference estimates varied between anchor- and distribution-based methods . Conclusions : The five outcome measures assessing shoulder function provided values for reliability and validity that meet measurement requirements for use in groups of people after a proximal humeral fracture . However , the use of these outcome measures might be limited by low absolute agreement between measurements and their content covering multiple domains of functioning . Implication s for Rehabilitation Linking the International Classification of Functioning , Disability and Health ( ICF ) to the content of common shoulder function outcome measures showed that multiple domains of functioning are combined into a single score . This might not be preferred for measurement of the single construct of “ shoulder function ” . Currently available shoulder function outcome measures may not be sufficiently reliable to monitor change in an individual after a proximal humeral fracture during the rehabilitation phase
The SPADI is the most frequently evaluated PROM and its measurement properties seem adequate apart from a lack of information regarding its measurement error and content validity .
Dutch users could use either the SDQ or the SST .
In Tamil , Slovene , Spanish and the Danish language s , the evaluated PROMs were not yet of acceptable validity .
None of these PROMs showed strong positive evidence for all measurement properties .
Objective To critically appraise and compare the measurement properties of self-administered patient-reported outcome measures ( PROMs ) focussing on the shoulder , assessing “ activity limitations . ”