Selfadministered questionnaire for assessment of symptoms and function of the shoulder according to Llnsalata et al [74

Questionnaires validated for assessment of general health status may not be specific enough to provide an accurate, comprehensive description of symptoms and function of an individual joint. The purpose of this paper is to present a self-administered questionnaire designed to assess symptoms and function of the shoulder and to report the results of a prospective evaluation of its validity, reliability, and responsiveness to clinical change.

Development of the questionnaire

A preliminary questionnaire was developed and was completed by thirty patients who were being managed for disorders related to the shoulder. A subset of these patients was interviewed, and each question was assessed for clinical relevance, relative importance, and ease of completion and grading. This allowed modifications to be made to produce the revised questionnaire that was prospectively assessed. After this assessment, questions that had poor reliability, substantially reduced the total or subset internal consistency, or contributed little to the clinical sensitivity of the over-all instrument were eliminated to produce the current questionnaire.

The Shoulder Rating Questionnaire includes six separately scored domains: global assessment, pain, daily activities, recreational and athletic activities, work, and satisfaction (Table 22). A final, nongraded domain allows the patient to select two areas in which he or she believes improvement is most important (Table 22).

The global assessment domain (Question 1) consists of a 10-cm long visual analog scale. A visual analog scale is a straight line, the ends of which are defined as the extreme limits of the response or sensation to be measured. In this case, the scale is from 0 (very poorly) to 10 (very well), with interval scores measured in millimetres between 0 and the mark made by the patient.

Each of the other scored domains consists of a series of multiple-choice questions with five selections scored from 1 (poorest) to 5 (best). Each domain is scored separately by averaging the scores of the completed questions and multiplying by two. Thus, the possible score for each domain ranges from 2 (poorest) to 10 (best).

The pain domain consists of four questions that assess the severity of pain at rest (Question 2) and during activities (Question 3), the frequency of pain that interferes with sleep (Question 4), and the frequency of severe pain (Question 5).

The daily activities domain consists of six questions, including one that requires a general assessment of the limitation of daily activities (Question 6) and a series of questions that assess difficulty with typical daily activities, such as putting on or removing a pullover shirt, combing hair, reaching shelves above the head, scratching or washing the lower back, and carrying groceries (Questions 7 to 11).

The recreational and athletic activities domain consists of three questions. One asks for a general assessment of limitation during recreational and athletic activities (Question 12), another requires an assessment of the degree of difficulty in throwing a ball overhand or serving in tennis (Question 13), and the third allows the patient to select an ac-

Table 22. Shoulder-rating questionnaire

Which is your dominant arm? Left Right

For which shoulder(s) have you been evaluated or treated? Left Right Both

Please answer the following questions regarding the shoulder for which you have been evaluated or treated. If a question does not apply to you, leave that question blank. lf you indicated that both shoulders have been evaluated or treated, please complete a separate questionnaire for each shoulder and mark the corresponding side (left or right) at the top of each form.

1. Considering all the ways that your shoulder affects you, mark X on the scale below for how well you are doing

Very poorly _ Very well

The following questions refer to pain.

2. During the past month, how would you describe the usual pain in your shoulder at rest?

A) Very severe

B) Severe

C) Moderate

D) Mild

E) None

3. During the past month, how would you describe the usual pain in your shoulder during activities?

A) Very severe

B) Severe

C) Moderate

D) Mild

E) None

4. During the past month, how often did the pain in your shoulder make it difficult for you to sleep at night?

A) Every day

B) Several days per week

C) One day per week

D) Less than 1 day per week

E) Never

5. During the past month, how often have you had severe pain in your shoulder?

A) Every day

B) Several days per week

C) One day per week

D) Less than 1 day per week

E) Never

Table 22 (continued)

The following questions refer to daily activities.

6. Considering all the ways you use your shoulder during daily personal and household activities (i.e., dressing, washing, driving, household chores, etc.), how would you describe your ability to use your shoulder?

A) Very severe limitation; unable

B) Severe limitation

C) Moderate limitation

D) Mild limitation

E) No limitation

Questions 7-11: During the past month, how much difficulty have you had in each of the following activities due to your shoulder?

