Patient self-report section of the ASES questionnaire: a Spanish validation study using classical test theory and the Rasch model

A new self-assessment tool following shoulder stabilization surgery, the auto-Walch and auto-Rowe questionnaires

PURPOSE

Patient-reported outcome measures (PROMS) are increasingly used for patient evaluation, as well as for scientific research. Few are used for practical purposes in the clinical setting, and few are reliable enough to allow proper feedback to physicians. Two of the most commonly used assessment tools in shoulder instability are the Walch-Duplay and the Rowe scores. The aim of this study was to evaluate the validity of self-administered versions of the Walch-Duplay and Rowe scores following shoulder stabilization procedure.

METHODS

Between the months of May and December 2021, all patients who were followed in one of six institutions for shoulder instability were included. Patients were required to anonymously fill a self-administered version of Walch-Duplay and Rowe score. The classic scores were measured by the surgeon. Correlations between self-assessment and physician-assessment were then recorded.

RESULTS

A total of 106 patients were evaluated during the study period. Using the Spearman coefficient for correlation, a strong correlation (r > 0.5) was found between the results of the self-administered questionnaire and the surgeon-measured score. The difference between surgeon- and patient-administered questionnaires was non-significant.

CONCLUSION

The self-administered version of the Walch-Duplay and Rowe questionnaires can reliably be used in the clinical setting for post-operative follow-up of patients undergoing shoulder stabilization procedures.

LEVEL OF EVIDENCE

Level II.

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).

Validity and reliability of the Greek version of the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form

Background

The aim of our study is to prove the validity and reliability of the Greek translated version of the self-report section of the American Shoulder and Elbow Surgeons (ASES) questionnaire.

Methods

A total of 108 patients with various shoulder disorders were evaluated at two different orthopedic centers. All patients answered the Greek ASES questionnaire as well as the previously validated Greek version of the Disability Arm Shoulder and Hand score. Three days after the first evaluation, a subgroup of 40 individuals was randomly selected to complete again the Greek ASES text to prove its reliability, after the test-retest procedure. Reliability was tested with Cronbach’s alpha, stability by calculating the intraclass correlation coefficient and by Blant Altman plot and structural validity with the confirmatory factor analysis.

Results

The internal consistency of the ASES functional score and the ASES total score was 0.925 and 0.750 respectively. The intraclass correlation coefficient between initial assessment and reassessment of the ASES functional and total score was 0.951 and 0.938 (P < .001), respectively. The correlation coefficients correlation between the ASES functional and total scores with DASH total score were −0.881 and −0.759 (P < .001), respectively.

Conclusions

The Greek ASES version proved to be equivalent to the English original version in evaluating different shoulder disorders in the Greek population.

How to Assess Shoulder Functionality: A Systematic Review of Existing Validated Outcome Measures

The objective of this review was to compile validated functional shoulder assessment tools and analyse the methodological quality of their validations. Secondarily, we aimed to provide a comparison of the tools, including parameter descriptions, indications/applications, languages and operating instructions, to choose the most suitable for future clinical and research approaches. A systematic review (PRISMA) was conducted using: PubMed, WoS Scopus, CINHAL, Dialnet and reference lists until 2020. The main criteria for inclusion were that papers were original studies of validated tools or validation studies. Pre-established tables showed tools, validations, items/components, etc. The QUADAS-2 and COSMIN-RB were used to assess the methodological quality of validations. Ultimately, 85 studies were selected, 32 tools and 111 validations. Risk of bias scored lower than applicability, and patient selection got the best scores (QUADAS-2). Internal consistency had the highest quality and PROMs development the lowest (COSMIN-RB). Responsiveness was the most analysed metric property. Modified UCLA and SST obtained the highest quality in shoulder instability surgery, and SPADI in pain. The most approached topic was activities of daily living (81%). We compiled 32 validated functional shoulder assessment tools, and conducted an analysis of the methodological quality of 111 validations associated with them. Modified UCLA and SST showed the highest methodological quality in instability surgery and SPADI in pain.

The Chinese version of the American shoulder and elbow surgeons standardized shoulder assessment form questionnaire, patient self-report section: a cross-cultural adaptation and validation study

Background

The patient self-report section of the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASESp) is one of the most validated and reliable assessment tools. This study aimed to establish a validated Chinese version of ASESp (ASESp-CH).

