The American Shoulder and Elbow Surgeons Elbow Questionnaire: cross-cultural adaptation into German and evaluation of its psychometric properties

Psychometric analysis of the questionnaires for the assessment of upper limbs available in their Italian version: a systematic review of the structural and psychometric characteristics

INTRODUCTION

There is no systematic review that analyzes the psychometric properties of questionnaires in Italian. Previous studies have analyzed the psychometric characteristics of instruments for the measurement of pathologies of upper limbs and their joints in different languages. The aim of the present study was to analyze the psychometric properties of the questionnaires published in Italian for the evaluation of the entire upper limb or some of its specific regions and related dysfunctions.

EVIDENCE ACQUISITION

For the development of this systematic review, the following databases were used: PubMed, Scopus, Cochrane, Dialnet, Cinahl, Embase and PEDro. The selection criteria used in this study were: studies of transcultural adaptation to Italian of questionnaires oriented to the evaluation of upper limbs or any of their structures (specifically shoulder, elbow and wrist/hand), and contribution of psychometric variables of the questionnaire in its Italian version.

EVIDENCE SYNTHESIS

After reading the titles and applying the inclusion and exclusion criteria to the complete documents, 16 documents were selected: 3 for the upper limb, 8 for the shoulder, 1 for the elbow and 4 for the wrist and hand. The cross-sectional psychometric variables show levels between good and excellent in all the questionnaires. Longitudinal psychometric variables had not been calculated in the vast majority of the analyzed questionnaires.

CONCLUSIONS

Italian versions of the questionnaires show good basic structural and psychometric characteristics for the evaluation of patients with musculoskeletal disorders of the upper limb and its joints (shoulder, elbow and wrist/hand).

Establishing the psychometric properties of 2 self-reported outcome measures of elbow pain and function: A systematic review

STUDY DESIGN

Systematic review.

INTRODUCTION

The Patient-Rated Elbow Evaluation (PREE) and the self-report section of the American Shoulder and Elbow Surgeons-elbow form (pASES-e) are 2 patient-reported outcome measures (PROMs) commonly used to assess pain and disability arising from elbow disorders.

PURPOSE OF THE STUDY

To systematically review and summarize the quality and content of the evidence that is available on the psychometric properties of the PREE and pASES-e.

METHODS

We systematically searched the online databases PubMed, EMBASE, ProQuest, Scopus, Cumulative Index to Nursing and Allied Health Literature, UptoDate, ProQuest Dissertations & Theses, and Google Scholar. Ninety-one articles were retrieved, and after screening, 9 were included in the final analysis. Data extraction and quality appraisal was performed by 2 independent raters. Descriptive synthesis of the reviewed studies was completed.

RESULTS

Seven of the 9 studies had a quality score of 75% or higher. Agreement between the raters was good (kappa, 0.81). Both the PROMs did not demonstrate any floor and ceiling effects except for the satisfaction subscale of the pASES-e. Factor analysis revealed multidimensionality in the function subscale for both the PROMs. Construct validity was good with correlations above 0.70. Both were highly reliable with interclass correlation coefficient of >0.90. They were also highly responsive with an effect size and standardized response mean above 1. The minimal clinical important difference was not estimated for either measures.

DISCUSSION

This study concluded that strong clinical measurement properties exist for both the PREE and the pASES-e. We identified gaps in the current evidence for both the ASES-e and the PREE. Future studies need to calculate clinically important estimates like MCID, SEM, and others; and provide clear and specific conclusions.

CONCLUSION

The PREE and pASES-e have been established to be valid, reliable, and sensitive to change in both clinical and research settings based on high-quality evidence.

Translation of the Mayo Elbow Performance Score (MEPS) into German (MEPS-G)

BACKGROUND

The Mayo Elbow Performance Score is a clinical assessment to rate the performance of the elbow from a medical and/or therapeutic perspective. It is simple and efficient to operate and therefore frequently used in research as well as in clinics. However, an adequate translation of the MEPS into the German language and a verification of the quality criteria for the use in the German health system are currently lacking.

GOAL OF THE STUDY

The aim of this study is to translate the MEPS and to review the applicability of the German version (MEPS-G) in Germany.

