The rotator cuff qualityoflife measure RCQOL [59

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Development of the disease-specific RC-QOL

The RC-QOL was developed through a process of item generation, item reduction, pretesting, and test/retest reliability analysis. Items were generated from a thorough review of the literature, discussions with clinicians experienced in the area of rotator cuff disease, and modifications of similar disease-specific quality-of-life outcome measures, as well as through direct input from a set of patients with a full spectrum of rotator cuff disease. These patients had documented rotator cuff pathoses ranging from primary impingement tendinopathy to massive rotator cuff defects. Their input resulted in the generation of a number of items directly pertaining to shoulder rotator cuff problems and generic quali-ty-of-life issues. The items were formulated into a preliminary questionnaire in which a standard 100-point visual analog scale (VAS) response format was used.

This preliminary questionnaire was then administered and pretested on a separate group of 20 patients with documented rotator cuff disease. Each patient underwent a structured interview that was conducted by one of the investigators. The interview consisted of five questions pertaining to whether the items were semantically appropriate, whether the patient considered the items important to his or her quality of life, whether the patient could comprehend the questions, and whether the patient would suggest any modifications to the questionnaire.

A revised 55-item questionnaire was then developed; it was produced according to standard questionnaire development techniques, and it too made use of the VAS response format. On the basis of qualitative and quantitative criteria, reduction of this 55-item instrument to a smaller, more manageable questionnaire was considered. The qualitative criteria included the importance of each item in demonstrating a quality-of-life issue, the importance of each item to patients, and the elimination of redundancy or ambiguity in the final set of items. The quantitative criteria were the measures of reliability of the questions.

The reliability of the outcome was determined by administering the questionnaire to a group of 30 consecutive patients with documented rotator cuff disease. The questionnaire was administered on each of two separate occasions, 2 weeks apart, so that test/retest reliability could be assessed. The reliability analysis involved calculating (1) the average differences between administrations of the questionnaires for each individual question and (2) the overall score, the maximum being 100. It was determined a priori that any question with an average error of 15% or greater would be considered for deletion from the final questionnaire.

The resulting questionnaire was then used in the second part of the investigation so that its validity could be determined. Two components of validation were tested. It was hypothesized that the RC-QOL should be able to distinguish between large and massive cuff tears; in this way, a measure of discriminant validity would be assessed.

The number of items in the RC-QOL questionnaire was reduced from 55 to 34; 21 of the original questions were eliminated because of poor test/retest reliability, redundancy, or lack of importance. These 21 items were eliminated on the basis of both quantitative and qualitative criteria. The final 34-item questionnaire had an overall average error differ-

Quality-of-Life Assessment in Rotator Cuff Patients

Section A

The first section is related to symptoms and physical complaints.

1 .With any prolonged activity (ie, greater than half an hour), how much pain or discomfort do you experience in your shoulder?

Severe pain No pain at all

2.With respect to your overall shoulder function, how much are you troubled by stiffness or loss of motion?

0-100

Severely troubled Not troubled at all

3.With respect to your overall shoulder function and considering the strength of your muscles, how weak is your shoulder?

0-100

Totally weak Not weak at all

4. With respect to bathing or taking a shower, how much pain/difficulty do you experience because of your shoulder?

0-100

Severe pain/difficulty No pain/difficulty at all

5.With respect to putting on or removing clothing over your head, how much pain/difficulty do you experience because of your shoulder?

0-100

Severe pain/difficulty No pain/difficulty at all

6. With respect to putting on a belt through the loop holes of a pair of pants that you are wearing, how much pain/difficulty do you experience because of your shoulder?

Severe pain/difficulty No pain/difficulty at all

7.With respect to cutting food for preparation or at meals, how much pain/difficulty do you experience because of your shoulder?

0-100

Severe pain/difficulty No pain/difficulty at all

8.With respect to doing household chores (ie, mopping floor/vacuuming the rug, ironing clothes, making a bed, scrubbing pots/pans, cleaning bathtub/toilet), how much pain/difficulty do you experience because of your shoulder?

Severe pain/difficulty No pain/difficulty at all

9.With respect to carrying 4.5 to 6.8 kg (10 to 15 lb), with your arm at your side (ie, carrying a heavy briefcase, small suitcase, or shopping bags), how much

Fig. 85. The Rotator Cuff Quality-of-Life Measure (RC-QOL)

pain/difficulty do you experience because of your shoulder?

Severe pain/difficulty No pain/difficulty at all

10. With respect to cutting the grass, raking the lawn, or shoveling snow, how much pain/difficulty do you experience because of your shoulder?

Severe pain/difficulty No pain/difficulty at all 1 1 .Do you have pain/difficulty falling asleep because of your shoulder?

-100

Severe pain/difficulty No pain/difficulty at all 12. Are you awakened from sleep because of your shoul der? 0-

-100

Never awakened

Always awakened

13.With respect to driving a motor vehicle, how much pain/difficulty do you experience because of your shoulder?

