Measuring Function of the Shoulder. A Cross-Sectional Comparison of Five Questionnaires*

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Abstract
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 prospectively the validity of five questionnaires 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 questionnaire 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 questionnaires. Spearman rank correlations were calculated to compare the questionnaires with each other and with other assessments. One-way analysis of variance was used to determine the ability of the questionnaires to discriminate between self-rated severity of the problem and over-all health. The frequency distributions were similar among the five shoulder questionnaires, but those of the five shoulder questionnaires differed from that of the SF-36. The correlations were good (0.73 < or = r < or = 0.80) among all of the five shoulder questionnaires 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 < or = r < or = 0.60). The shoulder questionnaires discriminated between levels of severity (p < 0.0001) but not between levels of over-all health (0.10 < or = p < or = 0.86). In this concurrent comparison of measures of shoulder-specific outcome in the same subjects, the shoulder questionnaires performed similarly, both in describing function of the shoulder and in discriminating between levels of severity. The shoulder questionnaires 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.