MATERIALS AND METHODS

The translation was undertaken on the basis of a guideline for cultural adaptation. Two independent translations were created, combined and translated back into English by two native speakers. The back translations were reviewed and the German version was amended accordingly. The suitability of the final questionnaire was verified in a pretest with 73 participants.

RESULTS

The MEPS was converted into the German version MEPS-G and was tested. Apart from minor adjustments, the questionnaire was translated into German without difficulty. The time to complete the assessment was on average 2.5 min (± 1.6).

CONCLUSION

First analyses of the psychometric properties of the German MEPS showed identical values as the English version. The detailed quality criteria will be reviewed in a subsequent study.

Development and validation of a novel questionnaire for self-determination of the range of motion of wrist and elbow

Background

The aim of this study was to develop and validate a novel self-administered questionnaire for assessing the patient’s own range of motion (ROM) of the wrist and the elbow.

Methods

In a prospective clinical study from January 2015 to June 2015, 101 consecutive patients were evaluated with a novel, self-administered, diagram-based, wrist motion assessment score (W-MAS) and elbow motion assessment score (E-MAS). The questionnaire was statistically evaluated for test-retest reliability, patient-physician agreement, comparison with healthy population, and influence of covariates (age, gender, affected side and involvement in workers’ compensation cases).

Results

Assessment of patient-physician agreement demonstrated almost perfect agreement (k > 0.80) with regard to six out of eight items. There was substantial agreement with regard to two items: elbow extension (k = 0.76) and pronation (k = 0.75). The assessment of the test-retest reliability revealed at least substantial agreement (k = 0.70). The questionnaire revealed a high discriminative power when comparing the healthy population with the study group (p = 0.007 or lower for every item). Age, gender, affected side and involvement in workers’ compensation cases did not in general significantly influence the patient-physician agreement for the questionnaire.

Conclusion

The W-MAS and E-MAS are valid and reliable self-administered questionnaires that provide a high level of patient-physician agreement for the assessments of wrist and elbow ROM.

Level of evidence: Diagnostic study, Level II

Electronic supplementary material

The online version of this article (doi:10.1186/s12891-016-1171-z) contains supplementary material, which is available to authorized users.

Linking of the Patient Rated Elbow Evaluation (PREE) and the American Shoulder and Elbow Surgeons - Elbow questionnaire (pASES-e) to the International Classification of Functioning Disability and Health (ICF) and Hand Core Sets

STUDY DESIGN

Content analysis-ICF linking.

INTRODUCTION

The Patient Rated Elbow Evaluation (PREE) and the self-report section of the American Shoulder and Elbow Surgeons society - Elbow form (ASES-e) are the two commonly used elbow pain and disability self-report measures (PROs). The content of these questions have never been analyzed in light of the International Classification of Functioning Disability and Health (ICF) which is the current standard to describe health and health-related states.

PURPOSE

The purposes of this study were to analyze the conceptual basis of the PREE and the ASES-e by linking the meaningful concepts in these PROs to the ICF using standardized linking rules and to determine the extent to which the ICF core set for hand conditions cover the content of elbow questionnaires using summary ICF linkage indicators.

METHODS

Two raters linked the two PROs to the ICF using the linking rules proposed by Cieza and colleagues. Percentage agreement was calculated between the raters. Summary linkage indicators proposed by MacDermid were used to estimate the extent to which the ICF core set for hand conditions cover the content of the elbow questionnaires.

RESULTS

All the items of the PREE (Measure to ICF linkage - 100%) and all but one item of the pASES-e (Measure to ICF linkage - 95%) were linked to the ICF. The satisfaction item on the ASES-e was not-covered by the ICF. Percentage agreement on linking between the raters was 96% and 95% for the PREE and the pASES-e respectively. The unique linkage of the PREE and the pASES-e to the unique codes on the brief and comprehensive core set were lower than absolute linkage to the core set for hand conditions. The PROs represented less than 20% of the comprehensive core set and more than 70% of the brief core set. While for the unique core set disability representation the 2 PROMs represented 100% brief core set unique disability codes and less than 35% of the comprehensive core set unique disability codes.

