The Western Ontario rotator cuff index WORC [69

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The purpose of the study was to develop a valid and reliable disease-specific quality-of-life measurement tool for patients with rotator cuff disease.

Methodology for the development and evaluation of the tool included the following: (1) identification of a specific patient population. (2) Generation of potential items, (3) item reduction, (4) protesting the prototype instrument, (5) determination of reliability, and (6) validation.

The WORC consists of 21 items representing five domains pertinent to health-related quality of life (HRQL). There are six questions in the physical symptoms domain, four in the sports and recreation domain, four in the work domain, four in the lifestyle domain, and three in the emotions domain (Fig. 84).

In the final instrument, each item has a possible score from 0 to 100 (100 mm VAS), and these scores are added in give a total score from 0 to 2100. The highest or most symptomatic score is 2100, and the best or asymptomatic score is 0. To present this in a more clinically meaningful format, the score can be reported as a percentage of normal by subtracting the total from 2100, dividing by 2100, and multiplying by 100. For example, a patient with a total score of 1800 would have a percentage score of (2100-1800)/2100X 100=14.3%.

This measurement tool can be used as the primary outcome in clinical trials evaluating treatments in this patient population, although its

Ol'T-PATIENT CLINIC

SHOULDER UNIT

The Walch-Duplay Score for Instability of the Shoulder

Patient's Details

Operation/Diagnosis:

Examination: 3 months 6 months

I.- Level of Sport Practised (please circle):

1 year

2 years

_ years

N ■ Not practising a sport

2.- Type of Sport {please circle):

1 = risk free athletics» rowing, swimming, breaststroke, underwater diving, voluntary gymnastics, cross-country skiing, shooting, sailing.

2 = with contact martial arts, cycling, motorcycling or biking, scrambling, socccr, rugby, water-skiing, downhill skiing, parachute jumping, horse riding.

3 = with cocking climbing, weight lifting, shot-putting, swimming overarm and butterfly, pole vaulting, of the arm figure skating, canoeing, golf, hockey, tennis, baseball.

4 = high risk basketball, handball, volleyball, hand gliding, kayaking, water polo.

3.- Side (please circle): Right

Left

D = dominant d = nondominant

3.- Side (please circle): Right

Left

D = dominant d = nondominant

ROM

Abduction:

FVVF-

FR

IP

ER in 90 abduction: __

POINTS (please circle)

A.- Daily Activity

Return to same level in the same sport Decrease level in the same sport Change in sport

Decrease level and change, or stop sport

B,- Stability

+25 points: No apprehension + 15 points: Persistent apprehension 0 points: Feeling of Instability -25 points: True recurrence

+25 points No discomfort

+15 points Slight discomfort in forceful movements

+10 points SI ight discomfort during simple movements

0 points Severe discom fort

C- Pain

+25 points: No or pain during certain climatic conditions +15 points: Pain during forceful movements or when tired 0 points: Pain during daily life

D.- Mobility

+25 points: Pure frontal abduction against a wall: symmetrical Internal rotation limited to less than three vertebrae External rotation at 90 degrees abduction limited to less than 10% of the opposite side. +15 points: Pure frontal abduction against a wall < 150 degrees IR; limited to less than three vertebrae ER; limited to less than 30% of the opposite side +5 points: Pure frontal abduction against a wall < 120 degrees IR: limited to less than six vertebrae ER: limited to less than 50% of the opposite side 0 points: Pure frontal abduction against a wall < 90 degrees IR: limited to more than six vertebrae ER: limited to more than 50% of the opposite side

OVERALL

Excellent:

91 to 100 points

Good;

76 to 90 points

Medium:

51 to 75 points

Poor

50 points or less

Fig. 83. Walch-Duplay Score features are equally attractive for monitoring patients' progress in clinical practice.

Walch Duplay Score
Fig. 84. The Western Ontario Rotator Cuff Index (WORC)

SECTION C: Work INSTRUCTIONS TO PATIENTS

The following section concerns the amount that your shoulder problem has affected your work around or outside of the home. Please indicate the appropriate amount for the past week with a slash

11. How much difficulty do you experience in daily activities about the house or yard?

no I

difficulty difficulty

12. How much difficulty do you experience working above your head?

difficulty difficulty

13. How much do you use your uninvolved arm to compensate for your injured one?

14. How much difficulty do you experience lifting heavy objects from the ground or below shoulder level?

16. How much difficulty have you experienced with styling your hair because of your shoulder?

difficulty extreme difficulty

17. How much difficulty do you have "roughhousing or horsing around" with family or friends?

no difficulty extreme difficulty

18. How much difficulty do you have dressing or undressing?

no difficulty extreme difficulty

SECTION E: Emotions INSTRUCTIONS TO PATIENTS

The following questions relate to how you have felt In the past week with regard to your shoulder problem. Please indicate your answer with a slash

19. How much frustration do you feel because of your shoulder ?

no frustration extreme frustration no extreme difficulty difficulty

20. How "down in the dumps" or depressed do you feel because of your shoulder?

SECTION D: Lifestyle INSTRUCTIONS TO PATIENTS

extreme

The following section concerns the amount that your shoulder problem has affected or changed your lifestyle. Again, please indicate the appropriate amount for the past week with a slash

15. How much difficulty do you have sleeping because of your shoulder?

21. How worried or concerned are you about the effect of your shoulder on your occupation or work?

notât all extremely concerned difficulty Fig. 84 (continued)

extremé difficulty

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