A comparison of four shoulder-specific questionnaires in primary care

Abstract

Objectives: To compare the validity, responsiveness to change, and user friendliness of four self completed, shoulder-specific questionnaires in primary care. Methods: A cross sectional assessment of validity and a longitudinal assessment of responsiveness to change of four shoulder questionnaires was carried out: the Dutch Shoulder Disability Questionnaire (SDQ-NL); the United Kingdom Shoulder Disability Questionnaire (SDQ-UK); and two American instruments, the Shoulder Pain and Disability Index (SPADI) and the Shoulder Rating Questionnaire (SRQ). 180 primary care consulters with new shoulder region pain each completed two of the questionnaires, as well as EuroQoL and 10 cm visual analogue scales (VAS) for overall pain and difficulty due to the shoulder problem. Each participant was assessed by a standardised clinical schedule. Postal follow up at 6 weeks included baseline measures and self rated assessment of global change of the shoulder problem (seven point Likert scale). Results: Strongest correlations were found for SDQ-UK with EuroQoL 5 score, and for SPADI and SRQ with shoulder pain and difficulty VAS. All shoulder questionnaires correlated poorly with active movement at the painful shoulder. SPADI and SRQ performed better on ROC analysis than SDQ-NL and SDQ-UK (areas under the curve of 0.87, 0.85, 0.77, and 0.77, respectively). However, SRQ scores changed significantly over time in stable subjects. Conclusions: Cross sectional comparison of the four shoulder questionnaires showed they had similar overall validity and patient acceptability. SPADI and SRQ were most responsive to change. Additionally, SPADI was the quickest to complete and scores did not change significantly in stable subjects. M ost shoulder region pain is seen and managed in primary care.1 Our understanding about the natural history and optimal treatment for shoulder complaints has been hampered, however, by the use of different outcome measures, including a variety of shoulder-specific questionnaires.2-4 It is therefore important to identify a preferred shoulder questionnaire to facilitate the consistent use of outcome measures and meaningful comparison of results in primary care based cross sectional and longitudinal studies.Since 1990, a number of groups have developed self administered shoulder pain and disability questionnaires. 5-13Many were developed and tested in secondary orthopaedic care settings and were primarily intended for measuring outcomes after surgical procedures. To date, the validity and responsiveness of shoulder questionnaires has not been compared in primary care.We describe the results from a prospective study comparing the validity, responsiveness, and acceptability of four shoulder pain and disability questionnaires when used to assess primary care consulters with new onset shoulder region pain.

Long-term effect of Prolotherapy on symptomatic rotator cuff tendinopathy

“…This exceeds MCID for SPADI, which is 8 points reduction (8). Eighteen patients (85.71%) would recommend dextrose Prolotherapy to other patients with a similar condition ( Figure 1) and no one patient reported significant side effects, which were not resolved within one week.…”

A Review Study: Clinical Assessment of Patients With Thoracic Outlet Syndrome

“…Moreover, the "arm, shoulder, and hand" questionnaire has been used in some studies conducted on the patients with thoracic outlet syndrome [20][21][22]. In Table 1, the characteristics of the resources and in Table 2, two characteristics on evaluating the treatment outcomes [23][24][25][26] are presented.…”

“…These instruments are recommended for patients with thoracic outlet syndrome, however none of them has been validated and reliable in these patients and using them requires more research on their psychometric properties in these patients. Although, the studies showed that the psychometric properties of these instruments are acceptable for clinical use [23,25,34], the clinical use of them requires more research and examinations. For instance, the shortness of questionnaire, simple answering with yes/no, and very simple grading in "simple shoulder test" makes this questionnaire an attractive research clinical instrument but in the systematic-review studies, the least detectable change (MDC) and the least minimal clinically important difference (MCID) are not defined [34].…”

“…The "shoulder pain and disability" has an easier grading and more acceptance compared to the "shoulder grading" questionnaire for participants and is completed faster but it has less validity. Responding to changes over time and the construct validity of both questionnaires are identical [25]. The "shoulder pain and disability index" has also been translated into Persian in Iran and the Persian version Cronbach α coefficient has been reported as 0.94 [43].…”

Management of frozen shoulder: a systematic review and cost-effectiveness analysis

“…In addition, the correlation between some of the included scales was at best moderate. [54][55][56] Because of the large number of different range of movement measures used, following discussion with the advisory group these were prioritised for the analyses. The passive range of movement outcomes of interest were passive external rotation, passive internal rotation and passive abduction; and the active range of movement outcomes were active external rotation, active internal rotation and active abduction.…”