title: Shoulder outcome measures: is there a right answer?
abstract: OBJECTIVE
  A number of outcome measures (instruments) are used to assess shoulder pain and function in clinical practice. No clear 'gold standard' exists and it is thought that different instruments will give a different answer. Our aim is to statistically compare four commonly used outcome measures in a group of trauma patients and to identify whether instruments which combine objective and subjective components differ from those which are purely subjective.
  
  
  METHODS
  Forty-four patients undergoing internal fixation of proximal humeral fractures were recruited between 2003 and 2008. Each was asked to complete a number of outcome measures: University of Los Angeles score (UCLA); Constant and Murley score (Constant); Oxford Shoulder Score (OSS); Quick form of the Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH). Each were measured on a different scale but were standardised to 0-100 for comparison.
  
  
  RESULTS
  Purely subjective instruments gave higher scores (better function and/or less pain). Statistical differences were found between each pair of instruments (p < 0.001), except for the comparison between UCLA and QuickDASH (p = 0.403). The study found inconsistencies between instruments, with outcomes varying depending on whether subjective or objective measurements were being assessed.
  
  
  CONCLUSIONS
  Outcome measures are useful tools, but clinicians need to be aware that their choice of instrument should be made carefully, taking into account the reason behind its use with regard to outcome.
authors.affiliation: Department of Orthopaedic Surgery, Aberdeen Royal Infirmary, Foresterhill Road, Aberdeen, UK. james.beastall@nhs.net.|Department of Trauma and Orthopaedic Surgery, Aberdeen Royal Infirmary, Foresterhill Road, Aberdeen, AB25 2ZN, UK. james.beastall@nhs.net.
authors.forename: James E
authors.initials: JE
authors.lastname: Beastall
authors.affiliation: Medical Statistics Team, University of Aberdeen, Foresterhill, Aberdeen, UK.
authors.forename: Shona
authors.initials: S
authors.lastname: Fielding
authors.affiliation: Department of Orthopaedic Surgery, Aberdeen Royal Infirmary, Foresterhill Road, Aberdeen, UK.
authors.forename: Eva
authors.initials: E
authors.lastname: Christie
authors.affiliation: Department of Orthopaedic Surgery, Aberdeen Royal Infirmary, Foresterhill Road, Aberdeen, UK.
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Johnstone
keywords: Outcome measures; Proximal humeral fractures; Scoring systems
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