Methods

A clinical prospective study was performed (ClinicalTrials.gov Identifier: NCT04755049; registered on 2021/02/11). Following the guidelines of forward-backward translation and cross-cultural adaptation, a Chinese version of ASESp was established. Patients older than 18 years with shoulder disorders were included. Patients who could not complete test-retest questionnaires within the interval of 7–30 days and patients who received interventions were excluded. Intraclass correlation (ICC) was calculated for test- retest reliability, whereas internal consistency was determined by Cronbach value. Construct validity was evaluated by comparing the corresponding domains between the ASESp-CH and a validated Chinese version of 36-Item Short Form Health Survey (SF-36).

Results

A total of 86 patients were included with a mean test-retest interval of 12 ± 5.4 days. Test-retest reliability was excellent with an ICC of 0.94. Good internal consistency was found, with a Cronbach alpha of 0.86. Construct validity of the ASESp-CH questionnaire was good. The major domains of the ASESp-CH were significantly correlated with the respective domains in the SF-36 (p <  0.01), except for the domain of stability of ASESp-CH.

Conclusions

The Chinese version of ASESp questionnaire is a highly validated and reliable tool for shoulder disorder assessment.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-021-04255-z.

Spanish translation and cross-language validation of the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form

BACKGROUND

The American Shoulder and Elbow Surgeons (ASES) Standardized Shoulder Assessment Form is one of the most frequently used outcomes score for shoulder pathology. The patient report section of the ASES questionnaire (p-ASES) is easy to complete, can be quickly administered, and is applicable to a wide range of shoulder pathologies, yet a validated Spanish translation of this questionnaire does not currently exist for diverse Spanish-speaking populations. The purpose of this study was to translate and culturally adapt the patient report section of the ASES to Spanish and to assess its validity and reliability among a culturally diverse group of Spanish-speaking patients, typically seen in the United States.

METHODS

The p-ASES Standardized Shoulder Assessment Form was translated into Spanish using a universal approach for translation and cultural adaptation of instruments. A total of 127 Spanish-speaking patients with shoulder pain were included in the study and asked to complete the Spanish translated p-ASES form, the Patient-Reported Outcomes Measurement Information System (PROMIS) v1.2 Physical Function SF 20a in Spanish and a demographics questionnaire. Construct validity was tested using correlational analysis between the Spanish translation of the p-ASES to the Spanish translation of the PROMIS v1.2 Physical Function Short Form 20a. Reliability was measured using both test-retest reliability and internal consistency (Cronbach α) in a subgroup of 27 patients who completed both surveys at a separate time point.

RESULTS

The p-ASES demonstrated desirable convergent validity with the validated Spanish version of the PROMIS v1.2 Physical Function Short Form 20a with a strong correlation (r = 0.82, P < .04) for Spanish speakers. The Spanish translation of the p-ASES proved to be a reliable tool with a high degree of internal consistency across question items (α = 0.90). The Spanish p-ASES also demonstrated excellent test-retest reliability with a strong correlation (r = 0.87, P < .001) between time 1 and time 2.

CONCLUSION

The Spanish p-ASES is both a valid and reliable tool for assessing shoulder function in Spanish-speaking patients from diverse cultural backgrounds and it demonstrates psychometric properties equivalent to those of the English-language version.

Cross-cultural adaptation and validation of the Argentine "American Shoulder and elbow surgeons, patient self-report section" questionnaire

BACKGROUND

American Shoulder and Elbow Surgeons questionnaire (ASES-p) has been translated into Spanish, but it has not been adapted to the Argentine population yet. Although Spain and Argentina speak the same language, linguistic differences between Spanish-speaking countries may affect the interpretation of the different items included in the questionnaire.

OBJECTIVE

To conduct the translation, cross-cultural adaptation and validation of the self-report section of the ASES-p into Argentine Spanish for patients with musculoskeletal shoulder disorders, and to assess its psychometric properties.

DESIGN

Study of diagnostic accuracy/assessment scale.

METHOD

The study was carried out in three consecutive phases: translation, cross-cultural adaptation and validation for its use in Argentina. In the third phase, we used the ASES-p, Short Form 36 (SF-36), EuroQol-5D (EQ-5D), and Disabilities of the Arm, Shoulder and Hand (DASH) questionnaires, and the Global Rating of Change (GROC) scale.

RESULTS

One hundred three participants completed a set of questionnaires on two occasions and were included in the final analysis. The time taken to answer and score the questionnaire was 118 and 52 s, respectively. Neither a ceiling nor a floor effect was observed. Cronbach's alpha coefficient was 0.85. Intraclass correlation coefficient was 0.83. A significant correlation was found between the DASH, the GROC and various SF-36 subscales. There were strong indices of concurrent-cross validation, longitudinal validity, and construct validity. The ASES-p questionnaire showed a minimal clinically important difference (MCID) value of 7.88 points.