CONCLUSION

The PREE and the ASES-e are aligned with the ICF framework and the core sets for hand conditions. The ICF Core Set devised for hand conditions may also be useful for elbow conditions.

LEVEL OF EVIDENCE

1b.

Outcomes of Elbow Arthroscopic Osteocapsular Arthroplasty

PURPOSE

To evaluate the results of elbow arthroscopic osteocapsular arthroplasty (AOA) and determine which factors influence the outcome in a large group of patients with primary osteoarthritis.

METHODS

A consecutive series of 46 patients with elbow osteoarthritis underwent AOA by a single surgeon (N.G.H.) between December 2005 and January 2013. Thirty-one patients returned for a comprehensive physical examination an average of 3.4 years later. The outcomes measures included visual analog scale (VAS), Mayo Elbow Performance Scores (MEPS), Disabilities of the Arm, Shoulder, and Hand (DASH), and American Shoulder and Elbow Society (ASES) scores. Preoperative and postoperative continuous variables were compared and a multivariable regression analysis was performed.

RESULTS

Thirty-one patients with a mean age of 48 years (range, 19-77 years) returned for final follow-up, including 27 men and 4 women. Statistically significant improvement was observed in extension deficit (24° before surgery to 12° after surgery), flexion (126° before surgery to 135° after surgery), visual analog scale (6.4 before surgery to 1.6 after surgery), and Mayo Elbow Performance Scores (57 [poor] before surgery to 88 [good] after surgery). Subjective scores included a mean postoperative Disabilities of the Arm, Shoulder, and Hand score of 13 and an American Shoulder and Elbow Society pain score of 40. No complications were noted at final follow-up.

CONCLUSIONS

Elbow AOA is a safe, efficacious treatment for patients with mild to moderate osteoarthritis. Our retrospective review found significant improvement in elbow motion, pain and clinical outcomes.

Translation and validation of the PREE (Patient Rated Elbow Evaluation) to a French version

BACKGROUND

Only a few outcome measures specific to elbow pathology and the assessment of their impacts on function are valid and reliable when used in French speaking populations. The English version of the Patient Rated Elbow Evaluation (PREE) was determined to be an optimal candidate for translation.

HYPOTHESIS

A French version of the PREE (PREE-Fr) will be generated and compared to its original version in terms of reliability and responsiveness.

MATERIALS AND METHODS

The PREE was translated following the guidelines of the American Academy of Orthopedic Surgeons. Patients with a variety of elbow pathologies completed the French version of the PREE (PREE-Fr), the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) and the Mayo Elbow Performance Score (MEPS) on three different occasions. The test-retest reliability of the PREE-Fr was calculated using questionnaires that were filled out with a one-week interval between them. The responsiveness was assessed using questionnaires filled out six months after treatment.

RESULTS

A French version of the PREE was generated. Data gathered from 54 patients yielded an intra-class correlation coefficient for reliability of 0.89 (CI95%: 0.79-0.94) for the PREE-Fr. For construct validity, using the Pearson correlation coefficient, we obtained excellent correlation between the PREE-Fr and QuickDASH at day one, one week and six months (0.89-0.96) while that between the PREE and MEPS was good to excellent (0.70-0.95). Responsiveness of the PREE-Fr was assessed and yielded a standardized response mean of 1.03, meaning that a large change was recorded between day one and six months.

DISCUSSION

The PREE-Fr should be considered in French speaking populations for patients with elbow pathology, whether it is for research or evaluation purposes as it is valid, reliable and responsive to change.

Evaluation of shoulder-specific patient-reported outcome measures: a systematic and standardized comparison of available evidence

BACKGROUND

The aim of this study was to perform a standardized and systematic evaluation of the available evidence on multi-item shoulder-specific patient-reported outcome measures that are applicable to a wide spectrum of disorders.

MATERIALS AND METHODS

A systematic review was conducted in PubMed to identify articles with information regarding the development process, metric properties, and administration issues of shoulder-specific patient-reported outcome measures. Two experts independently reviewed all the articles identified for one instrument and applied the EMPRO (Evaluating Measures of Patient Reported Outcomes) tool, which was designed to assess the quality of attributes in a standardized way. An overall EMPRO score and 6 attribute-specific scores were calculated (range, 0-100) to describe the quality of instrument performance.