Severe pain/difficulty No pain/difficulty at all

14. With respect to opening and closing a door with your affected arm, how much pain/difficulty do you experience because of your shoulder?

Severe pain/difficulty No pain/difficulty at all

15.With respect to reaching (ie, into the back of a car) with your affected arm, how much pain/difficulty do you experience because of your shoulder?

Severe pain/difficulty No pain/difficulty at all

16. Indicate the point ranging from 0 to 100 which most closely describes your overall present level of shoulder pain. 0-

-100

Section B

The following questions are related to your job or vocation (ie, work-related concerns). The questions are regarding your ability to function at work and the extent to which your shoulder has affected your current work-related concerns. If you are a full-time student/homemak-er, then consider this and any part-time work together. Consider the last 3 months.

If you are not working for reasons other than your shoulder problem, proceed to question 21.

Indicate, with a slash on the line, the point ranging from

0 to 100 that most closely represents your situation.

17.With respect to working with your arm at shoulder level, how much pain/difficulty do you experience because of your shoulder?

Severe pain/difficulty No pain/difficulty at all

1 8. With respect to working with your arm above shoulder level, how much pain/difficulty do you experience because of your shoulder?

Severe pain/difficulty No pain/difficulty at all

19. How much of the time are you concerned with missing days from work because of problems with or re-injury to your shoulder? (Make a slash at the extreme left if you are unable to work because of your shoulder.)

Greatly concerned Not concerned at all

20. How much of the time are you concerned that the activities you do at work may result in the state of your shoulder becoming worse? (Make a slash at the extreme left if you are unable to work because of your shoulder.)

All of the time

None of the time

Are there any other occupational issues that you feel should be addressed?

Severe pain/difficulty No pain/difficulty at all

Are there any other physical issues that you feel should be addressed?

Fig. 85 (continued)

Section C

The following questions are being asked with respect to your recreational activities and sport participation or competition. The questions are concerned with ence of 5.05%; this represents a 5-point error on the overall score (out of 100 points). The overall averages for the two administrations of the questionnaire were almost identical (58.84 vs. 59.63), and the range of responses demonstrated a normal distribution.

The final 34 questions were distributed into five separate domains representing different aspects of quality of life as it pertains to rotator cuff the extent to which your painful shoulder affects your ability to function and participate in these activities. Consider the last 3 months.

If you are not involved in any sporting activities whatsoever, proceed to question 25.

21. With respect to participating in general sports activities, how much pain/difficulty do you experience because of your shoulder?

Severe pain/difficulty No pain/difficulty at all

22.With respect to participating in upper-extremity sports (eg, baseball, tennis, golf, squash, volleyball, swimming, throwing), how much pain/difficulty do you experience because of your shoulder?

Severe pain/difficulty No pain/difficulty at all

23.How much of the time are you concerned that your sporting/recreational activities may result in the status of your shoulder becoming worse?

All of the time

None of the time

Totally limited

-100

No limitations

All of the time

None of the time

27. How often are you aware of your shoulder problem? 0-100

All of the time

None of the time

28. With respect to your lifestyle as it relates to you and your family together, how often are you concerned about your shoulder? 0-100

All of the time

None of the time

29.You have had your problem shoulder for some time. During this time, have you modified your lifestyle to avoid potentially damaging activities to your shoulder? 0-100

Totally modified

No modifications

24. With respect to your current level of athletic or recreational performance, how does it compare with your pre-injury level? 0-

Section D

The following questions are being asked with respect to your lifestyle. The questions are concerned with your lifestyle in general and the extent to which your painful shoulder affects activities other than those related to your work and sports/recreation. Consider the last 3 months.

25. How often do you have to concern yourself with general safety (eg, carrying small children, working in the yard, climbing a ladder, using power tools) with respect to your injured shoulder? 0-100 N/A

Section E

The following questions are regarding the social and emotional aspects of your shoulder problem. The questions are concerned with your attitudes and feelings as they relate to your painful shoulder. Consider the last 3 months.

30. Do you experience difficulty making decisions at home or at work because of your shoulder problem?

0-100

Extremely difficult Not difficult at all

31. Do you have peace of mind, or are you too worried to sleep at night because of your shoulder problem?

0-100

Extremely worried Not worried at all

32. Are you afraid of re-injuring your shoulder?

Extremely afraid Not afraid at all

33. Do you experience psychological difficulty when engaging in sexual activity because of your shoulder problem?

Extremely difficult Not difficult at all

34. Does your shoulder problem interfere with your ability to socialize with friends and family?

0-100

Unable to socialize Able to socialize fully

26. How much has your enjoyment of life been limited by your shoulder problem? 0-100

Totally limited

No limitations

Fig. 85 (continued)

disease of the shoulder. There were questions in the domains of (1) symptoms and physical complaints, (2) sports and recreation, (3) work-related concerns, (4) lifestyle issues, and (5) social and emotional issues (see Fig. 85). All questions were considered to have face validity on the basis of direct patient input at each stage of the development of the Instrument.

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