CONCLUSION

Some psychometric properties in reliability and validity were acceptable in the Argentine version of the ASES-p questionnaire.

The Dutch version of the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form is a reliable and valid questionnaire for shoulder problems

Background

The self-assessment section of the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASESq) is one of the most used patient-reported outcome measures for general shoulder problems. This study was performed to establish a valid Dutch version of the ASESq (ASESq-NL).

Materials and Methods

A clinical prospective, nonrandomized study was performed. Translation of the ASESq into Dutch was done following the guidelines of cross-cultural adaptation. Patients older than 17 years of age with shoulder problems were included. Patients who declined to participate or insufficiently completed questionnaires were excluded. For test-retest reliability analysis, the intraclass correlation coefficient (ICC) was calculated and an interval of 7-28 days between test and retest was set. Cronbach alpha was used to determine internal consistency. Dutch validated versions of the Shoulder Pain and Disability Index (SPADI) and 36-Item Short Form Health Survey (SF-36) were completed and compared with the ASESq-NL to evaluate construct validity using a Spearman rank correlation coefficient calculation.

Results

A total of 92 patients were included. Test-retest reliability was excellent with an ICC of 0.82. The mean test-retest interval was 13 days (standard deviation 4.4). Internal consistency was good, with a Cronbach alpha of 0.83. Construct validity of the ASES questionnaire was good. All domains of the ASESq-NL had significant (P < .05) correlations with the domains of the SPADI and the SF-36, except for the SF-36 domains stability with “physical function and energy" and "emotional well-being.”

Conclusion

The Dutch ASES questionnaire is a valid and reliable tool for the evaluation of shoulder problems and is permissible for implementation into the Dutch health care system.

Test-retest reliability of the ASES-p shoulder scale

INTRODUCTION

Shoulder disorders are common musculoskeletal problems. The self-assessed ASES questionnaire (ASES-p) is one of the most widely used tools for evaluating shoulder function. Its 11 items are divided in a function (10 items) and pain (1 item) dimension, assigned between 0 and 50 points each. Their sum is the scale's total score, with higher values indicating better health status. The current work explores the test-retest reliability of the Spanish version of the ASES-p score values.

MATERIALS AND METHODS

The scale was administered twice to a sample of subjects with various shoulder pathologies, via telephone interviews performed at 3-7 days apart. Exact agreement was calculated on an item and score basis. Score variability was assessed with the 95% limits of agreement method (LoA).

RESULTS

N = 161 subjects were initially contacted, and a total of 82 stable health status subjects provided valid test-retest replies. "Do usual sport" was the only item with missing data. Exact agreement oscillated between 67 and 89% per item. The 95% LoA ranged between -5.9 and 6.9 points for function; -13.2 to 11.9 for pain and -10.3 to 10.1 for the total ASES-p score.

CONCLUSIONS

Test-retest reliability in stable patients was considered acceptable for the function and total scores, but not for pain. This may reflect usual pain behaviour, but it also implies that the pain evaluation should be further studied. The ASES-p pain subscore should not be used as the single measure for monitoring shoulder pain. Revisiting the "do usual sports" item may increase the scale's applicability.

A concise shoulder outcome measure: application of computerized adaptive testing to the American Shoulder and Elbow Surgeons Shoulder Assessment

BACKGROUND

Patient-reported outcome measures enable quantitative and patient-centric assessment of orthopedic interventions; however, increased use of these forms has an associated burden for patients and practices. We examined the utility of a computerized adaptive testing (CAT) method to reduce the number of questions on the American Shoulder and Elbow Surgeons (ASES) instrument.

METHODS

A previously developed ASES CAT system was applied to the responses of 2763 patients who underwent shoulder evaluation and treatment and had answered all questions on the full ASES instrument. Analyses to assess the accuracy of the CAT score in replicating the full-form score included the mean and standard deviation of both groups of scores, frequency distributions of the 2 sets of scores and score differences, Pearson and intraclass correlation coefficients, and Bland-Altman assessment of patterns in score differences.

RESULTS

By tailoring questions according to prior responses, CAT reduced the question burden by 40%. The mean difference between CAT and full ASES scores was -0.14, and the scores were within 5 points in 95% of cases (a 12-point difference is considered the threshold for clinical significance) and were clustered around zero. The correlation coefficients were 0.99, and the frequency distributions of the CAT and full ASES scores were nearly identical. The differences between scores were independent of the overall score, and no significant bias for CAT scores was found in either a positive or negative direction.

CONCLUSION

The ASES CAT system lessens respondent burden with a negligible effect on score integrity.