RESULTS

We identified 11 instruments and 112 articles (2-30 articles per instrument). The American Shoulder and Elbow Surgeons (ASES) shoulder assessment, Simple Shoulder Test (SST), and Oxford Shoulder Score (OSS) were the best rated, with overall scores of 77.4 points, 72.6 points, and 69.7 points, respectively. They have been shown to be valid, reliable, and responsive, with a low administration burden. Acceptable results were also found for the Flexilevel Scale of Shoulder Function, Shoulder Pain and Disability Index, and Dutch Shoulder Disability Questionnaire, but some of their attributes need further evaluation.

CONCLUSIONS

Current evidence supports the use of the ASES, SST, or OSS. We recommend the SST for longitudinal studies or clinical trials, the Dutch Shoulder Disability Questionnaire for clinical practice to minimize administration burden, and the ASES or OSS to discriminate among patients' or groups' evaluations at one point of time.

Translation, cultural adaptation, validity and reliability of the Turkish ASES questionnaire

PURPOSE

The American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) is a standard shoulder assessment form, which is comprised of objective and subjective sections and prepared by shoulder and elbow surgeons. The purpose of this study was to translate the subjective part of the ASES into Turkish and establish its cultural adaptiveness and validity.

METHODS

The original version of the ASES was translated into Turkish in accordance with the stages recommended by Guillemin. Sixty-three patients (average age: 48.2 ± 13.4; range: 18-74 years) suffering from different shoulder complaints were included in the study. The ASES was completed twice at 3- to 7-day intervals for test-retest reliability. The intraclass correlation coefficient was used to calculate the test-retest reliability, and Cronbach's alpha was used for internal consistency. Patients were asked to complete the short form 36 (SF-36) and the Shoulder Pain and Disability Index (SPADI) for correlation. Validity was evaluated by external correlation of the ASES with the SPADI and SF-S6 questionnaire, which may also be defined as 'construct validity'. The results were analysed using Pearson's correlation test.

RESULTS

The test-retest reliability of the ASES pain and function subscales and total ASES score were 0.95, 0.86 and 0.94, respectively. Cronbach's alpha coefficient for the total ASES was 0.88. The correlation between the total ASES and total SPADI score was -0.82; the correlation coefficient between the ASES pain subscale and SPADI pain subscale was -0.79 (p < 0.000); and the correlation between the ASES and SPADI function subscales were -0.53 (p < 0.000). The highest correlation was between ASES and SF-36 bodily pain, as well as ASES and SF-36 mental health (r = 0.64, r = 0.56, p < 0.000), and the lowest correlations were between ASES and the SF-36 physical component score and between ASES and SF-36 social function (r = 0.28, r = 0.33 p < 0.000).

CONCLUSION

The Turkish version of the ASES is a valid and reliable shoulder assessment form that can be used for numerous shoulder disorders.

LEVEL OF EVIDENCE

III.

Validity and sensitivity to change of patient-reported pain and disability measures for elbow pathologies

STUDY DESIGN

Prospective cohort study.

OBJECTIVE

To evaluate the internal consistency, concurrent construct validity, longitudinal validity, sensitivity to change, and factor structure of the Patient-Rated Elbow Evaluation form (PREE), the patient-reported form of the American Shoulder and Elbow Surgeons Elbow Questionnaire (pASES-e), and the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH) in a diverse group of patients who had surgery for various elbow pathologies.

BACKGROUND

Measuring functional outcomes after surgical procedures of the elbow requires valid patient-reported pain and disability questionnaires. The PREE, the pASES-e, and the DASH are commonly used questionnaires. There is, however, insufficient evidence available concerning their validity and sensitivity to change.

METHODS

Data were prospectively collected from 128 patients (mean ± SD age, 46.5 ± 12.8 years) post-elbow surgery. Patients completed the PREE, the pASES-e, the DASH, and the Medical Outcomes Study 36-Item Short-Form Health Survey at baseline (first visit after surgery) and 6 months postsurgery. Concurrent construct validity, longitudinal validity, sensitivity to change, and factor structure were analyzed.