7. Putting on or removing a pullover sweater or shirt.

A) Unable

B) Severe difficulty

C) Moderate difficulty

D) Mild difficulty

E) No difficulty

8. Combing or brushing

A) Unable

B) Severe difficulty

C) Moderate difficulty

D) Mild difficulty

E) No difficulty

9. Reaching shelves that are above your head

A) Unable

B) Severe difficulty

C) Moderate difficulty

D) Mild difficulty

E) No difficulty

10. Scratching or washing your lower back with your hand

A) Unable

B) Severe difficulty

C) Moderate difficulty

D) Mild difficulty

E) No difficulty

11. Lifting or carrying a full bag of groceries [8-10 lbs (3.6-4.5 kg)].

A) Unable

B) Severe difficulty

C) Moderate difficulty

D) Mild difficulty

E) No difficulty

Table 22 (continued)

The following questions refer to recreational or athletic activities.

12. Considering all the ways you use your shoulder during recreational or athletic activities (i.e., baseball, golf, aerobics. gardening, etc.), how would you describe the function of your shoulder?

A) Very severe limitation; unable

B) Severe limitation

C) Moderate limitation

D) Mild limitation

E) No limitation

13. During the past month, how much difficulty have you had throwing a ball overhand or serving in tennis due to your shoulder?

A) Unable

B) Severe difficulty

C) Moderate difficulty

D) Mild difficulty

E) No difficulty

14. List one activity (recreational or athletic) that you particularly enjoy and then select the degree of limitation you have, if any, due to your shoulder.

Activity _

A) Unable

B) Severe limitation

C) Moderate limitation

D) Mild limitation

E) No limitation

The following questions refer to work.

15. During the past month, what has been your main form of work?

B) Housework

C) Schoolwork

D) Unemployed

E) Disabled due to your shoulder

F) Disabled secondary to other causes

G) Retired

If you answered D, E, F, or G to the above question, please skip questions 16-19 and go on to question 20.

Table 22 (continued)

16.

During the past month, how often were you unable to do any of your usual

work because of your shoulder?

A) All days

B) Several days per week

C) One day per week

D) Less than 1 day per week

E) Never

17.

During the past month, on the days that you did work, how often were you

unable to do your work as carefully or as efficiently as you would like because

of your shoulder?

A) All days

B) Several days per week

C) One day per week

D) Less than 1 day per week

E) Never

18.

During the past month, on the days that you did work, how often did you ha

ve to work a shorter day because of your shoulder?

A) All days

B) Several days per week

C) One day per week

D) Less than 1 day per week

E) Never

19.

During the past month, on the days that you did work, how often did you ha-

ve to change the way that your usual work is done because of your shoulder?

A) All days

B) Several days per week

C) One day per week

D) Less than 1 day per week

E) Never

The following questions refer to satisfaction and areas for improvement.

20.

During the past month, how would you rate your overall degree of satisfacti

on with your shoulder?

A) Poor

B) Fair

C) Good

D) Very good

E) Excellent

Table 22 (continued)

21. Please rank the two areas in which you would most like to see improvement (place a 1 for the most important, a 2 for the second most important).

Daily personal and household activities _

Recreational or athletic activities _

This is the end of the shoulder-rating questionnaire. Thank you for your cooperation.

tivity that he or she particularly enjoys and to assess his or her limitation in that activity (Question 14).

The work domain includes a nongraded question that categorizes the form of work (Question 15) and four graded questions that assess the frequency of inability to do any work (Question 16), inability to work efficiently (Question 17), and the need to work a shorter day (Question 18) or to change the manner in which usual work is performed (Question 19).

The satisfaction domain (Question 20) consists of a single question that asks the patient to grade his or her over-all satisfaction from poor to excellent. This domain is not included in the total score but rather is scored and presented separately.

Finally, the importance domain (Question 21) allows the patient to rank the two areas in which he or she most desires improvement. These are rated 1, for most important, and 2, for second most important. This does not contribute to the total score but can be used with the scores of the individual domains to determine if substantial improvement has occurred in the areas most important to the patient or to individualize the weighting method used to determine the over-all score.

A suggested weighting system for the calculation of a total score was developed after consultation with several shoulder surgeons and patients regarding the relative importance of each of the domains. The maximum score was 15 points for global assessment (domain score multiplied by 1.5; score range, 0 to 15 points), 40 points for pain (domain score multiplied by four; score range, 8 to 40 points), 20 points for daily activities (domain score multiplied by two; score range, 4 to 20 points),

15 points for recreational and athletic activities (domain score multiplied by 1.5; score range, 3 to 15 points), and 10 points for work (domain score multiplied by one; score range, 2 to 10 points). Therefore, the total possible score ranged from 17 to 100 points.

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