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Patient-reported outcome measures used for shoulder disorders: An overview of systematic reviews

  • Rochelle Furtado
    Correspondence
    Corresponding author. Faculty of Health Science, Western University, 1201 Western Rd, London, Ontario, Canada N6G 1H1.
    Affiliations
    Department of Rehabilitation Sciences, Faculty of Health Science, Western University, London, Ontario, Canada

    School of Physical Therapy, Faculty of Health Science, Western University, London, Ontario, Canada

    Collaborative Program in Musculoskeletal Health Research, Bone and Joint Institute, Western University, London, Ontario, Canada
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  • Pavlos Bobos
    Affiliations
    Department of Rehabilitation Sciences, Faculty of Health Science, Western University, London, Ontario, Canada

    School of Physical Therapy, Faculty of Health Science, Western University, London, Ontario, Canada

    Collaborative Program in Musculoskeletal Health Research, Bone and Joint Institute, Western University, London, Ontario, Canada

    Dalla Lana School of Public Health, Institute of Health Policy, Management and Evaluation, Department of Clinical Epidemiology and Health Care Research, University of Toronto, Toronto, Ontario, Canada
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  • Christina Ziebart
    Affiliations
    Department of Rehabilitation Sciences, Faculty of Health Science, Western University, London, Ontario, Canada

    School of Physical Therapy, Faculty of Health Science, Western University, London, Ontario, Canada

    Collaborative Program in Musculoskeletal Health Research, Bone and Joint Institute, Western University, London, Ontario, Canada
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  • Joshua Vincent
    Affiliations
    School of Physical Therapy, Faculty of Health Science, Western University, London, Ontario, Canada

    School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
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  • Joy MacDermid
    Affiliations
    Department of Rehabilitation Sciences, Faculty of Health Science, Western University, London, Ontario, Canada

    School of Physical Therapy, Faculty of Health Science, Western University, London, Ontario, Canada

    Collaborative Program in Musculoskeletal Health Research, Bone and Joint Institute, Western University, London, Ontario, Canada

    Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, Ontario, Canada

    School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
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Published:April 29, 2022DOI:https://doi.org/10.1016/j.jht.2022.03.008

      Highlights

      • There is moderate to high evidence of bias present within the current evident of shoulder specific patient reported outcomes. Many gaps remain surrounding certain measurement properties, such as the property of validity (ie, is the PROM measuring what it is intended to measure?)
      • Conclusive pooled estimates from previous systematic reviews indicate strong reproducibility (ie, test-retest, internal consistency) for the region-specific DASH and SPADI.
      • Strong measurement properties were reported across multiple systematic reviews for the WORC, DASH, SPADI, ASES and SST, which could be used in a clinical core set (standardized set of measures that should be gathered and reported as a minimum in all clinical research in specific areas of health or health care
      • Gaps in evidence remain in the lack of evaluation for the measurement properties of validity (eg, known groups, structural) and responsiveness (detecting meaningful change over time) for various shoulder PROMs.

      Abstract

      Background

      The aim of this study was to synthesize the psychometric evidence on different patient reported outcome measures (PROMs) for shoulder disorders.

      Methods

      This overview conducted a search of six databases. Included systematic reviews must address at least one psychometric property from a PROM for shoulder disorders. Risk of bias was assessed by A MeaSurement Tool to Assess Systematic Reviews (AMSTAR).

      Results

      Thirteen systematic reviews were identified that assessed measurement properties of 15 different PROMs. Based on AMSTAR, 1 review had a high risk of bias and 7 reviews had a moderate risk of bias. Excellent test-reliability scores of intraclass correlation coefficients (0.85-0.99) were reported by the Disabilities of the Arm, Shoulder and Hand, Shoulder Pain and Dsiability Index, American Shoulder and Elbow Surgeon score and Western Ontario Rotator Cuff Index. Construct validity was supported (r = 0.5-0.8) for the Disabilities of the Arm, Shoulder and Hand, Shoulder Pain and Dsiability Index, American Shoulder and Elbow Surgeon score and Western Ontario Rotator Cuff Index. Limited evidence of responsiveness was reported across various PROMs.

      Conclusion

      Strong reliability and convergent validity properties have been reported across multiple reviews for the Disabilities of the Arm, Shoulder and Hand, Shoulder Pain and Dsiability Index, American Shoulder and Elbow Surgeon score, Simple Shoulder Test and Western Ontario Rotator Cuff Index, which could be considered for a core clinical outcome set.

      Keywords

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      JHT Read for Credit

      Quiz: # 858

      Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue or to complete online and use a credit card, go to JHTReadforCredit.com. There is only one best answer for each question.
      • # 1.
        Risk of bias was assessed using
        • a.
          ASYM
        • b.
          AMBURG
        • c.
          AMSTAR
        • d.
          AMEX
      • # 2.
        The authors sought to identify
        • a.
          core sets of outcome measures
        • b.
          core concepts for treatment of shoulder pathology
        • c.
          resources for guiding treatment protocols for shoulder injuries
        • d.
          barriers to effective management of post-op shoulder conditions
      • # 3.
        The search produced
        • a.
          500 articles of which 25 were finally included
        • b.
          500 articles of which 50 were finally included
        • c.
          650 articles of which 60 were finally included
        • d.
          650 articles of which 30 were finally included
      • # 4.
        Discriminative validity was assessed in the population of
        • a.
          rotator cuff impingement syndrome
        • b.
          anterior instability
        • c.
          non-specific shoulder pain
        • d.
          biceps tendon rupture
      • # 5.
        A single PROM was identified as the gold standard for clinical use following rehabilitation for shoulder pathology
        • a.
          true
        • b.
          false
      When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.