RESULTS

Concurrent construct validity was demonstrated by confirmation of expected relationships; the strongest correlations were observed between the PREE pain score, the PREE total score, the pASES-e pain score, and the DASH score (r = 0.73-0.87). The pASES-e function score correlated the least with other constructs. Longitudinal validity demonstrated similar findings: the pASES-e pain change score and PREE change score were most strongly correlated, and the pASES-e function change score and DASH change score were moderately to weakly correlated. All 3 patient-reported questionnaires demonstrated a large effect size and standardized response means greater than 1.0. Structural validity was supported for the PREE (R2 = 77.2%, 4 factors) and the pASES-e (R2 = 74.4%, 4 factors), but not for the DASH (R2 = 71.3%, 5 factors).

CONCLUSION

The PREE, the pASES-e, and the DASH have acceptable validity and sensitivity to change. The pASES-e function subscale is the least sensitive to change and is less correlated to other measures.

Development of a score set to measure function and quality of life in patients suffering from elbow pathology

INTRODUCTION

Daily function plays an important role in the quality of life for patients suffering from pathology of the upper extremity. The recovery of functions of daily living determines the success or failure of the treatment for the patient. The goal of this study was to establish and validate a score set measuring quality of life, and objective and subjective function in general elbow pathologies.

METHODS

A literature review was performed, in order to find a patient-based elbow specific questionnaire. The score set was tested and validated in a cross-sectional setting.

RESULTS

The patient-rated elbow evaluation (PREE) was chosen as the patient-based elbow specific questionnaire. For measuring general health and subjective arm function, the short form-36 mental health (SF-36 MH) and the shortened disabilities of the arm, shoulder and hand questionnaire (quick DASH) were chosen, respectively. To measure objective function, several clinical tests were implemented. The score set was tested in 66 patients, of which 56.1% had function restrictions due to pain. The correlation between the PREE-function and quick DASH was found to be the highest (r = 0.74*). Between the PREE and quick DASH, the correlation was good (r = 0.70*) and between the PREE-pain and quick DASH, the correlation was moderate (r = 0.58*). The lowest correlation (r = 0.18) was found between the PREE and SF-36 MH (*p < 0.01).

CONCLUSION

General health, subjective and objective function can be measured in elbow pathology patients using a score set containing the SF-36 MH, quick DASH, PREE, and several clinical tests. Further testing of the score set needs to be executed in a prospective study.

Upper extremity-specific measures of disability and outcomes in orthopaedic surgery

Outcome measures may consist of simple questions or they may be more complex instruments that evaluate multiple interrelated domains that influence patient function. Outcome measures should be relevant to patients, easy to use, reliable, valid, and responsive to clinical changes. The Disabilities of the Arm, Shoulder and Hand score can be used to measure disability for any region of the upper limb. Joint and disease-specific outcome measures have been developed for the shoulder, the elbow, and the wrist and hand. Many of these measures would benefit from further research into their validity, reliability, and optimal applicability.

Reliability and validity of Milliken Activities of Daily Living Scale (MAS) in measuring activity limitations of a Turkish population

AIM

The Milliken Activities of Daily Living Scale (MAS) is a self-report scale to address limitation of ability to perform daily tasks in upper extremity injuries. It can address the necessity of each task, which makes MAS useful while planning individual treatment. The objective of this study was to perform cross-cultural adaptation of the MAS TURKISH and to evaluate its reliability and validity for Turkish-speaking patients with upper extremity conditions.

METHOD

A total of 99 patients were asked to complete the adapted MAS and DASH at baseline and one week after the initial assessment. Also grip strength was evaluated with an interval of one week.

RESULTS

The reliability of the adapted version was good, with high internal consistency (Cronbach's alpha = 0.964) and test-retest reliability (interclass correlation coefficient (ICC) = 0.772) for the total score. A statistically significant correlation between MAS and DASH scores and grip strength scores of the injured side was obtained.

CONCLUSION

The results of the study have shown that the Turkish version of MAS has excellent test-retest reliability and validity. It is a suitable assessment for evaluating function and giving an overview of activity limitations in many performance areas in a Turkish population.