title: Evaluation of shoulder-specific patient-reported outcome measures: a systematic and standardized comparison of available evidence.
abstract: 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.
  
  
  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.
authors.affiliation: IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; CIBER Epidemiología y Salud Pública, Barcelona, Spain.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Schmidt
authors.affiliation: IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; CIBER Epidemiología y Salud Pública, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain. Electronic address: mferrer@imim.es.
authors.forename: Montse
authors.initials: M
authors.lastname: Ferrer
authors.affiliation: Research Unit, University Hospital of Basurto, Bilbao, Spain; Health Services Research on Chronic Patients Network (REDISSEC), Barcelona, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: González
authors.affiliation: Health Services Research on Chronic Patients Network (REDISSEC), Barcelona, Spain; Research Unit, Hospital of Galdakao-Usansolo, Usansolo, Spain.
authors.forename: Nerea
authors.initials: N
authors.lastname: González
authors.affiliation: Health Services and Policy Research Group, Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
authors.forename: José Maria
authors.initials: JM
authors.lastname: Valderas
authors.affiliation: IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; CIBER Epidemiología y Salud Pública, Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Alonso
authors.affiliation: Research Unit, University Hospital of Basurto, Bilbao, Spain; Health Services Research on Chronic Patients Network (REDISSEC), Barcelona, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Escobar
authors.affiliation: Health Services Research on Chronic Patients Network (REDISSEC), Barcelona, Spain; Research Unit, Primary Care-Organization of Integrated Health Services, Gipuzkoa, Spain.
authors.forename: Kalliopi
authors.initials: K
authors.lastname: Vrotsou
mesh_terms: D000328:Adult; D004185:Disability Evaluation; D019317:Evidence-Based Medicine; D006801:Humans; D008297:Male; D008875:Middle Aged; D011594:Psychometrics / Q000295:instrumentation / Q000592:standards; D011788:Quality of Life; D015203:Reproducibility of Results; D000070599:Shoulder Injuries; D020069:Shoulder Pain / Q000517:prevention & control*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D054928:Validation Studies as Topic
keywords: Shoulder pain; disability evaluation; outcome assessment; psychometrics; quality of life; questionnaires; validation studies