Outcome Measures
Constant-Murley Score (CMS)
The CMS is a 100-point scale consisting of 4 subscales which help to determine the level of pain and functionality of a patient due to a shoulder injury (Roy et al. 2010). The higher the score, the higher function of the individual (Constant et al. 2008)
Roy et al. (2012) conducted a systematic review to review the psychometric evidence of the CMS. They found that the overall inter-rater reliability of the CMS was excellent (ICC: 0.89; 95% CI: 0.79-0.94). Construct validity was established with strong correlations associated with other shoulder outcome measures (Roy et al.2012). Responsiveness was confirmed also (Roy et al. 2012).
Kukkonen et al. (2013) reported a minimal clinically important difference (MCID) of 10 points on the CMS. The MCID is the smallest change in status on the outcome measure which is considered to be clinically relevant (Littlewood et al. 2012).
Please see Appendix (Online) for a link to the CMS.
Western Ontario Rotator Cuff Index
The Western Ontario Rotator Cuff (WORC) Index is a condition-specific, self-report questionnaire developed by Kirkley et al. (2003) used to assess Quality of Life (QoL) in patients with shoulder complaints as a result of Rotator Cuff tendinopathy.
It consists of 21 questions which relate to five different domains of shoulder dysfunction: Physical symptoms, Sports/Recreation, Work, Lifestyle and Emotional well-being (de Witte et al. 2012). Each question is scored from 0-100 on 100mm visual analogue scale, with each question scored as a percentage.
De Witte et al. (2012) examined the psychometric properties of the WORC and found high reliability and good validity and responsiveness when tested on people with Rotator Cuff tendinopathy. The WORC is shown to have a minimal detectable change (MDC) of 7.1 (Lopes et al. 2008). An MCID of 12 points has been reported (Kirkley et al. 2003).
One limitation observed by the authors was that the WORC failed to discriminate as well as the DASH score between individuals with severe and less severe shoulder symptoms (de Witte et al. 2012). However, a major strength of the WORC is it takes account of ADLs, mental health and QOL dimensions and not just physical findings (de Witte et al. 2012).
Please see Appendix (Online) for a link to the WORC Index with instructions on its completion and scoring.
Shoulder Pain and Disability Index (SPADI)
The SPADI is used to measure shoulder pain and disability. It consists of 13 questions separated into 2 domains: Pain (5 items) and Disability (8 items). Each item is scored from 0-10 on a numerical rating scale (NRS), and has been found easier to administer and score than the earlier VAS version (Williams et al. 1995). It takes <5 minutes to complete the SPADI (Williams et al. 1995).
One item omitted is allowed, however anymore and the no score is calculated (Roach et al. 1991).
Roy et al. (2009) found that the SPADI has reliability coefficients of ICC ≥ 0.89. Internal consistency has shown a similarly high value with Cronbach α > 0.90 (Roy et al. 2009, Hill et al. 2011). Paul et al. (2004) and Roy et al. (2009) confirmed good construct validity, correlating with other shoulder outcome measures such as the DASH. The SPADI has been shown good responsiveness and can adequately discriminate between improving patients and those who are deteriorating (Williams et al. 1995, Roy et al. 2009). Finally, a MCID of 8 points has been reported (Paul et al. 2004).
Disabilities of the Arm, Shoulder and Hand (DASH)
The DASH questionnaire has been demonstrated to perform consistently well in relation to reliability, validity, responsiveness to change (Haldorsen et al. 2014). It is a 30-item, self-report questionnaire designed to measure physical function and symptoms in patients with disorders of the shoulder, elbow, wrist and hand and takes approximately 3 – 4 minutes to complete. The DASH Outcome Measure was jointly developed by the Institute for Work & Health in Ontario and the American Academy of Orthopaedic Surgeons (AAOS). It is suitable for a broad range of shoulder pain presentations, including rotator cuff disorders, shoulder osteoarthritis, shoulder fractures, and frozen shoulder. The DASH outcome measure has been specifically validated for use with rotator cuff disorders (Huang et al. 2015).
DASH can be found here online